About this disease

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

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

    3. Meningococcal Australia The Facts 2014 Accessed 8 August 2017

Prevention

Immunisation is the best protection against meningococcal disease.

 

Who should get immunised?

 

Quadrivalent meningococcal disease vaccine protects against strains A, C, W and Y. It is part of the National Immunisation Program and is free for children aged 12 months.

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

 

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.

 

From 1 October 2018 Meningococcal B vaccinations will be available in a phased implementation in South Australia. For more information, see here.

 

Meningococcal C disease is now very well controlled with only a handful of cases per year.

  • 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.

Info for Clinicians

  • 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. In 2018, MenB became the predominant strain once again.

     

    Notifications of MenW doubled from 2014 (17) to 2015 (34), then more than tripled in 2016 (109) surpassing serogroup B (92 cases).1  

    In 2017, MenW (37%) and MenB (36%) emerged as predominant strains. In 2017, MenW notifications dramatically increased to 141 and MenB notifications to 137.2

    In 2018 MenW (36%) and MenB (42%) emerged as predominant strains with MenB (119 cases) surpassing MenW (100 cases)³

    Many of the MenW cases belong to the hypervirulent sequence type (ST) 11. ST 11 is associated with a higher risk of invasive disease, complications 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). In 2017, MenC notifications increased to 14 and declined to 4 in 2018.2,3

     

    There has been an increase in serogroup Y disease from 12 cases in 2014 to 41 cases in 2016 to 75 cases in 2017 and a decline to 45 in 2018.4

    Men ACWY vaccination programs have seen a drop in MenW and MenY in 2018.

    Serogroup A remains rare in Australia.

     

    Most meningococcal disease occurs in children aged less than 5 years of age and young people aged 15-24 years. MenW also has its peak in these age groups however, it is also somewhat increased in older adults. MenW accounted for 59% of Invasive Meningococcal Disease (IMD) in adults aged over 65 years in 2016.5

  • 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.6

  • See references 7,8

    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

     

  • 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.9

  • See reference 10

    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
    • Aboriginal and/or Torres Strait Islander people (Up to 19 years of age)
  • Vaccines

    Three types of meningococcal disease 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)

    • recombinant meningococcal B vaccines (MenB) Bexsero, Trumenba
    • quadrivalent (A, C, W, Y) meningococcal conjugate vaccines (4vMenCV): Menactra, Menveo and Nimenrix
  • See reference 11,3

    Quadrivalent meningococcal conjugate vaccines (4vMenCV for serogroups A, C, W and Y)

    Trade Name/Age available Formulation Who should be vaccinated?
    Menactra (from 9 months 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:

    Funded on NIP at 12 months of age.12

    WA Catch up for anyone 13 mths to <5 yrs of age.

    Nimenrix is NIP funded for 14-19 year olds.12

    On private prescription for other individuals.

    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 9 months3 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. ATAGI recommends that it can be given to children as young as 6 weeks.3 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 ATAGI recommends Menvio can be given to infants as young as 6 weeks of age.3

    Nimenrix available on NIP for 14-19 year-olds commencing April 2019.

    TAS: Free to anyone over 6 weeks born after 1st August 199711

    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)

    Dose schedule recommendations using MenACWY vaccines3

    Age at start of vaccine course Men ACWY Healthy individuals including Indigenous Australians, travellers and laboratory personnel With any specified medical conditions associated with increased risk of meningococcal disease
    6 weeks- 5 months Menveo*

    Nimenrix

    3 doses
    (8 weeks between 1st and 2nddoses; 3rddose at 12 months of age)
    4 doses
    (8 weeks between doses; 4thdose at 12 months of age or 8 weeks after 3rd dose, whichever is later)
    6-8 months Menveo
    Nimenrix
    2 doses
    (2nd dose at 12 months
    3 doses
    (8 weeks between each dose)
    9-11 months Menveo
    Nimenrix
    Menactra
    2 doses
    (2nd dose at 12 months of age or 8 weeks after 1st dose, whichever is later)
    3 doses
    (8 weeks between 1stand 2nd doses; 3rd dose at 12 months of age or 8 weeks after 2nd dose, whichever is later)
    12-23 months Menveo

    Menactra

     

    Nimenrix

    2 doses
    (8 weeks between doses)2 doses
    (8 weeks between doses)1 dose
    2 doses
    (8 weeks between doses)
    ≥ 2 years** Menveo

    Menactra

    Nimenrix

    1 dose 2 doses
    (8 weeks between doses)
    Booster doses for all ages Any brand Required every 5 years only for travellers and laboratory personnel facing ongoing risks For those with ongoing increased risk for IMD who completed the primary series at:
    i) ≤ 6 years of age: 3 years after completion of primary immunisation schedule, then every 5 years thereafterii) ≥ 7 years of age: every 5 years after completion of the primary immunisation schedule

    *The product information for Menveo states that infants aged 2-6 months should receive 3 primary doses and a booster dose at age 12 months. However, ATAGI recommends that infants aged 6 weeks- 5 months should receive 2 primary doses (8 weeks apart) and a booster dose at age 12 months. ATAGI also recommends that infants aged 6 months should receive 1 primary dose and a booster dose at age 12 months
    **Menveo and Nimenrix are preferred for children ≥ 2 years. If unavailable, use Menactra.

