Global epidemiology of the factor H binding protein in meningococcal serogroup B invasive isolates: a targeted literature review.

Abstract

Introduction: Invasive meningococcal disease (IMD) is a relatively rare but clinically serious infection caused by the bacterium Neisseria meningitidis, with meningococcal serogroup B (MenB) being one of the most common causes. Both of the currently available MenB vaccines contain factor H binding protein (fHbp), which has high antigenic variability; thus, it is important to monitor MenB-fHbp epidemiology. This targeted literature review aimed to assess the global prevalence and diversity of fHbp in MenB isolates over time.

Methods: A search of PubMed was conducted in June 2025 to identify studies reporting on MenB-fHbp characterization, without any search limits. Data were extracted and confirmed through independent review. Nomenclature was unified using PubMLST, and results were summarized descriptively.

Results: Of 1,354 identified studies, 52 were selected for inclusion, published between 2009 and 2025, representing 34 countries across Africa, Asia, Australia, Europe, North America, and South America. MenB-fHbp subfamily A variants were typically dominant in Africa, Asia, and South America, while MenB-fHbp subfamily B variants were typically dominant in Australia, Europe, and North America. Prevalent fHbp peptides in MenB isolates varied widely across countries and regions and within countries over time, including a multitude of less common peptides.

Conclusion: The studies included in this review demonstrate the global diversity of fHbp in MenB isolates, highlighting the importance of continued surveillance and the need for vaccines that provide broad fHbp coverage.