Meningococcal disease is caused by the bacteria Neisseria meningitidis. There are 13 known sub-types (serogroups) and of these, 5 are currently vaccine preventable (B and A, C, W, Y).

Serogroups B, C, W and Y account for the highest number of cases of invasive meningococcal disease (IMD) in Australia. In the first 6-months of 2019, just over half (52%) of meningococcal cases reported were due to serogroup B (n=46), 28% were due to serogroup W (n=25), 15% of cases were due to serogroup Y (n=13), and 6% were due to serogroup C (n=5).

Children < 2-years of age have the highest incidence of meningococcal disease. There is another peak of disease among adolescents and young adults aged 15-24 years. Aboriginal and Torres Strait Islander people have a  much greater burden of disease than non-Indigenous people.

People with meningococcal disease can become extremely unwell very quickly. IMD can cause meningitis (inflammation of the membrane covering the brain and spinal cord), septicaemia (infection in the blood) as well as other infections like pneumonia (lung infection), arthritis (inflammation of the joints) and conjunctivitis (eye infection). Mortality (death) can be as high as 5-10% and permanent lifelong complications can occur in 10-20% of those who survive. Disease is transmitted via respiratory droplets (sneezing and coughing etc).

MVEC strongly encourages the immunisation of anyone wishing to be protected against meningococcal disease.

Meningococcal ACWY

A four-in one combination vaccine is available for protection against meningococcal serogroups A, C, W and Y.

There are currently three quadrivalent conjugate vaccines (4vMenCV) available for immunisation against meningococcal A, C, W and Y.

  • Nimenrix® (Pfizer) – For use from 6-weeks of age
  • Menveo® (GSK) – For use from 6-weeks of age
  • Menactra® (Sanofi) – For use from 9-months of age

A single dose of Nimenrix® vaccine is currently provided for free at 12-months of age and for all adolescents in Year 10 secondary school (or age equivalent) with catch up available at 15-19 years of age on the National Immunisation Program (NIP). People with certain medical conditions that increase the risk of IMD may also be eligible for a funded dose [refer to MVEC: Meningococcal vaccines in special risk and immunosuppressed patients for more information].

Some local councils have Nimenrix®  available for purchase if patients wish to be protected but do not meet the criteria on the NIP. Alternatively, this vaccine is available at the GP on private prescription.

Table 1: Recommended MenACWY vaccine schedule (by brand) for healthy individuals, travellers and laboratory personnel

Vaccine Brand¥ Course commenced at age 6-weeks to ≤ 5-months of age Course commenced at 6 to ≤ 8- months Course commenced at 9 to ≤ 11-months of age Course commenced at ≥ 12 to 23-months of age Course commenced at ≥ 2-years of age
Nimenrix® 2 doses (minimum 8 weeks apart) + 1 booster^# dose 1 dose + 1 booster^# dose 1 dose + 1 booster^# dose 1 dose# 1 dose#
Menveo® 2 doses (minimum 8 weeks apart) + 1 booster^# dose 1 dose + 1 booster^ dose 1 dose + 1 booster^ dose 2 doses (minimum 8 weeks apart) 1 dose
Menactra®£ N/R* N/R* 1 dose* + 1 booster dose£ 2 doses (minimum 8 weeks apart)£ 1 dose

¥completing the course with the same vaccine brand is preferred but may not always be practical. The NIP funded 12-month dose of Nimenrix® may be used as the booster dose for those who have commenced the course < 12-months of age. 
there is no registered upper age limit for use of Menveo® or Nimenrix®
^booster dose is given at ≥ 12 months of age/8 weeks since previous dose (whichever is later)
#a single dose of Nimenrix® is funded on the NIP at 12-months of age and for year 10 students and adolescents aged 15-19 years of age who missed receiving the vaccine at school 
£ Menactra® should not be administered on the same day as the pneumococcal vaccine Prevenar 13®. Studies have shown that co-administration may result in a decreased immune response to some of the pneumococcal serotypes. If Prevenar 13® is inadvertently administered on the same day, a repeat dose should be administered a minimum of 8 weeks later. Menveo® and Nimenrix® may be co-administered with pneumococcal vaccines without any concern for efficacy.
* there are no published clinical trials data on the use of Menactra® in infants younger than 9-months of age. Given that infants typically have weaker immune responses than toddlers and older children, the clinical effectiveness of Menactra® in young infants is not yet known. Therefore Menactra® is not recommended in this age group. MVEC preferentially recommend Nimenrix® or Menveo® (if available) in infants < 12-months

Meningococcal B

There are currently 2 vaccines (4CMenB) available for the protection of meningococcal B disease.

