Meningococcal disease is any infection caused by bacteria called Neisseria meningitidis (also known as meningococcal bacteria). Although meningococcal disease is uncommon, it is very serious. About 10 per cent of the population carry meningococcal bacteria in their throat without becoming unwell. These people are known as ‘carriers’.
Invasive meningococcal disease occurs when these bacteria, which usually live in the throat, enter the blood stream to cause septicaemia (infection in the blood, also known as ‘bacteremia’) or meningitis, (inflammation of the membrane covering of the brain). Occasionally, severe infection can also occur in the joints, throat, lungs or intestines.
There are different strains (serogroups) of meningococcal bacteria designated by letters of the alphabet, including meningococcal serogroups A, B, C, W and Y. The strains that are most common in the population fluctuate over time. Serogroup W is currently the most common strain causing cases of invasive meningococcal disease in Victoria.
In recent years the prevalence of the meningococcal W strain – one of the main meningococcal strains – has increased significantly across Australia, with Victoria experiencing 48 cases in 2016, compared to 17 cases in 2015, four in 2014 and just one in 2013.
Meningococcal bacteria are passed from person to person by close, prolonged household and intimate contact. In a small number of people, the bacteria can enter the bloodstream and cause invasive meningococcal disease, which can develop very quickly and causes death in about five to 10 per cent of cases.
The meningococcal C vaccine provides good protection against serogroup C strains. The number of cases caused by the C serogroup bacteria has decreased following the introduction of the serogroup C meningococcal immunisation program in Australia in 2003. A meningococcal serogroup B vaccine that protects against about 76 per cent of serogroup B meningococcal strains is available to purchase on prescription. Children aged less than five years, particularly infants aged less than two years, have the highest numbers of meningococcal disease caused by meningococcal B strains. Another smaller peak in numbers occurs in late adolescence and early adulthood.
In Victoria a free school-based meningococcal ACWY vaccination program commenced in term 2 of the 2017 school year for students in Years 10,11 and 12 or age equivalent (15 to 19 years old) and ceases on 31 December 2017.
The four-in-one combined vaccine against meningococcal serogroups A, C, W, and Y is also available for people to purchase on private prescription who wish to protect themselves and their family from disease.
People at high risk include:
- •travellers to countries where epidemics of meningococcal disease occur
- people with poor functioning or no spleen
- people who have a complement component disorder (a rare immune deficiency disorder).
Immunisation against meningococcal disease
Immunisation against meningococcal bacteria is the best protection against meningococcal disease. It is important to know that even if you have had meningococcal disease, you may not develop lifelong immunity and are still advised to be immunised against this life-threatening disease.
Immunisation against meningococcal serogroup C disease is available for free in Victoria as part of the National Immunisation Program schedule for:
- children at 12 months – immunisation against meningococcal serogroup C is given in combination with the booster dose of vaccine against Haemophilus influenza type b (Hib)
- children from 13 months up to and including 19 years, to catch up.
In response to the recent increase in disease caused by meningococcal serogroup W Victoria commenced a free school-based meningococcal ACWY vaccination program in term 2 of the 2017 school year until 31 December 2017, for students in Years 10,11 and 12 or age equivalent (15 to 19 years of age). All young people who are not able to access the free vaccine through the secondary school vaccination program and are aged 15 to19 years between 18 April 2017 and 31 December 2017 can attend a GP for the vaccine. (Note that your GP may charge a consultation fee.)
This age group was chosen based on the recommendation of national immunisation experts as older adolescents are at increased risk of meningococcal disease and more likely to spread the disease to others.
Immunisation against meningococcal serogroup B disease is available on private prescription, but is not available free under the National Immunisation Program schedule. This vaccine is recommended for high risk groups, including:
- infants and young children, particularly those aged less than two years
- adolescents aged 15 to 19 years
- children and adults with medical conditions that place them at a high risk of meningococcal disease, such as a poor functioning or no spleen, a complement component disorder or a haematopoietic stem cell transplant
- laboratory personnel who frequently handle meningococcal bacteria.
Meningococcal serogroup B vaccine commonly causes fever in children younger than two years of age and skin reactions at the injection site. Paracetamol is recommended 30 minutes before or as soon as practicable after meningococcal B vaccine for children younger than two years of age. Two further doses of paracetamol are recommended six hours apart, regardless of whether fever is present.
