From 2000 through 2006, meningococcal serogroup was identified for isolates from 127 (45%) of 281 confirmed cases (Fig. 1); 105 (83%) were serogroup B, 20 (16%) were serogroup C and 2 selleck chemical (1%) were other serogroups (A [n = 1] and W135 [n = 1]). From 2007 through 2011, serogroup was determined for 335 (77%) of 437 meningococcal cases, and serogroup C replaced B as the most prevalent serogroup identified among confirmed

cases of meningococcal disease ( Fig. 1). Based on cases with known serogroup, cumulative incidence of serogroup C meningococcal disease in the city of Salvador was 0.1 cases per 100,000 population per year from 2000 through 2006 (Fig. 2) with 1 death (case-fatality, 5%). In 2007, 13 cases (0.45 cases/100,000 population) of serogroup C meningococcal disease were

identified with 2 deaths (case-fatality, 15%); in 2008, 53 cases (1.8 cases/100,000 population) were identified with 4 deaths (8%) and in 2009, 69 cases (2.3 cases/100,000 population) with 10 deaths (14.5%). From ABT-263 mouse 2007 to 2009, children younger than five years old accounted for 34 (25%) of 135 cases (incidence, 4.8 cases/100,000 children <5 per year; Fig. 3) and 4 (25%) of 16 deaths. Among 10–24 year olds, there were 43 (32%) cases (5.2 cases/100,000 population/year) and 3 deaths. MenC vaccine was introduced into the routine infant immunization schedule in the city of Salvador in February 2010,

with a catch-up vaccination campaign for all children younger than 5 years. In the first month, 87,111 doses of MenC were administered to children <5 years, reaching an estimated 44% coverage of the target population with at least one dose. By December 2010, an estimated 92% of children younger than 5 years had received at least one dose of MenC vaccine (Table 1). In the first six months of 2010, cases of meningococcal disease continued to increase, with 93% of 63 cases among persons 10–24 years of age. The state health department purchased an additional MenC vaccine and conducted mass vaccination in three phases of persons 10–24 years of age. The first phase, targeting 10–14 year olds, all began May 30; 160,554 (93%) of 172,624 MenC doses administered in this age group were applied in the first weekend of the campaign, reaching 75% of the target population. The second phase, targeting those 15–19 years began June 12; 145,249 (96%) of 151,884 MenC doses administered in this age group were applied in the first weekend. The third phase, targeting 20–24 year olds, was delayed until August 14; only 68,362 (67%) of 102,565 MenC doses administered in this age group were applied in the first weekend. At the end of the third phase, coverage with at least one dose of MenC had reached 80% among 10–14 year olds, 67% among 15–19 year olds, and 40% among 20–24 year olds (Table 1).