This MVEC guideline details our recommendations regarding meningococcal vaccines in those who are considered at higher risk of invasive meningococcal disease (IMD) either due to an underlying medical condition or due to immunosuppressive medication.

  • From 1 July 2020, recommendations for meningococcal vaccines are changing to make meningococcal vaccines more readily available and give extra protection to people who are most at risk of invasive meningococcal disease.

In 2019, Meningococcal B and Meningococcal W are still the most commonly circulating sub-types of Meningococcal disease in Australia. There are vaccines available to protect against Meningococcal A, B, C, W and Y.

A single dose of Nimenrix® (MenACWY) 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.

Bexsero® (MenB) vaccine is NIP funded (from the 1st July 2020) for Aboriginal and Torres Strait Islander children < 2-years of age. The incidence of IMD is around 4 times higher in Aboriginal and Torres Strait Islander children than non-indigenous children. The number of doses required depends on age and the presence of conditions associated with an increased risk of IMD.

MenB and MenACWY vaccines are now funded under the NIP for people of all ages with medical conditions that increase the risk of IMD. These are functional asplenia and hyposplenia (including sickle-cell disease or haemoglobinopathies), complement deficiency and those receiving treatment with eculizamab. People with these medical conditions are also eligible for NIP-funded booster doses of MenACWY vaccine as per The Australian Immunisation Handbook.

Some local councils offer Bexsero as a fee for service 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.

People with several other medical conditions that also result in an increased risk of IMD such as HIV, haemotopoietic stem cell transplant, young adults aged 20-24 who are smokers and laboratory workers who handle Neisseria meningitidis) are still recommended to receive these vaccines, however, MenACWY and MenB vaccines are not funded in this group. See ATAGI clinical advice on changes to vaccine recommendations and funding for people with risk conditions from 1 July 2020 for more information.

Bexsero® is funded under the NIP for Aboriginal and Torres Strait Islander infants < 2-years with any of the above conditions that increase the risk of IMD.

A list of common immune suppressive medications resulting in a patient being at higher risk of IMD can be found in Table 1.

We recommend administration of both vaccines from 6-weeks of age, or at the time of diagnosis/commencement of immunosuppressive therapies (see Table 2). Immunisation status should be reassessed regularly and as part of the transition to an adult facility, with booster doses to be considered every 5 years.

Local funding (RCH Melbourne)

At the Royal Children’s Hospital, Melbourne these meningococcal vaccines have Drug Utilisation Committee (DUC) approval and funding. There is a pharmaceutical (PBS) fee for these vaccines, which is reduced if the child has a healthcare card.

Table 1: Immunosuppressive medications

Mechanism of action Examples*
Anti-TNF Etanercept Infliximab Adalimumab
IL-1 inhibition Anakinra
Costimulation blockade Abatacept
B-cell depletion/inhibition Rituximab
Immunomodulators (antimetabolites) Azathioprine  6-Mercaptopurine  Methotrexate
Corticosteroids Prednisone
T-cell activation/inhibition Tacrolimus Cyclosporine

*NB: prednisolone doses considered immunosuppressive is > 2mg/kg (or 20mg) for 2-weeks, or 1mg/kg for > 1-month

Table 2: Nimenrix® (Meningococcal ACWY)^ and Bexsero® (Meningococcal B)¥ recommendations for people with medical conditions that increase risk of IMD

Age at commencement of vaccine course Primary immunisation course Adolescent doses

6-weeks to ≤ 5-months

4 doses*# (minimum 8 weeks apart, 4th dose at 12-months of age or 8 weeks after 3rd dose, whichever is later)

Even if the primary course has been completed adolescence is a time of increased risk of IMD.

A single dose of Nimenrix® vaccine is currently provided for all adolescents in year 10 (or age equivalent) with catch up available at 15-19 years of age on the NIP.

MVEC recommend a booster dose of Bexsero® at this time point in adolescence as well.

6-months to ≤ 11-months

3 doses*# (minimum 8 weeks between dose 1 and 2, 3rd dose at 12-months of age or 8 weeks after second dose, whichever is later)

≥ 12-months

2 doses*# (minimum 8 weeks part)

*Specified medical conditions that increase the risk of IMD include complement deficiency, receiving treatment with eculizumab, asplenia, HIV, haemopoietic stem cell transplant, young people aged 20-24 who are smokers and laboratory workers who handle Neisseria meningitidis
^Note the meningococcal ACWY vaccines are not equivalent – MVEC preferentially recommends Nimenrix® brand
#Refer to MVEC: Meningococcal disease and vaccines for advice on Bexsero® and paracetamol administration
¥Meningococcal B vaccines are not equivalent or interchangeable – MVEC preferentially recommends Bexsero® brand

Resources 

Authors: Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute) and Rachael McGuire (Research Nurse SAEFVIC, Murdoch Children’s Research Institute)

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