Meningococcal vaccine development in the United States began in the 1960s with the organization of a U.S. military meningococcal research group. Throughout both World Wars, meningococcal disease outbreaks occurred and often impacted new recruits within their first three months of service. While meningococcal disease death rates had decreased as result of the discovery and use of sulfonamides by the late 1930’s, sulfa-resistant meningococcal strains had begun to emerge in the 1940s, leading military scientists to begin research and develop a meningococcal vaccine.
The first polysaccharide vaccine targeting meningococcal serogroup C was developed by and tested on members of the U.S armed forces in early 1968. Military scientists also developed a meningococcal serogroup A polysaccharide vaccine; however, clinical trials of this vaccine took place in African communities where serogroup A meningococcal disease was endemic.
By October of 1971, all new U.S. Armed Forces recruits were required to receive the military’s meningococcal serogroup C vaccine, a vaccine not yet licensed for use by the FDA. It wasn’t until 1974 that the FDA licensed three meningococcal polysaccharide vaccines, but only for limited use. The first licensed vaccines included a monovalent meningococcal serogroup A vaccine, a monovalent meningococcal serogroup C vaccine, and a bivalent serogroup A and C vaccine. In 1975, the CDC’s Advisory Committee on Immunization Practices (ACIP) declined to routinely recommend the vaccines and stated that there was “insufficient data on their benefits.” The vaccines were, however, recommended for use in the event of a meningococcal serogroup A or C outbreak but permission for use was required by both the FDA and CDC. Additionally, the CDC stated that while travelers visiting countries where meningococcal disease was considered endemic might benefit from vaccination, they also noted that no cases of meningococcal disease had ever been reported among Americans visiting these high risk areas. The military continued to routinely administer meningococcal polysaccharide serogroup C vaccine to all new recruits until 1978 at which time it switched to the bivalent meningococcal serogroup A and C polysaccharide vaccine.
Menomune, the first tetravalent meningococcal polysaccharide vaccine targeting meningococcal serogroups A, C, Y and W-135 received FDA approval for use in 1981 and by 1982, the military began using this vaccine in place of the bivalent vaccine. In 1985, ACIP issued their first recommendations on use of the tetravalent vaccine and recommended the vaccine for individuals with terminal complement component deficiencies, functional or anatomical asplenia, or in the event of an outbreak of serogroup A, C, Y and W-135 meningococcal disease. In the spring of 2000, ACIP recommended college students, particularly college freshman living in dormitories, consider tetravalent meningococcal polysaccharide vaccination but chose not to recommend routine vaccination, stating that meningococcal disease rates were low and routine vaccination would not be cost effective.
