Meningococcal Disease Guide

Find out how to protect your patients against meningococcal, a fast acting and potentially deadly disease.

Immunisation Coalition

About Meningococcal Disease

Meningococcal disease progresses very rapidly. Deaths can occur in as little as a few hours.

The disease is caused by the bacterium Neisseria meningitidis. The most common strains worldwide are A, B, C, W and Y.

Since the introduction of MenACWY vaccination programs, the incidence of MenW disease has reduced. Currently, MenB and MenW cause most meningococcal disease in Australia.[1]

The Meningococcal health professionals guide provides useful information about clinical features of the disease, as well as information on epidemiology, transmission, and vaccination recommendations.

Download a PDF of the 2020 guide here or please contact us if you would like hard copies of the guide sent to you.

 

As health professionals you can help stop the spread of meningococcal disease by:

  • advising patients and parents about the importance and safety of vaccination
  • helping to prevent meningococcal disease in adolescents. Vaccine effectiveness of a 4vMenCV adolescent vaccination program in the United States has been estimated at 80 to 85%.[4]
  • helping to prevent the spread of meningococcal disease to the broader community (herd immunity).
  • considering testing for invasive meningococcal disease in older patients who may have atypical presentations (septic arthritis and epiglottitis).[5]
  • being on the lookout for diagnosis and provide early management.

 

 

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Meningococcal vaccines for Australians/ NCIRS Fact sheet: 1 July 2020.

4 MacNeil JR, Cohn AC, Zell ER, et al. Early estimate of the effectiveness of quadrivalent meningococcal conjugate vaccine. Pediatric Infectious Disease Journal 2011;30:451-5.

5 Australian Government Department of Health Meningococcal W Disease-Information for Health Professionals Date issued: 14 December 2016

Meningococcal 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: sudden onset of fever, rash of red-purple pinpricks or bruises, headache, neck stiffness, photophobia, muscle aches, cold hands and feet, confusion, irritability, joint pain, nausea and vomiting.[6]

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

What causes meningococcal disease

Meningococcal disease is transmitted by close, prolonged household and intimate contact. The spread of the disease is through the 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 surfaces, swimming pools, buildings or animals.

About one in 10 people[11] can have meningococcal bacteria in their throat or nose. These very rarely cause illness, but can be transmitted to others more susceptible and cause illness.  Teenagers have the highest carriage rates, peaking in 19-year-olds, and so play an important role in transmission.[12]

Meningococcal disease is caused by the bacterium Neisseria meningitidis. The most common strains worldwide are A, B, C, W and Y.

Men W emerged as an increasing cause of meningococcal disease, making up almost half of the Australian cases in 2016. In 2017, MenB strains increased to levels similar to MenW. In 2018, following MenACWY school vaccination programs, Men B emerged as predominant strains. MenC, the target of a national immunisation programme since 2003, has dramatically declined (225 in 2002, 3 in 2016, 14 in 2017, 4 in 2018).[2] There has been a decrease in MenY.

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

11 Centers for Disease Control and Prevention (CDC) Meningococcal Disease Causes and Transmission (page last updated 28 March 2017) Accessed 5 September 2017.

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

 

Who are most effected

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.[14]

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14 National Notification Disease Surveillance System Annual Report Writing Group. Australia’s notifiable disease status, 2012: annual report of the National Notifiable Diseases Surveillance System. Communicable Diseases Intelligence 2015; 39: E46-E136.

Risk factors

Individuals at greater risk of meningococcal infection:[5][10]

  • 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
  • Recent or current viral infection
  • Aboriginal and/or Torres Strait Islander people (Up to 19 years of age)
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5 Australian Government Department of Health Meningococcal W Disease-Information for Health Professionals Date issued: 14 December 2016 (Accessed 28 September 2017).

10 McCall BJ, Neill AS, Young MM. Risk factors for invasive meningococcal disease in southern Queensland, 2000–2001. Internal Medicine Journal 2004;34:464-8.

Complications

A common presentation of MenW in Australia has been severe sepsis. MenW disease has been associated with atypical presentations, such as septic arthritis, pneumonia and epiglottitis, in up to 20% of cases.[7]

Some people may experience permanent brain damage, and 1 in 10 may die. One in five people[8] who recover may have lingering health problems such as:

  • Skin scarring
  • Limb deformity
  • Limb loss
  • Deafness
  • Impaired vision
  • Learning difficulties[9]
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7 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.

8 Meningococcal Australia The Facts 2014 (Accessed website 8 August 2017).

9 Victoria State Government. Health and Human Services. Better Health Channel Meningococcal Disease Fact Sheet (Accessed 28 September 2017).

Quadrivalent meningococcal vaccine

4vMenCV for serogroups A, C, W and Y – Nimenrix available on NIP for 14-19 year olds

Trade Name/ Age availableAge AvailableFormulation
Menactrafrom 9 months of age onwards [**]Quadrivalent diphtheria toxoid conjugate
Menveofrom 2 months onwards [*]Quadrivalent CRM 197 conjugate
Nimenrixfrom 12 months onwards [*]Quadrivalent tetanus toxoid conjugate

Who should be vaccinated?

Vaccination may be offered to anyone aged 2 months or older wishing to reduce the risk of Men A, C, W and Y.

Those with increased medical, occupational or other exposure including travel risks of meningococcal disease caused by serogroups A, C, W and Y.
Infants 12 months of age

Adolescents/ young adults 14–19 years of age

Availability

Funded for adolescents or children (for varying and limited periods of time [*]):

  • Funded (Nimenrix) on NIP for children 12 months of age
  • WA has a catch up for 13 months to < 5 years
  • Funded on NIP through school-based program for 14-16 yr olds
  • 15-19 yr olds who did not receive the vaccine at school can receive it from their GP
  • From 1 July 2020. funded through NIP for people with certain medical conditions at increased risk of IMD. See Immunisation Handbook for details.
  • Vaccine is otherwise available on private prescription [∏].

