Meningococcal disease

About meningococcal disease

Meningococcal disease is caused by meningococcal bacteria, also known as Neisseria meningitidis or meningococcus.

Some people (around 10 per cent of the population) have meningococcal bacteria living naturally in their nose and throat. These people are known as ‘carriers’. In a small number of people, a dangerous strain of the bacteria can become invasive and move through the lining of the throat, causing meningococcal disease (or 'invasive meningococcal disease').

Meningococcal disease usually takes the form of a blood infection (septicaemia) or an infection of the membranes covering the brain and spinal cord (meningitis). Other less common forms can include lung infection (pneumonia), joint infection (arthritis), infection of part of the windpipe (epiglottitis), infection of the heart sac (pericarditis), infection of part of the urinary tract (urethritis), and infection of part of the eye (conjunctivitis).

People with meningococcal disease can become unwNurseell very quickly. If infection is diagnosed early enough and the right antibiotics are given quickly, most people make a complete recovery. Even with antibiotic treatment, invasive meningococcal disease causes death in about 5 to 10 per cent of cases.

Most cases occur suddenly and are unrelated to any other cases. Outbreaks where more than one person is affected are rare. Although everyone is a carrier at some time, carriers are most common among young adults and people who smoke.

There are 13 different strains, or serogroups, of meningococcal bacteria designated by different letters of the alphabet. Meningococcal vaccines are available to protect against the common disease-causing strains such as serogroups A, B, C, W and Y. These vaccines are provided through the National Immunisation Program (NIP) for people at increased risk of meningococcal disease.

Symptoms of meningococcal disease

Meningococcal disease (septicaemia or meningitis) causes a range of symptoms. If you or your child have any symptoms of meningococcal disease, seek urgent medical attention as soon as possible - contact your doctor immediately, call triple zero (000) for an ambulance or go to the nearest hospital emergency department.

Meningococcal disease in the form of septicaemia or meningitis can cause a range of symptoms such as:

• fever
• feeling generally unwell or tired
• joint or muscle pain
• headache
• neck stiffness
• dislike of bright lights (photophobia)
• nausea and vomiting
• reduced appetite
• diarrhoea
• a rash of red or purple pinprick spots or larger bruises
• cold hands and feet
• drowsiness
• confusion
• reduced consciousness.

Infants and young children can also have less specific symptoms such as:

• being irritable or unsettled
• refusal to eat
• difficulty waking
• tiredness or floppiness
• high pitched crying
• grunting or moaning
• pale or blotchy skin
• fits (convulsions).

Not all symptoms may be present at once.

The characteristic rash of red or purple pinprick spots can appear anywhere on the body and usually does not disappear with gentle pressure. Not all people with meningococcal disease get the rash.

Complications of meningococcal disease

About 1 in 5 people who recover from meningococcal disease have serious long term health problems such as:

• hearing loss
• difficulties with vision
• skin scarring or limb amputation
• limb weakness
• seizures
• intellectual or behavioural disabilities
• permanent brain damage.

Spread of meningococcal bacteria

Meningococcal bacteria are only found in humans and are not easily spread as the bacteria do not survive well outside the human body.

The bacteria are usually spread from person-to-person through close, prolonged or intimate contact with infected secretions from the back of the nose and throat, such as between household members or intimate partners. Some people carry the bacteria in the nose and throat without developing illness and can spread it to others.

Meningococcal bacteria are not easily spread by sharing drinks, food or cigarettes.

Meningococcal disease can occur all year round, but it is more common during winter and early spring.

People at risk of meningococcal disease

Meningococcal disease can affect anyone. However, certain groups are at higher risk:

• infants and young children, particularly those aged less than 5 years
• adolescents and young adults, particularly those aged 15 to 24 years
• people who are not vaccinated against meningococcal disease
• people who smoke
• people with recent respiratory tract infections
• people without a working spleen or with a weakened immune system
• close contacts of someone with meningococcal disease, such as household members and intimate partners
• travellers to countries with high rates of meningococcal disease
• laboratory workers who may handle meningococcal bacteria.

Speak to your doctor about recommended vaccines to protect against meningococcal disease if you are in one of these high-risk groups.

