New vaccine in the SUS: what changes in protecting babies against meningitis

Since July 1st, the national vaccination schedule has included the meningococcal ACWY vaccine for 12-month-old children. Announced on June 28th by the Ministry of Health, this update represents an important advance in the prevention of meningitis in Brazil, expanding the protection that was previously limited to type C.

The new vaccine protects against four serogroups of the Neisseria meningitidis bacteria (A, C, W and Y) and replaces the booster dose of the meningococcal C vaccine, which is administered at 3 and 5 months of age. Until now, the most complete version of the vaccine, ACWY, was offered by the Unified Health System (SUS) only to adolescents between 11 and 14 years old. For young children, the available immunization covered only serogroup C, historically the most prevalent in the country.

With the expansion, children are now also protected against serogroups A, W and Y. According to pediatrician Flávia Bravo, director of the Brazilian Society of Immunizations (SBIm), the main difference between the C vaccine and the ACWY vaccine is precisely the scope of the serogroups covered. “The technology of both is the same, but the ACWY vaccine offers protection against three more serogroups that can cause serious invasive disease,” she explains.

The ACWY vaccine is inactivated, meaning it is not capable of causing the disease. It is composed of fragments of bacterial capsules from serogroups A, C, W and Y, linked to a protein that helps generate a more efficient immune response.

Serogroup C remains the most common in Brazil, but the inclusion of other groups is important, since all of them can cause a highly lethal form of meningitis with the potential to leave severe sequelae. “Serogroup W, for example, has attracted attention because we have seen an increase in cases in the South of the country and in other Latin American countries,” Bravo notes. “These outbreaks can arise unexpectedly, and when we vaccinate the population against different serogroups, we prevent future changes in the epidemiological scenario.”

The epidemiology of meningococcal disease is dynamic and difficult to predict. “Even though serogroup W is not the most worrying today, at some point it could become one. Therefore, expanding protection is essential. When the population is already largely immunized, we reduce the impact of possible outbreaks,” he comments.

Regarding the safety of the ACWY vaccine, the specialist states that the adverse reaction profile is similar to that of the vaccine against serogroup C. “It can cause local pain, redness, swelling – which is expected with any vaccine. Conjugated vaccines are a little more reactogenic, but nothing to worry about. The only contraindication is cases of allergy to components of the vaccine or previous doses”, points out the Sbim specialist.

Drop in the number of cases

According to data from the Ministry of Health's meningitis panel , 4,406 cases of the disease have already been registered in Brazil in 2025. Of this total, 1,731 were caused by bacteria (361 of them by meningococci), 1,584 by viruses and 1,091 by other causes or of unidentified origin.

In 2024, the country recorded 13,831 cases of meningitis, 5,558 of which were bacterial, of which 820 were attributed to meningococcus. In 2023, 16,464 cases were confirmed, including 5,435 of bacterial origin, with 730 infections caused by meningococcus.

According to Flávia Bravo, the drop in cases of the disease in Brazil is directly related to vaccination, especially against serogroup C. “Here, the main victims are children. When we introduced the vaccine against meningo C, we saw a sharp drop in cases, because we protected precisely the most affected group,” she reports.

Over time, however, this success ended up changing the profile of the disease. As children became protected against type C, other serogroups (such as B) began to become proportionally more prevalent. “In absolute terms, there was no increase. However, as the vaccine against B is not available in the SUS for all children, it has been more common among young children today,” he says.

Identification is still complex

Identifying the serogroup that causes meningitis is still a challenge in Brazil. Logistical and structural factors make accurate laboratory diagnosis difficult in all regions, which depend on specialized central laboratories to correctly identify the agent. “Collecting adequate material, such as cerebrospinal fluid or blood, at the right time, and ensuring that it reaches the central laboratories with quality is still an obstacle in several parts of the country,” says Bravo.

Furthermore, starting antibiotic treatment before collecting samples, a necessary measure given the severity of the disease, can also compromise the diagnosis. “The disease is extremely aggressive and can lead to death within 24 hours. When meningitis is suspected, antibiotic treatment should begin immediately, even without a definitive laboratory diagnosis. Even so, with the samples we were able to obtain, it is possible to establish a good overview of the circulation of serogroups and support public policies,” says the pediatrician.

Vaccination schedule

With the update of the calendar, which is already in effect, the vaccination schedule against meningitis in the SUS is now: meningococcal C at 3 and 5 months, meningococcal ACWY at 12 months and a new dose of ACWY between 11 and 14 years. For children under 5 years of age who have not yet received the booster at 12 months, it will be possible to update the schedule with the most comprehensive vaccine.

According to infectologist Alfredo Gilio, coordinator of the Immunization Clinic at Einstein Hospital Israelita, this is a significant change in the national strategy. “The introduction of ACWY for children considerably increases coverage against meningitis. Although serogroup A has little relevance in Brazil, groups W and Y already represent around 10% of meningococcal infections,” he warns.

Meningitis is an inflammation of the meninges, the membranes that cover the brain. The most common symptoms are severe headache, vomiting, high fever and stiff neck. “The skin manifestation of petechiae [ small bleedings on the skin ] is more common with meningococcal meningitis. When it appears together with these other symptoms, we immediately suspect meningococcal meningitis and we will start treating it immediately,” explains the director of Sbim.

Meningococcal disease is serious, rapidly progressive and highly lethal. When it does not lead to death, it can leave serious consequences, such as deafness, amputations and neurological impairment. Vaccination is the most effective preventive measure.

Source: Einstein Agency

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