Meningococcal disease

Meningococcal disease is caused by the bacterium Neisseria meningitidis. At least 13 groups have been identified and of these groups A, B, C, X, Y and W (previously called W-135) are the most likely to cause disease in humans. Patterns of infection differ throughout the world. In New Zealand, group B is most likely to cause disease (around two-thirds of cases in 2016 and 2017, around just under half in 2018). In 2018, 120 meningococcal disease cases were reported. This was 2.5 cases of meningococcal disease for every 100,000 people in New Zealand. A closer look at regions shows that Northland had the highest rate of 7.4 cases for every 100,000 people in Northland. Whilst meningococcal disease rates remain relatively low and the disease is still rare in New Zealand, there has been an increase over the last three years.

Infants, children aged less than five years and adolescents have an increased risk of meningococcal disease. Māori, particularly infants aged less than one year, and Pacific peoples have a higher risk of meningococcal disease than other ethnic groups in New Zealand.

When you are assessing patients with influenza symptoms, be alert for meningococcal disease.

Symptoms of meningococcal disease

The initial symptoms are difficult to distinguish from other infectious illnesses, particularly flu-like illnesses. Symptoms usually progress quickly to a severe illness, often within 24 hours. 

  • Infants may have: a more gradual onset than adults, fever, cry, appear unsettled, feed poorly, vomit, be sleepy or hard to wake, dislike bright light, or have a rash or spots. They may have a bulging fontanelle.
  • Older children and adults may have: a fever, malaise, nausea, vomiting, muscle aches and pains, drowsiness, headache, dislike of bright light, neck stiffness, or have a rash or spots.
  • Individuals may also present with atypical symptoms, including gastrointestinal symptoms, pneumonia, septic arthritis, endocarditis, epiglottitis or supraglottitis.
  • Almost 80% of cases will develop a rash that does not blanch (become pale/go white) when pressed on. This type of rash is often a late sign of infection.

If you are not sure if it is meningococcal disease:

  • Advise parents/caregivers to check the sick person frequently (eg, every hour). The sick person should not remain on their own.
  • Make sure the case seeks immediate medical attention if they deteriorate.
  • Reassess the case within 6 hours.

Four meningococcal vaccines are available in New Zealand. BEXSERO® protects against group B only, NEISVAC-C® protects against group C only, MENACTRA® and NIMENRIX® protect against groups A, C, Y and W.

NEISVAC-C® and MENACTRA® are the two free meningococcal vaccines on the 'special groups' Immunisation Schedule for children and adults with a medical condition that increases their risk of meningococcal disease AND is listed on the Pharmaceutical Schedule. Doctors may recommend meningococcal immunisation for people with a medical condition that is not listed on the Pharmaceutical Schedule, but the vaccine will not be free. BEXSERO®, NEISVAC-C®, MENACTRA® and NIMENRIX® vaccines can be purchased from Healthcare Logistics for ineligible individuals.

For further information visit:

The Immunisation Advisory Centre

Meningococcal chapter in the current Immunisation Handbook

Medsafe

References

  • Harrison LH, Granoff DM, Pollard AJ. Meningococcal vaccines. In: Plotkin S, Orenstein W, Offit P, editors. Vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018. p. 619-43.
  • Lopez L, Sexton K. The epidemiology of meningococcal disease in New Zealand 2012. Wellington: Institute of Environmental Science and Research Ltd (ESR), 2013. 
  • Ministry of Health. Immunisation handbook 2017. Wellington:Ministry of Health; 2017.
  • Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet. 2007;369(9580):2196-210.
  • World Health Organization. The immunological basis for immunization series: Module 15: Meningococcal disease. Geneva: World Health Organization, 2010.
 

BEXSERO® (multicomponent meningococcal group B vaccine (recombinant, adsorbed)): Single dose 0.5 mL suspension for injection. Indications: for active immunisation against invasive disease caused by N. meningitidis group B strains in children from 2 months of age and older. Contraindications: Hypersensitivity to any component of the vaccine, or to a previous dose of Bexsero. Postpone if acute febrile illness. Precautions: In individuals with impaired immune responsiveness this vaccine may not induce protective antibody levels following vaccination.  Interactions: Inactivated vaccines and live vaccines, particularly those in the childhood schedule, can be given during the same visit but in different limbs. Adverse reactions: Fever is part of a robust immune system response to Bexsero. Similarly, redness, swelling and/or mild–moderate pain around the injection site are also common expected immune responses. The advice for the use of prophylactic paracetamol for children aged under 2 years only applies to immunisation events when Bexsero is administered, either as the only vaccine or with other vaccines. Dosage: Adults and children from 8 weeks of age: 0.5 mL. Administration: IM injection. Presentation: Single-dose 0.5 mL pre-filled glass syringe in packs of 1. Cold chain: Store between +2°C and +8°C. Protect from light. Sponsor: GlaxoSmithKline Limited.