Immunisation against meningococcal serogroups A, C, W and Y is available in a four-in one combined vaccine for purchase by anyone wishing to protect themselves or their family. It is recommended for high risk groups including:
- travellers to countries where epidemics of meningococcal disease occur
- people with poor functioning or no spleen, a complement component disorder or a haematopoietic stem cell transplant
- laboratory personnel who frequently handle meningococcal bacteria.
Speak to your doctor about which vaccine you should have (and how long protection will last) if you are in one of these high-risk groups, including:
- people who have close household contact with those who have meningococcal disease and who have not been immunised
- people who are travelling to places, such as Africa, that have epidemics caused by serogroups A, C, W and Y
- pilgrims to the annual Hajj in Saudi Arabia – Saudi Arabian authorities require a valid certificate of vaccination to enter the country
- people who work in a laboratory and who handle the meningococcal bacteria
- children aged from six weeks and over, and adults who have high-risk conditions, such as a poor functioning or no spleen, a complement component disorder or a haematopoietic stem cell transplant.
Pregnancy and meningococcal disease immunisation
Meningococcal vaccines are not usually recommended for women who are pregnant, but they might be given if your doctor thinks your situation puts you at risk of the disease.
Meningococcal pre-immunisation checklist
Before immunisation, tell your doctor or nurse if you (or your child):
- are unwell on the day of immunisation (have temperature over 38.5 °C)
- have ever had a serious reaction to any vaccine
- have had a serious reaction to any component of the vaccine
- have had a severe allergy to anything
- are pregnant.
Side effects of the meningococcal vaccines
Vaccines against meningococcal bacteria are effective and safe, although all medications can have unwanted side effects.
Side effects from these vaccines are uncommon and are usually mild, but may include:
- localised pain, redness and swelling at the injection site
- occasionally, an injection-site lump that may last many weeks, but treatment is not needed
- low-grade temperature (fever)
- children can be unsettled, irritable, may cry, or be generally unhappy, drowsy and tired
- meningococcal B vaccine commonly causes fever, localised pain, redness and swelling at the injection site
- Fever and high fever is common in children aged two to 12 months when meningococcal B vaccine is given (see below).
Managing fever after meningococcal immunisation
Common side effects following immunisation are usually mild and temporary (occurring in the first few days after immunisation). Specific treatment is not usually required.
There are a number of treatment options that can reduce the side effects of the vaccine, including:
- drinking extra fluids and not overdressing if there is a fever
- although routine use of paracetamol after vaccination is not recommended (meningococcal B vaccine is the exception), if fever is present, paracetamol can be given – check the label for the correct dose or speak with your pharmacist, (especially when giving paracetamol to children).
Fever is common in children aged two to 12 months when meningococcal B vaccine is given on the same day with other vaccines commonly given to infants, compared to when meningococcal B and other routine vaccines are given on separate days.
It is recommended to use paracetamol with every dose of meningococcal B vaccine administered to children less than two years of age, to reduce the chance and severity of fever that may develop following immunisation with meningococcal B vaccine.
The first dose of paracetamol (15 mg/kg per dose) is recommended 30 minutes before immunisation. This should be followed by two more doses of paracetamol given six hours apart, regardless of whether fever is present.
Managing injection site discomfort
Many vaccine injections may result in soreness, redness, itching, swelling or burning at the injection site for one to two days. Paracetamol might be required to ease the discomfort.
Concerns about immunisation side effects
If a side effect following immunisation is unexpected, persistent or severe, or if you are worried about yourself or your child’s condition after an immunisation, see your doctor or immunisation nurse as soon as possible or go directly to a hospital. Immunisation side effects may be reported to SAEFVIC, the Victorian vaccine safety and central reporting service on Tel. 1300 882 924 #1.
You can discuss with your immunisation provider how to report adverse events in other states or territories. It is also important to seek medical advice if you (or your child) are unwell, as this may be due to other illness rather than because of the vaccination.
Rare side effects of meningococcal immunisation
There is a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine. This is why you are advised to stay at the clinic or medical surgery for at least 15 minutes following immunisation in case further treatment is required. If any other reactions are severe and persistent, or if you are worried, contact your doctor for further information.
Immunisation and HALO
The immunisations you may need are decided by your health, age, lifestyle and occupation. Together, these factors are referred to as HALO.
Talk to your doctor or immunisation provider if you think you or someone in your care has health, age, lifestyle or occupation factors that could mean immunisation is necessary. You can check your immunisation HALO using the Immunisation for Life downloadable poster (pdf).
Where to get help