Can we, should we, eradicate the meningococcus?

Highlights ► New meningococcal vaccines are being developed and implemented. ► We examine the degree of meningococcal disease control achievable with vaccination. ► Population and evolutionary considerations are important in control of meningococci. ► Eradication of all meningococci is currently neither achievable nor desirable. ► Control of particular meningococci is an achievable end that can be attempted.
The eradication of infectious agents is an attractive means of disease control that, to date, has been achieved for only one human pathogen, the smallpox virus. The introduction of vaccines against Neisseria meningitidis into immunisation schedules, and particularly the conjugate polysaccharide vaccines which can interrupt transmission, raises the question of whether disease caused by this obligate human bacterium can be controlled, eliminated, or even eradicated. The limited number of meningococcal serogroups, lack of an animal reservoir, and importance of meningococcal disease are considerations in favour of eradication; however, the commensal nature of most infections, the high diversity of meningococcal populations, and the lack of comprehensive vaccines are all factors that suggest that this is not feasible. Indeed, any such attempt might be harmful by perturbing the human microbiome and its interaction with the immune system. On balance, the control and possible elimination of disease caused by particular disease-associated meningococcal genotypes is a more achievable and worthwhile goal.