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Further information on these aspects is essential to understand the dynamics of meningococcal infection and the main factors leading from asymptomatic colonization to disease onset, as well as the evolution of the pathogenic phenotype in Neisseria , in line with the idea that microbial pathogenicity is a multifactorial and complex trait, as indicated by Ren Dubos in the mid-1990s, who also challenged the then-dominant notion of bacterial fixity and urged bacteriologists to take note of the plasticity of bacteria in order to be ready to deal with them (Dubos, 1955, Dubos, 1959)

Mechanisms and outcomes Vitamin B12 interventions are commenced upon diagnosis of low B12 status, typically comprise high dose injections until levels are within acceptable range, and then the intervention is changed to a maintenance dose that is typically administered every 3 months ad infinitum

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