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Abstract
Meningococcal outer membrane proteins have been used for over 20 years in more than
80 million doses; either as carrier protein in a Haemophilus influenzae type b (Hib)
polysaccharide conjugate vaccine or as vesicle vaccine formulations against meningococcal
disease. Conventional wild-type outer membrane vesicle (wtOMV) vaccines are the only
formulations that have shown efficacy against serogroup B meningococcal disease. This
has been demonstrated in Cuba, Norway and New Zealand; where epidemics, dominated
by one particular strain or clone, were causing high rates of disease and wtOMV vaccines
have been used for epidemic control. The most significant limitation for widespread
use of wtOMV is that the immune response is strain-specific in infants, mostly directed
against the immuno-dominant porin protein, PorA. The natural orientation of surface-exposed
membrane antigens and the preservation of good physico-chemical stability are key
features of OMV vaccines. The efficacy, tolerability and safety of wtOMV vaccines
have been well proven. The most recent experience from New Zealand demonstrated a
vaccine effectiveness of 80% for children less than 5 years of age, over a period
of 24 months. Such results are encouraging for the further use of "tailor-made" OMV
vaccines for epidemic control. Moreover, it provides opportunities for development
of OMV vaccines with various additional cross-protective potential. There is good
reason to believe that in the coming few years the "OMV-concept" will be exploited
further and that a number of cross-protective "universal" antigens will be included
in vaccines against serogroup B meningococcal disease. The desire to have a global
vaccine strategy that enables susceptible individuals to be protected against all
the relevant serogroups of meningococcal disease may become a reality.