With the rising incidence and high associated case-fatality of meningococcal serogroup C disease among young children and the availability of effective conjugate vaccines, several state and local Bcl-2 phosphorylation governments purchased meningococcal serogroup C polysaccharide-protein conjugate vaccines (MenC) for routine infant immunization or outbreak control in targeted age groups. From 2007 to 2009, meningococcal serogroup C disease increased substantially in the state of Bahia, with a five-fold increase in

the number of cases reported in the capital, Salvador. In 2009, 194 cases of meningococcal disease (1.5 cases per 100,000 population) with 50 deaths (39% case-fatality) were reported to the Bahia state health department, with 50% of the cases and 48% of the deaths occurring in Salvador [5]. Meningococcal serogroup C conjugate vaccine was introduced into the routine childhood immunization schedule of the state of Bahia in February 2010, with a two-dose primary immunization Pifithrin-�� in vivo series (at 2 and 4 months) followed by a booster dose in the second year of life. All children younger than five

years in the state of Bahia were eligible to receive at least one dose of MenC conjugate vaccine. During the first semester of 2010, unusually high numbers of meningococcal disease cases and deaths among persons older than 10 years occurred in the city of Salvador, leading the state immunization program to conduct mass vaccination (a single dose) of city residents 10–24 years of age from May to August 2010. We analyzed data from meningitis surveillance and immunization programs to evaluate the impact of vaccination on rates of meningococcal disease among vaccinated age groups and those not targeted for vaccination. Reporting of suspected cases of meningitis is mandatory in Brazil.

Suspected cases of meningitis are reported by public and private health facilities to municipal and state health departments using standardized case report forms from the national Notifiable Diseases Information System [Sistema de Informação de Agravos de Notificação (SINAN)]. Case report forms include patient identification, age, gender, clinical signs and symptoms, samples collected, diagnostic tests performed, antibiotic susceptibility and cerebrospinal fluid (CSF) evaluation. Suspected below meningococcal disease includes the presence of fever, intense headache, profuse vomiting, neck stiffness, clinical signs of meningeal irritation (Kernig or Brudzinski), convulsions or petechial or purpural rash. In infants, clinical signs may include irritability, persistant crying and bulging fontanelle. Clinical presentation of meningococcal disease is reported as meningitis, meningococcemia or meningitis with meningococcemia based on physician diagnosis and laboratory findings. Confirmed cases of meningococcal disease are defined by isolation of meningococci or positive antigen detection tests in blood, CSF or normally sterile fluid specimens from suspected cases.