Meningococcal disease: Sumeyra’s story
Sumeyra contracted Meningococcal disease, a sometimes life-threatening illness when she was 20 years old. She had to be placed in a medically induced coma. Luckily Sumeyra survived, but she still suffers from the effects of Meningococcal disease today.
Meningococcal disease is a rare but often life-threatening disease caused by the bacterium Neisseria meningitidis (commonly known as the meningococcus). There are 13 strains of meningococcus. The strains that worldwide are the most common cause of disease are A, B, C, W and Y.
There has been a recent increase in strain W since 2013, which now makes up almost half of Australian cases. Meningococcal W presently has a higher death rate than the other strains because most cases are due to a particularly virulent strain.
Most meningococcal disease occurs in children aged under five years of age and in older adolescents and young adults.1
1. Meningococcal vaccines for Australians/NCIRS Fact sheet: March 2017
People with meningococcal disease can become extremely unwell very quickly. They may feel sicker than they have ever felt before. After being infected, it usually takes one to ten days for symptoms to appear. The possible symptoms are: fever, rash, headache, neck stiffness, sensitivity to light, muscle aches, cold hands and feet, confusion, irritability, joint pain, nausea and vomiting.
Babies often don’t have many of these symptoms but may be febrile, be slow or inactive, unsettled, drowsy, floppy and not feeding.
Meningococcus is only carried and passed on by humans. It is spread by coughing, sneezing and regular, close, prolonged household or intimate contact with infected secretions from the back of the nose and throat. The bacteria can only survive a few seconds outside the body so they cannot be picked up from the environment.
Carriage rates are highest in older teenagers.
People with meningococcal disease could develop a number of conditions:
1 in 5 people3 who recover may have lingering health problems. Many of the problems get better with time. Some of the issues experienced are:
3. Meningococcal Australia The Facts 2014 Accessed 8 August 2017
Immunisation against meningococcal disease is the best protection against meningococcal disease.
Who should get immunised?
Meningococcal C vaccine is part of the National Immunisation Program and is free for children aged 12 months. Meningococcal C disease is now very well controlled with only a handful of cases per year.
Quadrivalent meningococcal vaccine protects against strains A, C, W and Y
In most states/territories, the vaccine is free for adolescents between 15-19 years of age. In states where it is not funded, the vaccine is available as a private prescription for adolescents.
Vaccine is also available as a private prescription for:
* Menveo is the only brand of 4vMenCV that should be used in infants <12 months of age
Meningococcal B vaccine is available on private prescription for:
* MenBV is registered for use from 2 months of age. However, the 1st dose can be given as early as 6 weeks of age to align with the schedule for other routine infant vaccines.
5. Meningococcal vaccines for Australians/NCIRS Fact sheet: March 2017
6. The Australian Immunisation Handbook 10th ed part 4 (page last updated 1st August 2017). Canberra: Australian Government Department of Health; 2015
If meningococcal disease is suspected, an antibiotic (usually penicillin) is given immediately by injection. People with meningococcal disease are almost always admitted to hospital and may require admission to an intensive care unit.
From 2002 to 2015 the predominant meningococcal serogroup in Australia was serogroup B. However, the incidence of serogroup B has declined in the absence of any significant vaccine use.
Notifications of MenW doubled from 2014 (17) to 2015 (34), then more than tripled in 2016 (109) surpassing serogroup B (92 cases).1
Many of the MenW cases belong to the hypervirulent sequence type (ST) 11. ST 11 is associated with a higher risk of invasive disease and a higher case fatality rate.
MenC, the target of a national immunisation programme since 2003, has dramatically declined from 225 notifications in 2002 to 3 notifications in 2016 (a 99% decline).
There has been a smaller increase in serogroup Y disease from 12 cases in 2014 to 41 cases in 2016.
Serogroup A remains rare in Australia.
Most meningococcal disease occurs in children aged less than 5 years of age and adolescents. MenW also has its peak in these age groups however it has a diverse age range. Men W accounted for 59% of Invasive Meningococcal Disease (IMD) in adults aged over 65 years in 2016.2
About one in 10 people can have meningococcal bacteria in their throat or nose. These very rarely cause illness.
Adolescents have the highest carriage rates, peaking in 19-year olds, and so play an important role in transmission.3
See references 4,5
|Fever and/or vomiting||
|Limb joint muscle pain||
|Cold hands and feet/chills||
|Pale or mottled skin||
|Dislike of bright lights||
A common presentation of meningococcal serogroup W disease in Australia has been severe sepsis. Classical meningitis symptoms have been less common. Serogroup W disease has also been associated with atypical presentations, such as septic arthritis, pneumonia and epiglottitis, in up to 20% of cases.6
See reference 7
Individuals at greater risk of meningococcal infection:
Certain disorders of the immune system (particularly complement deficiencies)
Three types of meningococcal vaccines are available in Australia:
-a single vaccine (NeisVac-C)
-a combination with Haemophilus type B (Menitorix)
See reference 8
Quadrivalent meningococcal conjugate vaccines (4vMenCV for serogroups A, C, W and Y)
|Trade Name/Age available||Formulation||Who should be vaccinated?|
|Menactra (from 2 years of age onwards)||Quadrivalent diphtheria toxoid conjugate||Those with increased medical, occupational or other exposure including travel risks of meningococcal disease caused by serogroups A, C, W and Y.
Adolescents/ young adults 15-19 years of age
Vaccination may be offered to anyone aged 2 months or older wishing to reduce the risk of Men A, C, W and Y.
