Invasive meningococcal disease over five decades in the Faroe Islands: high incidence, low mortality, and implications for vaccination policy.

Objectives: The Faroe Islands have previously experienced a very high incidence of meningococcal disease, with an epidemic beginning in the late 1970s followed by more than a decade of endemic transmission.To present a population-based epidemiological overview of invasive meningococcal disease (IMD) in the Faroe Islands from 1980 to 2025. Methods: Cases were identified through records from the Chief Medical Officer and hospital diagnosis registers. Clinical data were extracted from hospital records. Results: A total of 234 IMD cases were identified. Incidence peaked in 1981 at 100 per 100,000 population and declined gradually to 13 per 100,000 by 1990, remaining stable at 0-7 per 100,000 thereafter. Ninety-one percent of cases occurred in individuals under 20 years of age, with 53% in children aged ≤4 years. The case fatality rate was 5% in 1980-1986 and zero thereafter. The predominant serogroup was B, with a prevalence of 89% until 1984 followed by a decline to 77% in the following years (1985-2025). Conclusion: IMD in the Faroe Islands was characterized by an unusually high and prolonged incidence followed by a marked decline to low endemic levels, with consistently low mortality. Despite the current low incidence, the potential role of childhood meningococcal vaccination warrants further evaluation.