What is it?
Meningococcal disease constitutes any illness caused by the bacteria Neisseria meningitidis. There are 13 known subtypes (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 to 7 days, more commonly 3 to 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 to 22 hours) or not at all.
How is it transmitted?
Disease can be transmitted from person to person via respiratory droplets (e.g. 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 under 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 and older 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
There are 3 conjugate meningococcal ACWY vaccines available:
- Nimenrix
- MenQuadfi
- Menveo
Nimenrix is currently provided for free on the NIP for children 12 months of age (single dose) and for people of any age with specified medical risk factors, for example, immunosuppression (see below for number of doses recommended). Adolescents in Year 10 (or age equivalent) and those aged 15 to 19 years on a catch-up schedule are funded to receive MenQuadfi.
Meningococcal ACWY primary course and booster doses for healthy individuals
Primary course
WordPress Tables PluginVaccine brand Course commenced at 6 weeks to ≤ 5 months of age Course commenced at 6 months to ≤ 11 months of age Course commenced at 12 months to ≤ 23 months of age Course commenced at ≥ 2 years of age Nimenrix* 3 doses (minimum 8 weeks between 1st and 2nd doses; 3rd dose given at ≥ 12 months of age/8 weeks after 2nd dose, whichever is later)^ 2 doses (2nd dose at ≥ 12 months of age/8 weeks after 1st dose, whichever is later)^ 1 dose^# 1 dose^# MenQuadfi* N/A N/A 1 dose^# 1 dose^# Menveo* 3 doses (minimum 8 weeks between 1st and 2nd doses; 3rd dose given at ≥ 12 months of age/8 weeks after 2nd dose, whichever is later)^ 2 doses (2nd dose at ≥ 12 months of age/8 weeks after 1st dose, whichever is later)^ 2 doses (minimum 8 weeks apart)^# 1 dose# * there is no registered upper age limit for the use of Nimenrix, MenQuadfi or Menveo.
^ 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 to complete a course.
N/A- not recommended in this age group.
# MenQuadfi is funded on the NIP for Year 10 students (or age equivalent), and those completing catch-up aged 15-19.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 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
WordPress Tables PluginVaccine brand Course commenced at 6 weeks to ≤ 5 months of age Course commenced at 6 months to ≤ 11 months of age Course commenced at ≥ 12 months of age Nimenrix* 4 doses (minimum 8 weeks apart, with the 4th dose given at ≥ 12 months of age/more than 8 weeks after the 3rd dose, whichever is later)^ 3 doses (minimum 8 weeks apart, with the 3rd dose given at ≥ 12 months of age/8 weeks after 2nd dose, whichever is later)^ 2 doses (minimum 8 weeks apart)^# MenQuadfi* N/A N/A 2 doses (minimum 8 weeks apart)^# Menveo* 4 doses (minimum 8 weeks apart, with the 4th dose given at ≥ 12 months of age/more than 8 weeks after the 3rd dose, whichever is later)^ 3 doses (minimum 8 weeks apart, with the 3rd dose given at ≥ 12 months of age/8 weeks after 2nd dose, whichever is later)^ 2 doses (minimum 8 weeks apart)^# * there is no registered upper age limit for the use of Nimenrix, MenQuadfi or Menveo.
^ 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 to complete a course.
N/A- not recommended in this age group.
# MenQuadfi is funded on the NIP as a single for Year 10 students (or age equivalent), and those completing catch-up aged 15-19. However, only Nimenrix is funded on the NIP as a course of vaccination for those with specified medical risk factors.Booster doses
WordPress Tables PluginVaccine brand*^ Where the primary course was completed at ≤ 6 years of age Where the primary course was completed at ≥ 7 years of age Nimenrix/ MenQuadfi /Menveo Give a booster dose 3 years following the completion of the primary course, then further booster doses every 5 years Give a booster dose every 5 years following the completion of the primary course * there is no registered upper age limit for the use of Nimenrix, MenQuadfi or Menveo.
^ regardless of the brand used for completing a primary course, there is no preference for using either Nimenrix, MenQuadfi or Menveo as a booster dose. However, only Nimenrix is funded on the NIP for people requiring meningococcal ACWY vaccination due to medical risk factors.
Meningococcal B vaccines
Bexsero is the only meningococcal B vaccine available in Australia. It is funded on the NIP for Aboriginal and Torres Strait Islander children under 2 years of age, as well as some individuals of any age with immunocompromising conditions. Other individuals who wish to be protected can purchase vaccines.
Trumenba was previously available as an alternate meningococcal B vaccine for individuals aged 10 years and older. Trumenba and Bexsero are not interchangeable; therefore, anyone who commenced a primary course of Trumenba but did not complete it should begin their primary course again using Bexsero. For more information refer to The Australian Immmunisation Handbook: meningococcal, interchangeability of meningococcal vaccines.
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 under 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
WordPress Tables PluginVaccine brand Course commenced at 6 weeks to ≤ 11 months of age Course commenced at ≥ 12 months of age Bexsero* 3 doses (minimum 8 weeks between 1st and 2nd doses; 3rd dose at ≥ 12 months of age/more than 8 weeks after the 2nd dose, whichever is later)^# 2 doses (minimum 8 weeks apart)^# * Bexsero is registered for use in those 6 weeks of age and older.
^ 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).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
WordPress Tables PluginVaccine brand Course commenced at 6 weeks to ≤ 5 months of age Course commenced at 6 months to ≤ 11 months of age Course commenced at ≥ 12 months Bexsero* 4 doses (minimum 8 weeks apart, with the 4th dose given at ≥ 12 months of age/more than 8 weeks after the 3rd dose, whichever is later)^ 3 doses (minimum 8 weeks apart, with the 3rd dose given at ≥ 12 months of age/8 weeks after 2nd dose, whichever is later)^ 2 doses (minimum 8 weeks apart)^ * Bexsero is registered for use in those 6 weeks of age and older.
^ prophylactic paracetamol is recommended to those < 4 years of age (refer to advice above).Booster doses
WordPress Tables PluginVaccine brand Where the primary course was completed at ≤ 6 years of age Where the primary course was completed at ≥ 7 years of age Bexsero* Give a single booster dose 3 years after completing the primary course Give a single booster dose 5 years after completing the primary course * Bexsero is registered for use in those 6 weeks of age and older.
Resources
- National Immunisation Program: Meningococcal ACWY vaccines, key points and updates for 1 July 2024
- Better Health Channel: Meningococcal disease- immunisation
- Australian Immunisation Handbook: Meningococcal
- RCH Kids Health information: Meningococcal infection
- ATAGI clinical advice on changes to recommendations for meningococcal vaccines from 1 July 2020
- MVEC: Febrile seizures (febrile convulsions) and vaccines
- MVEC: Asplenia and hyposplenia
- NCIRS: Meningococcal vaccines GRADE assessments
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)
Date: December 2024
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.