     

    Administering quadrivalent meningococcal disease 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

     

    Co-Administering with 13vPCV

    Menveo and Nimenrix can be co-administered with 13vPCV. Do not co-administer Menactra with 13vPCV. Ideally 13vPCV should be given first followed by Menactra, with a minimum interval of 4 weeks between the dose of 13vPCV and Menactra.

     

    Meningococcal C conjugate vaccines (MenCCV for serogroup C)

    Trade Name Formulation Who should be vaccinated?
    NeisVacC Men C conjugate vaccine  

    Monovalent vaccine replaced by Hib-MenCCV combination vaccine for use under NIP since July 2013.

     

    In July 2018, Men A, C, W and Y replaced Hib-Men C on the NIP at 12 months

    In July 2018, an injection of Hib became available on NIP at 18 months as Hib is no longer available at 12 months12

    Catch up vaccine for children 10-19 years of age

     

    Availabilty: Monovalent MenC vaccine available on the NIP for those requiring catch up of the 12-month childhood dose (when they are not eligible to receive MenACWY vaccine)13

    Menitorix Hib-MenC conjugate combination vaccine

     

    Meningococcal B vaccine (MenBV for serogroup B)

    Trade Name Formulation Who should be vaccinated?
    Bexsero

     

    In SA

    Bexsero for childhood program

     

    Bexsero/Trumenba for school immunisation program and under 21 catch up program

    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

     

    Funded vaccination available in SA for14:

    • 6 weeks to 12 months of age: Meningococcal B Childhood program commencing October 2018/ ongoing
    • Catch up program over 12 months to 4 years of age: October 2018 – 31 December 2019
    • Year 10 Men B Vaccination commencing February 2019/ ongoing
    • Year 11 Men B Catch up program commencing February 2019 – 31 December 2019
    • 17 years to less than 21 years of age Meningococcal B Young adult catch up program commencing February 2019 – December 2019

    * 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.15

     

    Dose schedule recommendations using Men B vaccines3

     

    Age at start of vaccine course

    (Brand)

    Number of primary doses Intervals between doses Booster
    6 weeks-5 months

    (Bexsero)

    3 (healthy)

    4 (increased risk)

    8 weeks between doses 4th dose (booster) at 12 months
    6-11 months
    (Bexsero)
    3 8 weeks between doses 3rd dose (booster) at 12 months
    12 months-23 months
    (Bexsero)
    2 8 weeks
    2-9 years
    (Bexsero)
    2 8 weeks
    ≥ 10 years
    (Bexsero)Or≥ 10 years
    (Trumenba)*
    2

     

     

    2 or 3

    8 weeks

     

     

    6 months for 2 doses

    For those with specified medical conditions, 3 doses are required (at least 4 weeks between 1st and 2nd doses; 3rd dose at least 4 months after 2nd dose and at least 6 months after 1st dose

     

     

     

     

    *Bexsero and Trumenba are not interchangeable. The same vaccine should be used to complete vaccination course.

  • 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 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).15

     

    Be on the lookout with diagnosis and provide early management.

  • Click to download the Meningococcal disease GP Guide:

  • 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 – January 2018

    3.Meningococcal vaccines for Australians/NCIRS Fact sheet: April 2019

    4.Australian Government Department of Health; Invasive Meningococcal Disease National Surveillance Report-1 October to 31 December 2018

    5.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/Content/ohp-meningococcal-W.htm (Accessed February 2017)

    6.Christensen H. et al. 2010. Meningococcal carriage by age: a systematic review and meta-analysis. Lancet Infectious Diseases Dec 2010: 853-61

    7.Centers for Disease Control and Prevention (CDC) Meningococcal Disease Fact sheet April 2017

    8.Meningitis Research Foundation Symptoms of meningitis and septicaemia (Accessed 22ndAugust 2017)

    9.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

    10.Australian Technical Advisory Group on Immunisation (ATAGI). The Australian Immunisation Handbook 10thed (2017 update) Canberra: Australian Government Department of Health, 2017

    11.Department of Health Vic, Tas, WA, NT, SA, QLD, NSW, ACT

    12.Department of Health National Immunisation Program last updated 14thJune 2019

    13.Meningococcal vaccines for Australians/NCIRS Fact sheet: August 2018

    14.Dept of Health, SA

    15.Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook, Australian Government Department of Health, Canberra, 2018, immunisationhandbook.health.gov.au.

Date published: 10 May 2017

Last updated: 19 August 2019

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