NEISVAC-C® (meningococcal group C polysaccharide conjugate vaccine tetanus toxoid protein conjugate): Single-dose 0.5 mL pre-filled glass syringe. Indications: For the prevention of invasive disease caused by Neisseria meningitidis serogroup C in adults and children from 8 weeks of age. Contraindications: Hypersensitivity to any component of the vaccine, including tetanus toxoid, or to a previous dose of NeisVac-C. Postpone if acute febrile illness. Precautions: In individuals with impaired immune responsiveness this vaccine may not induce protective antibody levels following vaccination. Immunisation with this vaccine is not a substitute for routine tetanus immunisation. Interactions: Inactivated vaccines and live vaccines, particularly those in the childhood schedule, can be given during the same visit but in different limbs. Adverse reactions: Local reactions, decreased appetite, diarrhoea, vomiting, sore throat, restlessness, poor sleep, somnolence, headache, rash. Dosage: Adults and children from 8 weeks of age: 0.5 mL. Administration: IM injection. Presentation: Single-dose 0.5 mL pre-filled glass syringe in packs of 1. Cold chain: Store between +2°C and +8°C. Sponsor: Pfizer New Zealand Limited.

MENACTRA® (meningococcal groups A, C, Y and W-135 polysaccharide diphtheria toxoid conjugate vaccine): Single-dose 0.5 mL pre-filled glass syringe. Indications: For the prevention of invasive disease caused by Neisseria meningitidis serogroups A, C, Y and W-135 in adults aged 55 years or younger and children from 9 months of age. Contraindications: Hypersensitivity to any component of the vaccine, including diphtheria toxoid, or to a previous dose of a similar vaccine. Postpone if acute febrile illness. Precautions: If the vaccine is used in individuals under immunosuppressive therapy, the expected immune response may not be obtained. Interactions: Menactra can be given with tetanus, diphtheria, measles, mumps, rubella, varicella and typhoid vaccines. Separate injection sites should be used in case of concomitant administration. Adverse reactions: Local reactions, decreased appetite, diarrhoea, vomiting, abnormal crying, irritability, fatigue/malaise, drowsiness, headache, joint pain. Dosage: Adults aged 55 years or younger and children from 8 weeks of age: 0.5 mL. Administration: IM injection. Presentation: Single-dose 0.5 mL vial in packs of 1. Cold chain: Store between +2°C and +8°C. Protect from light. Sponsor: Sanofi-Aventis New Zealand Pty. Ltd.

NIMENRIX® (meningococcal polysaccharide groups A, C, Y and W-135 conjugate vaccine): Single-dose glass vial with 0.5 mL solvent in a pre-filled glass syringe. Indications: For the prevention of invasive disease caused by Neisseria meningitidis serogroups A, C, Y and W-135 in adults aged 55 years or younger and children from 12 months of age. Contraindications: Hypersensitivity to any component of the vaccine. Precautions: Postpone if acute febrile illness. Syncope (fainting) can occur following, or even before, any vaccination as a psychogenic response to the needle injection. If the vaccine is used in individuals under immunosuppressive therapy, the expected immune response may not be obtained. Interactions: Nimenrix can be given with tetanus, diphtheria, pertussis, hepatitis B, hepatitis A, 10-valent or 13-valent pneumococcal conjugate, influenza, measles, mumps, rubella and varicella vaccines. If Nimenrix is to be given at the same time as another injectable vaccine, the vaccines should always be administered at different injection sites. Adverse reactions: Local reactions, decreased appetite, gastrointestinal symptoms, irritability, fatigue, drowsiness, headache. Dosage: Adults aged 55 years or younger and children from 12 months of age: 0.5 mL. Administration: IM injection. Presentation: Single-dose glass vial with solvent in a pre-filled glass syringe in packs of 1. Cold chain: Store between +2°C and +8°C. Store in the original packaging to protect from light. Sponsor: Pfizer New Zealand Limited.