What is Meningococcal Disease?

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

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1. Meningococcal vaccines for Australians/NCIRS Fact sheet: March 2017

Symptoms

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.

How is it spread?

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.

Complications

People with meningococcal disease could develop a number of conditions:

  • An infection of the lining around the brain (meningitis)
  • An infection of the blood (septicaemia)
  • Joint infection (arthritis)
  • Lung infection (pneumonia)
  • Permanent brain damage
  • Death in up to 10%2

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:

  • Skin scarring (1 in 30)
  • Limb deformity
  • Deafness
  • Blurring and double vision
  • Learning difficulties

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2.https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/meningococcal-disease

3. Meningococcal Australia The Facts 2014 Accessed 8 August 2017

Prevention

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:

  • Some travel destinations, occupations and medical conditions
  • Anyone over 2 months* wanting to protect themselves or their family from these strains of meningococcal disease4,5

* 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:

  • Infants, young children, adolescents, young adults living close together, some medical conditions and occupations
  • Anyone over 6 weeks* wanting to protect themselves or their family from this strain of meningococcal6

* 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.

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4.http://www.dhhs.tas.gov.au/publichealth/communicable_diseases_prevention_unit/infectious_diseases/meningococcal_disease

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

Treatment

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.

More information for Clinicians

Epidemiology

 

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

 

Transmission

 

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

 

Symptoms4,5

Symptoms Septicaemia Meningitis
Fever and/or vomiting

Severe headache  

Limb joint muscle pain

 
Cold hands and feet/chills

 
Pale or mottled skin

 
Breathing fast/breathless

 
Rash

Stiff neck  

Dislike of bright lights  

Very sleepy/vacant

Confused

Seizures

 

Complications

 

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

 

Risk Factors7

 

Individuals at greater risk of meningococcal infection:

  • Immunocompromised due to:

Certain disorders of the immune system (particularly complement deficiencies)

  • HIV infection
  • Haemotapoetic stem cell transplant
  • Certain medical treatments (e.g. eculizimab)
  • Asplenia
  • Occupational exposure in labs
  • Exposure to smokers (who are more likely to be carriers)
  • Crowded living conditions
  • Intimate kissing with multiple partners
  • Recent or current viral infection

 

Prevention

 

Vaccines

Three types of meningococcal vaccines are available in Australia:

  • meningococcal C conjugate vaccine (MenCCV) is available as:

-a single vaccine (NeisVac-C)
-a combination with Haemophilus type B (Menitorix)

  • meningococcal B vaccine (MenBV) Bexsero
  • quadrivalent (A, C, W, Y) meningococcal conjugate vaccines (4vMenCV): Menactra, Menveo and Nimenrix

 

Who should be vaccinated?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:

  1. Prevent meningococcal disease in adolescents
  2. Prevent the spread of meningococcal disease to the broader community (herd immunity)

 

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?
Bexsero Recombinant multi-component

MenB

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

 

Vaccine safety

 

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.

 

What is the role of the GP for meningococcal disease?

 

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.

 

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References for clinicians information:

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)

 

 

Page published: 10 May 2017

Page updated:     17 October 2017