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), 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 can occur very quickly. Permanent lifelong complications can occur 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 [refer to Recommendations for those at increased risk of IMD below for more information on risk groups].

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.

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 recommendations for healthy individuals

    ¥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.
    †there is no registered upper age limit for the use of Menveo® or Nimenrix®.
    ^booster doses are given at ≥ 12 months of age/8 weeks since the previous dose (whichever is later).
    #a single dose of Nimenrix® is funded on the NIP at 12 months and for year 10 students and adolescents aged 15-19 years who missed receiving the vaccine at school.

  • Meningococcal ACWY recommendations 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 vaccines. These groups include:

    • those with complement deficiency (including factor H, factor D or properdin deficiency), those receiving treatment with eculizumab or those who are planning to receive treatment with eculizumab in the future,
    • functional or anatomical asplenia,
    • sickle cell disease or haemoglobinopathies
    • HIV
    • previous haemopoietic stem cell transplant (HSCT).

    Refer to ATAGI clinical advice on changes to recommendations for meningococcal vaccines from 1 July 2020 for a full list of immunocompromising conditions.

    ^booster doses are given at ≥ 12 months of age/8 weeks since the previous dose (whichever is later).
    ¥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.
    †there is no registered upper age limit for the use of Menveo® or Nimenrix®.
    ^booster doses are given at ≥ 12 months of age/8 weeks since the previous dose (whichever is later).
    #a single dose of Nimenrix® is funded on the NIP at 12 months and for year 10 students and adolescents aged 15-19 years who missed receiving the vaccine at school.

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 only, 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 recommendations for healthy individuals

    †Bexsero® is registered for use in those 6 weeks of age and older. Trumenba® is registered for use in those 10 years of age or older.
    ¥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.
    £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).

  • Meningococcal B recommendations 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 vaccines. These groups include:

    • those with complement deficiency (including factor H, factor D or properdin deficiency), those receiving treatment with eculizumab or those who are planning to receive treatment with eculizumab in the future,
    • functional or anatomical asplenia,
    • sickle cell disease or haemoglobinopathies,
    • HIV,
    • previous haemopoietic stem cell transplant (HSCT).

    Refer to ATAGI clinical advice on changes to recommendations for meningococcal vaccines from 1 July 2020 for a full list of immunocompromising conditions.

    †Bexsero® is registered for use in those 6 weeks of age and older. Trumenba® is registered for use in those 10 years of age or older.
    ¥Meningococcal B vaccines are not equivalent or interchangeable – MVEC preferentially recommends Bexsero® brand.
    #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.

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 Francesca Machingaifa (MVEC Education Nurse Coordinator)

Date: June 7, 2022

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.