Availability: Private prescription
Funded vaccination in most states or territories for adolescents/young adults aged 15-19 years of age
|Menveo* (from 2 months onwards)||Quadrivalent CRM 197 conjugate|
|Nimenrix (from 12 months onwards)||Quadrivalent tetanus toxoid conjugate|
Menactra is approved for use in children from 2 years of age. PI states upper age limit is 55 years of age. The ATAGI recommends instead that this vaccine can be given to persons > 55 years of age.
Nimenrix is indicated for active immunisation of individuals from the age of 12 months. PI states upper age limit is 55 years of age. The ATAGI recommends instead that this vaccine can be given to persons > 55 years of age.
Menveo vaccine schedule for children from 2 to 23 months of age. *Menveo is the only brand of 4vMenCV that should be used in infants < 12 months of age.
States/Territories offering funded quadrivalent (A, C, W and Y) meningococcal vaccine to adolescents in 2017:
NSW: Students in Years 11 and 12
Victoria, Queensland and Tasmania: Adolescents from 15-19 years of age
WA: Students in Years 10 to 12
Vaccine is available in other states/territories on private prescription
Benefits of vaccinating adolescents:
Administering quadrivalent meningococcal vaccines
Menactra is in a liquid form and simply drawn up and administered to the individual.
Menveo* and Nimenrix** consist of a powder and a liquid which need to be combined before they are administered.
*Menveo contains one vial with lyophilised Meningococcal Group A conjugate and a syringe containing liquid Meningococcal C, W-135 and Y conjugate component.
**Nimenrix contains a white lyophilised powder reconstituted with normal saline
Meningococcal C conjugate vaccines (MenCCV for serogroup C)
|Trade Name||Formulation||Who should be vaccinated?|
|NeisVacC||Men C conjugate vaccine||All children at 12 months
Monovalent vaccine replaced by Hib-MenCCV combination vaccine for use under NIP since July 2013.
Catch up vaccine for children 10-19 years of age
Availabilty: Funded under NIP for children aged 12 months and as a catch-up vaccine for children 10-19 years of age.
|Menitorix||Hib-MenC conjugate combination vaccine|
Meningococcal B vaccine (MenBV for serogroup B)
|Trade Name||Formulation||Who should be vaccinated?|
|Infants and young children, particularly those < 2 years, adolescents and those with increased medical or occupational exposure risks of MenB disease.
Vaccination can be offered to anyone aged 6 weeks* or older who wants to reduce the risk of MenB disease.
Availabilty: Private prescription.
Funded vaccination may be available in some states or territories for adolescents
* MenBV is registered for use from 2 months of age. However, the 1st dose can be given as early as 6 weeks of age to align with the schedule for other routine infant vaccines.9
Meningococcal conjugate vaccines are safe and well tolerated.
Meningococcal 4vMen CV
Side effects may include fever, headache, dizziness and erythema at the injection site. Erythema resolves in 48-72 hours.
Meningococcal C conjugate vaccines
Side effects may include pain and tenderness at the injection site which resolves in 1 day and transient headache. Serious adverse effects are rare.
Multicomponent meningococcal B vaccine
Fever is the most common side effect in infants and young children especially when given concurrently with other vaccines. Prophylactic paracetamol is recommended with MenBV administration in children aged under 2 years of age.
Other common side effects: Tenderness, swelling and erythema around injection site, irritability, sleepiness, change in eating habits, unusual crying, rash, vomiting and diarrhoea. The side effects are mild or moderate and transient.
Offer meningococcal ACWY vaccine to adolescents in states where it is not provided in schools. In states where vaccine is available in schools, GPs could offer the vaccine to adolescents not attending school e.g. those working or being home schooled
Consider testing for invasive meningococcal disease in older patients who may have atypical presentations (septic arthritis and epiglottitis).10
Be on the lookout with diagnosis and provide early management.
1.Australian Government Department of Health. Invasive Meningococcal Disease National Surveillance Report with a focus on MenW 19 June 2017
2.Australian Government Department of Health. Invasive meningococcal disease national surveillance report, with a focus on MenW. 9 January 2017. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Conte nt/ohp-meningococcal-W.htm (Accessed February 2017)
3.Christensen H. et al. 2010. Meningococcal carriage by age: a systematic review and meta-analysis. Lancet Infectious Diseases Dec 2010: 853-61
4.Centers for Disease Control and Prevention (CDC) Meningococcal Disease Fact sheet April 2017
5.Meningitis Research Foundation Symptoms of meningitis and septicaemia (Accessed 22nd August 2017)
6.Martin NV, Ong KS, Howden BP, et al. Rise in invasive serogroup W meningococcal disease in Australia 2013– 2015. Communicable Diseases Intelligence 2016;40: E454-E9. 12
7.Australian Technical Advisory Group on Immunisation (ATAGI). The Australian Immunisation Handbook 10th ed (2017 update) Canberra: Australian Government Department of Health, 2017
8.Meningococcal vaccines for Australians/NCIRS Fact sheet: March 2017
9.The Australian Immunisation Handbook 10th ed part 4 (page last updated 1st August 2017). Canberra: Australian Government Department of Health; 2015
10.Australian Government Department of Health Meningococcal W Disease-Information for Health Professionals Date issued: 14 December 2016 (Accessed 28 September 2017)
Date published: 10 May 2017
Last updated: 14 March 2018