What is Meningococcal Meningitis?
Meningococcal meningitis is an acute disease caused by one of 12 serogroups of Neisseria meningitides bacteria; it is characterised by the sudden onset of fever, intense headache, vomiting and neck stiffness. A skin rash appears in the later stages of the disease and signifies severe illness. Although the disease is treatable with antibiotics, sufferers may become very sick or even die within hours of onset if the condition is not diagnosed promptly and correctly. The disease is transmitted from person-to-person by respiratory droplets i.e. coughing, sneezing, kissing. Extensive travels in crowded conditions and prolonged contact with the local population in crowded places are risk factors.
Meningitis in Australia
In Australia and other developed nations meningitis mainly occurs in the form of serogroups B & C; however since the introduction of the MenC vaccine into the immunisation program, this strain is much less common in Australia.
The Conjugate C vaccine provides long-term immunity against this form of the disease and can be used in the standard childhood schedule to provide active immunisation of children from the age of 6 weeks, and in adolescents and adults.
Vaccines against serogroup B are available in Australia and may be provided as part of an immunisation program by some states; in others the vaccines are only available through the private market.
The federal government has plans to introduce an ACWY vaccination program for specific age groups (high school students).
Where is it found?
Meningococcal Meningitis occurs in all countries. In sub-Saharan Africa, epidemics of serogroup A meningococcal disease occur frequently during the dry season (December through June) particularly in the savannah areas extending from Mali eastward to Ethiopia, a region known as the ‘Meningitis Belt’. Epidemics due to serogroups A and/or C have also occurred in areas further south in Africa (Tanzania, Burundi, Angola) as well as in parts of Asia, in particular northern India, Nepal and Mongolia, again during the dry season (November to May). A complex range of risk factors cause epidemics.
Risk to travellers
The risk to travellers is generally low. Vaccination is recommended for travel to the 'Meningitis Belt' during the dry season, for travel to areas with an active epidemic, or for prolonged travel when extensive contact with the local population in endemic areas is expected.
NOTE - ACWY meningococcal meningitis vaccination is mandatory for travellers making the pilgrimage to Saudi Arabia for the Hajj or Umrah. Full details of the requirement are set each year by the Ministry of the Hajj in Saudi Arabia.
What is Meningococcal Meningitis Vaccination?
Travel & Domestic:
- Conjugate ACYW135 vaccine (Menactra/Menveo/Nimenrix)
- MenB - two types
- a. Recombinant multicomponent B vaccine (Bexsero - MenBV)
- b. Recombinant lipidated factor H binding protein meningococcal serogroup B vaccine (Trumenba - MenB-fHBP)
ACWY conjugate vaccines:
- Menactra: 9 mths to 55 years of age; Menveo: ≥2 months of age; Nimenrix 12 months to 55 years of age. Protection for 5+ years. (The Australian Technical Advisory Group on Immunisation (ATAGI) recommends extended suitability for some of the vaccines/age groups - see Australian Immunisation Handbook.)
Meningococcal B vaccines:
- Recombinant multicomponent B vaccine (Bexsero - MenBV) - Administration of paracetamol is advised when giving each dose of MenBV to children <2 years of age due to the increased risk of fever following vaccine administration.
- Aged 2 months to 5 months (for first dose): Three intramuscular doses administered 8 weeks apart & single booster at 12 months of age. ATAGI advises that the first dose can be given at 6 weeks of age.
- Aged 6 months to 11 months: Two intramuscular doses administered 8 weeks apart & single booster at 12 months or 8 weeks after last dose (if later).
- Aged 12 months and older: Two intramuscular doses administered 8 weeks apart. No booster required. (No data on administration to adults over 50 years of age but may be recommended if at high risk).
- Recombinant lipidated factor H binding protein meningococcal serogroup B vaccine (Trumenba - MenB-fHBP)
- Standard schedule for routine immunisation: 2 doses (0.5 ml each) administered at 0 and 6 months
- Schedule for individuals at increased risk of invasive meningococcal disease: 2 doses (0.5 ml each) administered at least 1 month apart, followed by a third dose at least 4 months after the second dose.
The choice of dosing schedule may depend on the risk of exposure and the patient’s susceptibility to meningococcal B disease.
Level of protection
- Meningococcal C conjugate vaccines:
Infants - Data indicates that immunity was achieved in 91% of infants after 1 dose and 98-100% of infants one month after the third dose. There are currently no recommendations for boosting.
Adults - 99-100% of adults have an adequate response after a single dose of vaccine.
- Meningococcal B vaccines
Bexsero: vaccine effectiveness after 2 doses given at 2 and 4 months of age was 82.9%.
Trumenba: vaccine effectiveness after 2 doses given at 0 and 6 months was 73.5% and 82–83% after 3 doses received at 0, 1 and 6 months, or 0, 2 and 6 months
- ACWY conjugate vaccine (Travel & Domestic):
Effective against serotypes A, C, Y, W135.
Contraindications: Should not be administered to individuals who have previously experienced a serious reaction to any of these vaccines or those who are known to be hypersensitive to any of the vaccines' components.
Possible Side Effects
Usually infrequent and mild:
- Common: Redness and swelling around the injection site.
- Less common: Feeling unwell, headache, fever, lethargy.
- Rare: Wheezing, rash, sever local reactions.
As with all vaccines, there is a small risk of allergic reaction.