Commencement of the Meningococcal Vaccination for the Republic of Korea Army

Editorial On December 11, 2012, the Korean military authorities made an official announcement that all recruits will receive a quadrivalent (group A, C, Y, and W-135) meningococcal conjugate vaccine (Menveo [1]. The meningococcal outbreak at the Nonsan Recruit Training Center in April 2011 raised public awareness of the need for a meningococcal vaccination for the Republic of Korea Army (ROKA). Although the outbreak of 2011 became a huge social concern promoted by mass media, patients were consistently diagnosed with meningococcal diseases in the ROKA for a long time. Serving as a medical officer at the Armed Forces Capital Hospital, I experienced 12 cases of meningococcal meningitis or septicemia from August 2000 to July 2001 and two of them died within 12 hours after admission [2]. Meningococcal disease is the most frightening infectious disease I have ever experienced. Invasive meningococcal disease is one of the most severe vaccine-preventable diseases [3]. The effectiveness of primary prevention through vaccination is clearly illustrated by the successful introduction of the meningococcal serogroup C conjugate vaccine in Europe. Following the introduction of the conjugate vaccine in the UK, there was a 93% reduction in serogroup C disease [4] and 81% reduction in carriage which was considered consistent with herd immunity [5]. Age groups at high risk for developing meningococcal diseases are infants, adolescents, and young adults. Moreover, military recruits are at the highest risk, due to numerous risk factors they encounter, such as age, diverse geographic background, and crowded living conditions [6]. In the US Army, beginning in October 1971, all new recruits were vaccinated with the serogroup C vaccine, and by Fall 1982, all recruits received quadrivalent polysaccharide vaccines [6]. However, in the ROKA, the vaccination of recruits has only commenced starting in November 2012 [1]. Generally, a preventive strategy is instituted for two reasons. First, preventive tactics can be usefully employed against certain diseases with extremely high incidence, despite their low morbidity and mortality. For instance, the incidence of Plasmodium vivax malaria cases exhibited an exponential growth since its re-emergence in 1993 until 2000 (4,142 cases) along the demilitarized zone. The ROKA instituted the mass chemoprophylaxis program in 1997 and not a single mortality case has been reported since. The program was expanded annually from approximately 16,000 soldiers in 1997 to more than 140,000 soldiers in 2002 [7]. The second indication for