Prevention of meningococcal disease

Vaccination is the best protection against meningococcal disease. There are two vaccines available to protect against the common disease-causing strains of meningococcal bacteria:

• meningococcal ACWY vaccine protects against serogroups A, C, W and Y
• meningococcal B vaccine protects against serogroup B.

Routine childhood vaccines do not protect against all strains of meningococcal bacteria. All people should be alert for the symptoms of meningococcal disease, even if they have been vaccinated.

Meningococcal ACWY vaccination

Free meningococcal ACWY vaccine is available under the NIP for:

• children at 12 months
• adolescents at Year 10 (or age equivalent) through the secondary school-based vaccination program
• people with asplenia, hyposplenia, complement deficiency, or receiving treatment with eculizumab.

Free catch-up meningococcal ACWY vaccination is available under the NIP for young people under the age of 20 years.

Meningococcal B vaccination

Free meningococcal B vaccine is available under the NIP schedule for:

• Aboriginal and Torres Strait Islander children aged 2 months (from 6 weeks), 4 months, 6 months (certain medical conditions) and 12 months
• people with asplenia, hyposplenia or complement deficiency, or people receiving treatment with eculizumab.

Free catch-up meningococcal B vaccine is available under the NIP for Aboriginal and Torres Strait Islander children up to the age of 2 years.

Meningococcal ACWY and B vaccines are available for purchase by private prescription from your immunisation provider for anyone wishing to protect themselves or their family.

Meningococcal ACWY vaccine is required for pilgrims to the Hajj and strongly recommended for people travelling to regions where epidemics of meningococcal A,C, W and Y occur, such as sub-Saharan Africa.

Meningococcal vaccines are not routinely recommended if you are pregnant or breastfeeding. Contact your doctor to discuss your individual needs.

Refer to Meningococcal disease – immunisation for further details about meningococcal vaccines and recommendations for vaccination.

Diagnosis of meningococcal disease

Early diagnosis of invasive meningococcal disease is extremely important. Your doctor will take a medical history. If meningococcal disease is suspected, samples of blood and the fluid around the spinal cord (cerebrospinal fluid) are taken.

The samples are sent to a laboratory to be tested for the presence of meningococcal bacteria. Growing the bacteria confirms the diagnosis and will help to determine which type of bacteria is causing the infection.

Treatment of meningococcal disease

If meningococcal disease is suspected, an antibiotic (usually penicillin) is given immediately by injection. People with meningococcal disease are always admitted to hospital and may require admission to an intensive care unit.

The sooner people receive treatment, the less damage the disease may cause. It is important to remember that this is an unpredictable infection that can progress very rapidly, despite the best treatment.

Public health response for meningococcal disease

People with meningococcal disease

People with meningococcal disease are usually admitted to hospital for treatment and cared for under precautions until 24 hours after appropriate antibiotic treatment has been given.

Children with meningococcal disease must not go to school, childcare centres or kindergarten until they have completed antibiotic treatment to remove the meningococcal bacteria from the nose and throat.

People who have been exposed to meningococcal disease

Local public health units work with the doctor and patient or patient’s family to identify people who may have been exposed to meningococcal disease. These people are called contacts.

Most people, such as school and work friends who have had contact with an affected person, do not need antibiotics.

People who have had close, prolonged or intimate contact with someone with meningococcal disease 7 days before they became unwell may also be recommended to receive clearance antibiotics. These people may include:

• household members
• people in shared residential settings such as dormitories, boarding schools or military barracks
• intimate partners
• anyone who stayed overnight in the same house as the person with meningococcal disease
• children in a childcare facility who have spent at least 4 hours or more in the same room as the person with meningococcal disease.

Clearance antibiotics help remove the meningococcal bacteria from the nose and throat, and prevent it from spreading to other people.

All contacts should be aware of the symptoms of meningococcal disease and seek urgent medical care if symptoms occur.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• Local government immunisation service - Find your council
• Your nearest immunisation provider
• Maternal and Child Health Line (24 hours, 7 days) Tel. 13 22 29
• Nurse-on-call Tel. 1300 60 60 24 (24 hours, 7 days) - for expert health information and advice
• Immunisation Unit, Department of Health, Victorian Government Email: immunisation@health.vic.gov.au
• National Immunisation Information Line Tel. 1800 671 811
• Your local public health unit
• Your pharmacist