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.

Vaccine safety

Meningococcal vaccines are safe and well tolerated. 4vMenCV’s most frequent side effects include: fever, headache, dizziness and erythema around injection site.

Erythema resolves in 48–72 hours.

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∏ Contact your state or territory health department for more information.

* ATAGI recommends Menveo and Nimenrix can be given from 6 weeks of age

**  Do not co-administer Menactra with 13vPCV

**  Menveo and Nimenrix are preferred in individuals ≥ 2 years of age. If unavailable, use Menactra.

 

Meningococcal B vaccine

MenBV for serogroup B

Trade NameFormulation
Bexsero

In South Australia: Bexsero for childhood program

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

Who should be vaccinated?

Vaccination can be offered to anyone aged 6 weeks [**][5] or older who wants to reduce the risk of MenB disease.

Infants and young children, particularly those <2 years, adolescents and those with increased medical or occupational exposure risks of MenB disease.

From 1 July 2020, funded on NIP for people with medical conditions that increase risk of IMD (i.e. asplenia, hyposplenia, complement deficiency and those receiving treatment with eculizumab).

On NIP for Aboriginal and Torres Strait Islander children at 2, 4 and 12 months of age. (Catch up available up to 2 years of age until 30 June 2023).

Availability

Private prescription.

Funded on NIP for Aboriginal and Torres Strait Islander children aged <2 years.

Funded on NIP for all ages with specific risk conditions.

Funded vaccination available in South Australia:[16]

  • 6 weeks to 12 months of age: Meningococcal B childhood program commencing October 2018/ongoing
  • Year 10 Men B vaccination commencing February 2019/ongoing

Vaccine effectiveness

Based on laboratory tests, estimated vaccine induces protective antibodies against 76% of MenB strains in Australia.[17]

Vaccine safety

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.

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Australian Government Department of Health Meningococcal W Disease-Information for Health Professionals Date issued: 14 December 2016 (Accessed 28 September 2017).

16 SA Health Meningococcal B Immunisation Program.

17 Therapeutic Goods Administration (TGA) Novartis Vaccines & Diagnostics Pty Ltd. Product information: BEXSERO® suspension for injection. Multicomponent meningococcal group B vaccine (recombinant, adsorbed). 2016.

Meningococcal C conjugate vaccines

MenCCV for serogroup C

Trade NameFormulation
NeisVacCMen C conjugate vaccine
MenitorixHib-MenC conjugate combination vaccine

Who should be vaccinated?

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

In July 2018, MenACWY replaced Hib-MenC on the NIP at 12 months

In July 2018, an injection of Hib became available on NIP at 18 months as Hib no longer available at 12 months.[18]

Availability

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).[19]

Vaccine effectiveness

Use from 2003 in Australia resulted in a 96% reduction in MenC invasive disease in all age groups by 2012.[20]

Vaccine safety

Common side effects: pain, tenderness and occasional erythema at injection site which resolves in 1 day, transient headache.

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18 Department of Health National Immunisation Program last update 1st July 2020.

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

20 Lawrence GL, Wang H, Lahra M, Booy R, McIntyre PB. Meningococcal disease epidemiology in Australia 10 years after implementation of a national conjugate meningococcal C immunization programme. Epidemiology and Infection 2016; 144:2382-91.

More information

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.

References for HCP Meningococcal Disease Guide

1 Meningococcal vaccines for Australians/ NCIRS Fact sheet: 1 July 2020.

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

3 Australian Government Department of Health. Invasive meningococcal disease national surveillance report, with a focus on Men W. 9 January 2017 (Accessed 28 September 2017).

4 MacNeil JR, Cohn AC, Zell ER, et al. Early estimate of the effectiveness of quadrivalent meningococcal conjugate vaccine. Pediatric Infectious Disease Journal 2011;30:451-5.

5 Australian Government Department of Health Meningococcal W Disease-Information for Health Professionals Date issued: 14 December 2016 (Accessed 28 September 2017).

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

7 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.

8 Meningococcal Australia The Facts 2014 (Accessed website 8 August 2017).

9 Victoria State Government. Health and Human Services. Better Health Channel Meningococcal Disease Fact Sheet (Accessed 28 September 2017).

10 McCall BJ, Neill AS, Young MM. Risk factors for invasive meningococcal disease in southern Queensland, 2000–2001. Internal Medicine Journal 2004;34:464-8.

11 Centers for Disease Control and Prevention (CDC) Meningococcal Disease Causes and Transmission (page last updated 28 March 2017) Accessed 5 September 2017.

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

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

14 National Notification Disease Surveillance System Annual Report Writing Group. Australia’s notifiable disease status, 2012: annual report of the National Notifiable Diseases Surveillance System. Communicable Diseases Intelligence 2015; 39: E46-E136.

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

16 SA Health Meningococcal B Immunisation Program.

17 Therapeutic Goods Administration (TGA) Novartis Vaccines & Diagnostics Pty Ltd. Product information: BEXSERO® suspension for injection. Multicomponent meningococcal group B vaccine (recombinant, adsorbed). 2016.

18 Department of Health National Immunisation Program last update 1st July 2020.

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

20 Lawrence GL, Wang H, Lahra M, Booy R, McIntyre PB. Meningococcal disease epidemiology in Australia 10 years after implementation of a national conjugate meningococcal C immunization programme. Epidemiology and Infection 2016; 144:2382-91.

More Guides for Health Professionals

Page Published: 5 November 2017 | Page Updated: 3 February 2021