Conjugate vaccines targeting Neisseria meningitidis serogroup X
N meningitidis is a leading cause of bacterial meningitis globally, with six serogroups (A, B, C, W, X, and Y) responsible for over 95% of invasive meningococcal disease cases worldwide.[65]World Health Organization. WHO guidelines on meningitis diagnosis, treatment and care. Apr 2025 [internet publication].
https://www.who.int/publications/i/item/9789240108042
In the African meningitis belt, following the success of vaccination programs with serogroup A meningococcal conjugate vaccine, N meningitidis serogroups C, W, and X, and Streptococcus pneumoniae have been identified as the main causative agents of more recent epidemics.[82]Preziosi MP, Greenwood B. NmCV-5 meningococcal vaccine: Neisseria meningitidis' nemesis? Lancet Infect Dis. 2018 Oct;18(10):1049-50.
http://www.ncbi.nlm.nih.gov/pubmed/30120070?tool=bestpractice.com
The Men5CV (NmCV-5) vaccine is a pentavalent vaccine targeted at meningococcal serotypes A, C, W, Y, and X. This vaccine is directed toward global control of meningococcal disease in the African meningitis belt and beyond, with demonstrated safety and effectiveness against a wider variety of serogroups including serogroup X.[83]Haidara FC, Umesi A, Sow SO, et al. Meningococcal ACWYX conjugate vaccine in 2-to-29-year-olds in Mali and Gambia. N Engl J Med. 2023 May 25;388(21):1942-55.
https://www.doi.org/10.1056/NEJMoa2214924
http://www.ncbi.nlm.nih.gov/pubmed/37224196?tool=bestpractice.com
The vaccine has demonstrated comparable immune response in phase 1 and 2 trials.[83]Haidara FC, Umesi A, Sow SO, et al. Meningococcal ACWYX conjugate vaccine in 2-to-29-year-olds in Mali and Gambia. N Engl J Med. 2023 May 25;388(21):1942-55.
https://www.doi.org/10.1056/NEJMoa2214924
http://www.ncbi.nlm.nih.gov/pubmed/37224196?tool=bestpractice.com
[84]Sherman AC, Stephens DS. Serogroup A meningococcal conjugate vaccines: building sustainable and equitable vaccine strategies. Expert Rev Vaccines. 2020 May;19(5):455-63.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8214415
http://www.ncbi.nlm.nih.gov/pubmed/32321332?tool=bestpractice.com
It has been recommended by the World Health Organization (WHO) for incorporation into routine immunization programs in countries in the African meningitis belt, and Nigeria was the first country in the world to introduce the vaccine.[65]World Health Organization. WHO guidelines on meningitis diagnosis, treatment and care. Apr 2025 [internet publication].
https://www.who.int/publications/i/item/9789240108042
[85]Ukoaka BM, Okesanya OJ, Daniel FM, et al. A perspective on the novel pentavalent Men5CV (NmCV-5) meningitis vaccine and Nigeria's pioneering rollout campaign. Infez Med. 2024 Sep 1;32(3):323-9.
https://www.doi.org/10.53854/liim-3203-6
http://www.ncbi.nlm.nih.gov/pubmed/39282539?tool=bestpractice.com
WHO: defeating meningitis by 2030 - a global road map
Opens in new window While the vaccine is available in Africa, it is not currently available in other countries as yet.
Invasive intracranial pressure (ICP) monitoring
One systematic review looked at the role of invasive ICP monitoring and ICP-based management in the treatment of acute bacterial meningitis. Overall, the studies demonstrated enhanced patient outcomes in acute bacterial meningitis with the use of treatment strategies aiming to normalize ICP using continuous invasive monitoring and cerebrospinal fluid diversion techniques.[86]El-Hajj VG, Pettersson I, Gharios M, et al. Detection and management of elevated intracranial pressure in the treatment of acute community-acquired bacterial meningitis: a systematic review. Neurocrit Care. 2024 Aug;41(1):228-43.
https://www.doi.org/10.1007/s12028-023-01937-5
http://www.ncbi.nlm.nih.gov/pubmed/38356077?tool=bestpractice.com