Meningococcal Disease and Vaccination

Meningitis, it’s a word that strikes fear into most people’s hearts. Although it is a rare illness, it’s consequences can be catastrophic, and even with appropriate antibiotic care, up to 10% of cases are fatal. Most people will make a complete recovery, although up to 25% of survivors may be left with serious long term complications.

Meningococci are common bacteria. About 10% of the population is carrying them in the nose or throat at any one time. Carriers tend to be young adults rather than young children, or older people. There is no way of knowing when someone becomes a carrier, and the bacteria will be cleared naturally after a few weeks or months.

The age group most at risk of developing invasive meningococcal disease are babies and children under the age of five, and also 15 – 24 year olds, but it is important to remember anyone of any age can catch it. It is not easily spread from person to person; the bacteria cannot survive well outside the human body. Most cases are unrelated to others, but it can be passed on to close household contacts, or by passionate kissing. Peak months for invasive meningococcal disease are August and September. 

What are the symptoms?

The symptoms of meningococcal disease include:
In infants and young children:

  • fever
  • disinterest in feeding
  • irritability
  • extreme tiredness or floppiness
  • dislike of being handled
  • vomiting and/or diarrhoea
  • turning away from light
  • drowsiness
  • convulsions or twitching
  • rash of red-purple pinprick spots or larger bruises

In older children and adults:

  • headache
  • photophobia (dislike of bright lights)
  • fever
  • vomiting and/or diarrhoea
  • neck stiffness and/or aching
  • backache
  • joint pains and sore muscles
  • general malaise/off food
  • drowsiness/confusion
  • rash of red-purple pinprick spots or larger bruises

Signs and symptoms can appear very quickly and people with meningococcal can get much worse within a few hours.
If somebody close to you has some of these signs, and appears to you to be much sicker than usual, seek medical help immediately.

Different types of meningococcal bacteria

There are different sub-groups of meningococcal bacteria , types A, B, C, W and Y. The prevalence of these strains fluctuates over time,
The incidence of Men C has become very rare (currently 1.2% of cases) since the introduction of the vaccine to the National Immunisation Programme in 2003.
In recent years Men W and Y have become the more common strains causing invasive meningococcal disease. This is happening overseas also.

Vaccinations.

It is important to know, all of the meningococcal strains currently circulating Australia are potentially preventable with a vaccine.
It is a complicated subject, and there have been some significant changes this year

Meningococcal C

Immunisation against Men C has been on the National Immunisation Program for infants aged 12 months of age,  since 2003. This has been a very successful programme and has kept the numbers of Men C disease at a very low level. This  was recently replaced with the  Men A C W Y to cover more strains of the disease.

Meningococcal A C W Y

This is a new addition to the National Immunisation programme, introduced for adolescents last year, and to babies 12 months of age, this year.

Men W causes a more severe illness, in higher numbers, than any other strain currently. Without intervention, it is predicted cases will continue to rise. Some of the highest rates of carriers and illness are among adolescents and young adults. Initial action is targeting this group, with immunisation experts believing this will also reduce transmission to other groups, including young children.

In 2018 a single dose of ACWY vaccine is being offered to all students in years 10 and 11. Those who miss out will be able to be vaccinated at their GP. This is similar to a large scale program that has been running in the UK since 2015, and in the US since 2005.

Men ACWY (Nimenrix) is now offered to children at 12 months. Nimenrix has very good safety data, offering good protection and minimal side effects.

The Men A C W Y is also suggested for those with weak immune systems, or those travelling to Sub-Saharan Africa. Please talk to your GP or immunisation provider if you feel you may need it.

Meningococcal B Vaccine

Immunisation against Men B (commonly a vaccine called Bexsero) is available on private prescription and is recommended for:

  • infants and young children, especially those under 2 years old
  • adolescents aged 15-19
  • children and adults with certain conditions affecting their immune system (such as HIV, poorly functioning spleen, complement component disorder)

Men B has not become part of the government funded vaccination program, the illness caused by the current Men B strain is not as aggressive as others, and even with no widespread immunisation, the number of Men B cases in Australia are falling.
It is recommended to give paracetamol with every dose of Men B vaccine as it is known to cause high fever. The first dose should be given 30 minutes before, with two more doses given 6 hours apart.

Talk to your doctor about your needs

The immunisations you need are determined by your health, age, lifestyle and occupation. Please talk to your doctor or immunisation provider if you are not sure if you, or someone in your care, needs immunisation.

About the author

1
Dr Samantha Pethen BM FRACGP
Dr Pethen arrived in Australia in 2008 having worked on the South Coast of the UK since 1996. She has been with this practice ever since. She is passionate about the art of General Practice as a whole, but particularly enjoys paediatrics, adolescent medicine and chronic disease management.

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