  • Bexsero® – For use from 6-weeks of age
  • Trumenba® – For use in ≥ 10-years of age

These vaccines can be administered at the same time as routine NIP vaccines [refer to advice below on paracetamol in infants < 4-years].

Meningococcal B vaccines brands are not interchangeable.

From July 1 2020 Bexsero® was funded on the NIP for Aboriginal and Torres Strait Islander children < 2-years of age due to the incidence of IMD being around 4 times higher in this patient group than in non-indigenous children [refer to ATAGI clinical advice on vaccination recommendations for Aboriginal and Torres Strait Islander people from 1 July 2020 and table 3 below for more information]. The number of doses required depends on age and the presence of conditions associated with an increased risk of IMD.

Some local councils have Bexsero® available for purchase if patients wish to be protected but do not meet the criteria on the NIP. Alternatively, this vaccine is available at the GP on private prescription.

Paracetamol advice

The RCH and Monash Immunisation services recommend the use of paracetamol with every dose of 4CMenB given to children < 4-years of age, to reduce the likelihood and severity of fever that may occur after immunisation with 4CMenB. The first dose of paracetamol (15 mg/kg per dose) should be given in the 30 minutes before vaccination, or as soon as possible after immunisation, even if children do not have a fever. This should be followed by 2 more doses of paracetamol given 4 to 6 hours apart.

Table 2: Recommended MenB vaccine schedule for healthy individuals, travellers, laboratory workers, young adults living in close quarters and smokers*

Vaccine Brand¥ Course commenced at age 6 weeks to ≤ 11 months Course commenced at 12 months to ≤ 9 years of age Course commenced at ≥ 10 years of age
Bexsero®# 2 doses (minimum 8 weeks apart) + 1 booster^ dose 2 doses (minimum 8 weeks apart) 2 doses (minimum 8 weeks apart)
Trumenba® N/R N/R  2 doses (6 months apart)

*Australian Immunisation Handbook recommendations
¥meningococcal B vaccines brands are not interchangeable
#paracetamol recommended to those < 4-years of age (refer to advice above)
^booster dose at ≥ 12-months of age/8 weeks since previous dose (whichever is later)
N/R- not recommended in this age group

Table 3: NIP funded Bexsero® (MenB) vaccine schedule for Aboriginal and Torres Strait Islander (ATSI) children  < 2-years

Vaccine brand ATSI children with no medical risk conditions ATSI children with risk conditions for IMD#
Bexsero® 2 doses* (minimum 8 weeks apart) + booster dose^¥  3 doses* (minimum 8 weeks apart) + booster dose^¥ 

#refer to National Immunisation Program: Meningococcal vaccination schedule from 1 July 2020
*can be given from 6-weeks of age
^booster dose from ≥ 12-months of age/8 weeks since previous dose (whichever is later)
¥paracetamol recommended to those < 4-years of age (refer to advice above

Special risk groups

Patients with certain medical conditions and those taking immunosuppressive medications are potentially at increased risk of infection with IMD.

MenB and MenACWY vaccines are now funded under the NIP for people of all ages with some specified medical conditions associated with a high risk of IMD.

Please refer to  MVEC: Meningococcal vaccines in special risk and immunosuppressed patients and ATAGI clinical advice on vaccination recommendations for people with risk conditions for specific immunisation recommendations for this patient group.

Resources

Authors: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute, Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute), Georgina Lewis (Clinical Nurse Manager, SAEFVIC, Murdoch Children’s Research Institute

Reviewed by: Georgina Lewis (Clinical Manager SAEFVIC, Murdoch Children’s Research Institute) and Francesca Machingaifa (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Date: July 2020

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.