Travelers' protection against meningococcal disease: a new vaccine option.

C with other infections, such as yellow fever or malaria, awareness of the potential for travelers to contract meningococcal disease is low. Global disease incidence rates, however, may be as high as 1,000/100,000 population in the ‘‘meningitis belt’’ of sub-Saharan Africa and are generally between 100 and 800/100,000 population during epidemics in Africa.1,2 In the United States, the annual incidence is 0.5 to 1.1/100,000 or about 1,400 to 2,800 cases annually.3 Although the highest disease incidence is in infants, in many regions and countries, a second peak occurs in the 14to 25-year-old demographic. Surveillance data from 1999 to 2008 estimated the highest rates of meningococcal disease incidence in the United States were in children aged 4 years and younger (∼2/100,000 population) and adolescents aged 15 to 19 years (∼1/100,000 population).4 In addition to consideration of the disease incidence, it is also important to consider the impact of meningococcal disease on the patient. Onset of meningococcal disease is often sudden and the rate of progression is unpredictable. Initial symptoms are nonspecific and can resemble those of other common and/or benign diseases.5 Therefore, it may be difficult to identify and treat the disease quickly. Invasive disease may develop 1 to 14 days after acquisition of meningococci.6 Despite the availability of appropriate treatment and intensive care, up to 10% to 14% of persons in the United States and 5% to 10% of persons worldwide who contract meningococcal disease die, with a rate of∼40%among patientswithmeningococcal sepsis.1,5,7 Additionally, 11% to 19% of persons who survive meningococcal disease can suffer from permanent disabilities, including brain damage, hearing loss, limb loss, or learning disabilities.5,7 The rapid progression and devastating consequences of disease make prevention through vaccination the best option for controlling meningococcal disease in the community. For travelers, the risk of contracting invasive meningococcal disease depends on their destination,