What is it?

Meningococcal disease constitutes any illness 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).

Invasive meningococcal disease (IMD) can cause meningitis (inflammation of the membrane covering the brain and spinal cord) and 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% with permanent lifelong complications occurring in 10-20% of those who survive.

What to look for

The incubation period of meningococcal is 1-7 days, more commonly 3-4 days. People with meningococcal disease can become extremely unwell very quickly. Symptoms can include fever, headache, neck stiffness, nausea, vomiting and photophobia (sensitivity to light). Cool, mottled extremities and leg pain can also occur. Babies can appear irritable or unsettled, have a high-pitched moaning cry, refuse or not wake for feeds and be lethargic (sleepy) or floppy. A petechial or purpuric rash can appear late in the disease progression (within 13-22 hours) or not at all.

How is it transmitted?

Disease can be transmitted from person to person via respiratory droplets (eg. sneezing and coughing). Meningococcal bacteria can also live harmlessly at the back of the nose or throat, resulting in individuals being asymptomatic carriers.

Epidemiology

Children < 2 years of age have the highest incidence of meningococcal disease in Australia, with another peak of disease among adolescents and young adults (15-24 years). Aboriginal and Torres Strait Islander people have a much greater burden of disease than non-Indigenous people.

There are also certain medical conditions and medications that can increase an individual’s risk of IMD. These include (but are not limited to) those with functional asplenia and hyposplenia, complement deficiency and those receiving treatment with eculizamab [see below for specific information for those with increased risk of IMD].

Prevention

MVEC strongly recommends everyone wishing to be protected against ACWY and B strains of meningococcal disease be immunised. Some individuals are eligible for funded vaccines via the National Immunisation Program (NIP). Those aged ≥ 6 weeks of age who do not meet the funding criteria can purchase vaccines privately through some councils, GPs and pharmacies.

The number of vaccine doses recommended depends on a person’s age and risk factors for IMD.

Meningococcal ACWY vaccines

MVEC recommends 2 conjugate meningococcal ACWY vaccines:

  • Nimenrix®
  • Menveo®

A single dose of Nimenrix® is currently provided for free at 12 months of age and for all adolescents in Year 10 (or age equivalent) with catch up available for those aged 15-19 years. It is also funded for certain individuals of any age with immunocompromising conditions.

  • Meningococcal ACWY primary course and booster doses for healthy individuals

    Primary course

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    † there is no registered upper age limit for the use of Menveo® or Nimenrix®.
    ¥ 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 dose given at ≥ 12 months of age.

    Booster doses

    Further booster doses are not routinely recommended for healthy individuals. In circumstances where someone has previously received a primary course of meningococcal ACWY and is offered a further dose in year 10 in line with the NIP, it is acceptable to to receive this dose.

  • Meningococcal ACWY primary course and booster doses for those at increased risk of IMD

    Individuals with specified medical conditions that increase the risk of IMD are recommended and funded to receive additional meningococcal vaccines and booster doses. These groups include:

    • those with defects in, or deficiency of complement components (including factor H, factor D or properdin deficiency),
    • those currently receiving or planning treatment with eculizumab (or biosimilar),
    • those with functional or anatomical asplenia (including sickle cell disease or haemoglobinopathies and congenital or acquired asplenia),
    • anyone with HIV (regardless of disease stage or CD4+ cell count),
    • anyone who previously received a haemopoietic stem cell transplant (HSCT).

    Primary course

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    † there is no registered upper age limit for the use of Menveo® or Nimenrix®.
    ¥ 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 at < 12 months of age.

    Booster doses

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    † there is no registered upper age limit for the use of Menveo® or Nimenrix®.
    § using either Menveo® or Nimenrix® as a booster dose, regardless of the brand used for the primary course, is approriate.

Meningococcal B vaccines

There are currently 2 vaccines available for protection against meningococcal B disease.

  • Bexsero®
  • Trumenba®

Meningococcal B vaccines brands are not interchangeable.

A primary course of Bexsero® is available on the NIP for Aboriginal and Torres Strait Islander children < 2 years of age, as well as some individuals of any age with immunocompromising conditions.

Paracetamol advice

It is widely recognised that children receiving Bexsero® are more likely to experience fever following vaccination. It is for this reason that children < 4 years of age are recommended to receive prophylactic paracetamol (15mg/kg per dose) 30 minutes prior to vaccination (or as soon as possible after), as well as 2 subsequent doses (4-6 hours apart) to reduce the likelihood and severity of fever. This should be administered regardless of whether the child is experiencing a fever or not.

  • Meningococcal B primary course and booster doses for healthy individuals

    Primary course

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    † Bexsero® is registered for use in those 6 weeks of age and older. Trumenba® is only registered for use in those 10 years of age or older.
    ¥ meningococcal B vaccine brands are not interchangeable for primary courses or booster doses.
    # prophylactic paracetamol is recommended to those < 4 years of age (refer to advice above).
    £ funded on the NIP for Aboriginal and Torres Strait Islander children < 2 years of age and those identified as medically at risk (see recommendations below for further information).
    N/A- not recommended in this age group.

    Booster doses

    Further booster doses of meningococcal B vaccines are not routinely recommended for healthy individuals.

  • Meningococcal B primary course and booster doses for those with increased risk of IMD

    Individuals with specified medical conditions that increase the risk of IMD are recommended and funded to receive additional meningococcal B vaccines. From December 2022, following an NCIRS-led GRADE review of the evidence, ATAGI endorsed an update to the Australian Immunisation Handbook recommendations which now include booster doses of meningococcal B vaccines.

    Eligible individuals include:

    • those with defects in, or deficiency of complement components (including factor H, factor D or properdin deficiency),
    • those currently receiving or planning treatment with eculizumab (or biosimilar),
    • those with functional or anatomical asplenia (including sickle cell disease or haemoglobinopathies and congenital or acquired asplenia),
    • anyone with HIV (regardless of disease stage or CD4+ cell count),
    • anyone who previously received a haemopoietic stem cell transplant (HSCT).

    MVEC strongly encourages the active follow up of individuals who meet these criteria to ensure that appropriate vaccine schedules and their recommended booster doses are administered in line with the updated guidance to optimally protect vulnerable patients.

    Primary course

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    † Bexsero® is registered for use in those 6 weeks of age and older. Trumenba® is only registered for use in those 10 years of age or older.
    ¥ meningococcal B vaccine brands are not equivalent or interchangeable for primary courses or booster doses.
    # prophylactic paracetamol is recommended to those < 4 years of age (refer to advice above).
    N/A- not recommended in this age group.

    Booster doses§

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    § refer to GRADE assessment for more information.
    † Bexsero® is registered for use in those 6 weeks of age and older. Trumenba® is only registered for use in those 10 years of age or older.
    ¥ meningococcal B vaccine brands are not equivalent or interchangeable for primary courses or booster doses.
    N/A- not recommended in this age group.

Resources

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

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)

Date: July 4, 2023

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.