Abstract

Invasive meningococcal disease (IMD) is associated with high morbidity and mortality. Recently, use of the quadrivalent MenACWY conjugate vaccines has increased with the emergence of a hypervirulent MenW:cc11 strain in certain parts of the world, especially South America. In England, MenW:cc11 IMD cases increased rapidly after 2009 and was responsible for 24% of all IMD cases in 2014/15 compared to <5% previously, leading to the emergency introduction of a national teenage MenACWY conjugate vaccine programme in August 2015. Unusually, MenW:cc11 cases have been described presenting with severe gastrointestinal symptoms, including abdominal pain and diarrhoea, followed by rapid clinical deterioration and death.