Meningococcal disease and vaccines

Meningococcal disease is caused by the bacteria Neisseria meningitidis. There are 13 known sub-types and of these, 5 are currently vaccine preventable (B and A, C, W, Y).

In 2018, the main serotypes causing disease in Australia are B, W and Y, with variations noted by state. The increase in Meningococcal W disease has been clearly outlined and regularly updated by the Australian Department of Health (see references) Importantly, all of the meningococcal strains currently circulating in Australia are potentially vaccine preventable.

People with meningococcal disease can become extremely unwell very quickly. Invasive meningococcal disease (IMD) can cause meningitis (inflammation of the membrane covering the brain and spinal cord), septicaemia (infection in the blood) as well as other infections like pneumonia (lung infection), arthritis (inflammation of the joints) and conjunctivitis (eye infection). Mortality (death) can be as high as 5-10% and permanent lifelong complications can occur in 10-20% of those who survive. Disease is transmitted via respiratory droplets (sneezing and coughing etc.).

Prevention of Meningococcal infection

There are vaccines available for protection against Meningococcal B and Meningococcal ACWY.

Meningococcal ACWY

A four-in one combination vaccine is available for protection against meningococcal serogroups A, C, W and Y.

There are currently three quadrivalent conjugate vaccines (4vMenCV) available for immunisation against Meningococcal A, C, W and Y.

  • Nimenrix® (Pfizer) – For use from 6-weeks of age (see References)
  • Menveo® (GSK) – For use from 6-weeks of age
  • Menactra® (Sanofi) – For use from 9-months of age

A single dose of Nimenrix® is currently provided for free at 12-months of age on the National Immunisation Program (NIP).
Time-limited programs also exist on the Victorian immunisation schedule (ending December 31 2018) providing free Menactra® to Year 10 students and for all men who have sex with men (MSM).

A private script is required to purchase the Meningococcal A, C, W, Y vaccine if patients wish to be protected but do not meet the criteria on the NIP.

Table 1: Recommended MenACWY vaccine schedule (by brand) for healthy individuals, travellers and laboratory personnel

Vaccine Brand¥ Course commenced at 6 weeks < 8 months of age Course commenced at 9 to < 11 months of age Course commenced at 1 – 2 years of age Course commenced at ≥ 2 years of age
 Nimenrix® 2 doses (minimum 8 weeks apart) + 1 booster#Y 1 dose + 1 booster#Y 1 dose¤ 1 dose
 Menveo® 2 doses (minimum 8 weeks apart) + 1 booster# 1 dose + 1 booster# 2 doses (minimum 8 weeks apart) 1 dose
 Menactra® N/R* 1 dose + 1 booster# 2 doses (minimum 8 weeks apart) 1 dose

# Booster dose at ≥ 12 months of age/8 weeks since previous dose (whichever is later)
Y Nimenrix® is currently not registered for use in this age group in Australia, but studies have shown it to be immunogenic in this age group (see Resources)
N/R – not currently registered in Australia for use in the specified age group
¤ A single dose of Nimenrix® is funded on the NIP at 12-months of age
* There are no published clinical trials data on the use of Menactra® in infants younger than 9 months of age. Given that infants typically have weaker immune responses than toddlers and older children, the clinical effectiveness of Menactra® in young infants is not yet known. Therefore Menactra® is not recommended in this age group. MVEC preferentially recommend Nimenrix® or Menveo® (if available) in infants < 12-months
There is no registered upper age limit for use of Menveo®. Although both Menactra® and Nimenrix ® are registered for use of up to 55 years of age only, either brands can be given to people over 55 years of age, as per The Australian Immunisation Handbook
¥ Completing the course with the same vaccine brand is preferred but may not always be practical. The NIP funded Nimenrix® may be used as the 12-month booster dose for those who have commenced the course < 12-months of age.

Please note: There is a current shortage of Menveo® vaccine availability (See TGA Announcement). We recommend that Nimenrix® be used as the alternate brand for infants < 12-months of age. Studies have shown that Nimenrix® is safe and immunogenic in infants from 6-weeks of age (see resources). The use of Nimenrix® in this age group is also consistent with the approval for use given by regulatory bodies in Europe.

Meningococcal B

There are currently 2 vaccines available on the private market for the protection of Meningococcal B disease.

  • Bexsero® – For use from 6 weeks of age
  • Trumenba® – For use in ≥10 years of age

These vaccines can be administered at the same time as routine NIP vaccines (Refer to advice below on paracetamol in infants < 4-years)

Meningococcal B vaccines brands are not interchangeable.

Paracetamol advice

The RCH and Monash Immunisation services recommend the use of paracetamol with every dose of 4CMenB given to children < 4-years of age, to reduce the likelihood and severity of fever that may occur after immunisation with 4CMenB. The first dose of paracetamol (15 mg/kg per dose) should be given in the 30 minutes before vaccination, or as soon as possible after immunisation, even if children do not have a fever. This should be followed by 2 more doses of paracetamol given 4 to 6 hours apart.

Table 2: Recommended MenB vaccine schedule for healthy individuals, travellers and laboratory 

Vaccine Brand¥ Course commenced at age 6 weeks to ≤ 5 months Course commenced at 6 months to ≤ 11 months Course commenced at 12 months to ≤ 9 years of age Course commenced at ≥ 10 years of age
Bexsero®#

3 doses (minimum 8 weeks apart) + 1 booster dose 

Booster dose at ≥ 12 months of age/8 weeks since previous dose (whichever is later)

2 doses (minimum 8 weeks apart) + 1 booster dose 

Booster dose at ≥ 12 months of age/8 weeks since previous dose (whichever is later)

2 doses (minimum 8 weeks apart) 2 doses (minimum 8 weeks apart)
Trumenba® N/R N/R N/R 2 doses (6 months apart)

N/R- Not recommended in this age group
#Paracetamol recommended to those < 4 years of age (refer to advice above)
¥Meningococcal B vaccines brands are not interchangeable 

Special risk groups

Certain medical conditions and taking some medications can pre-dispose individuals to Meningococcal disease. The list below outlines examples of patient groups who would be considered high risk.

  • Complement deficiency (including factor H, factor D or properdin deficiency)
  • HIV
  • Asplenia
  • HSCT
  • Eculizumab (anti-C5 antibody: eg- HUS)

These patients are recommended to receive protection against Meningococal B and A, C, W, and Y based on the schedule below.

Table 3: Recommended Meningococcal vaccine schedule for immune compromised individuals

Vaccine Brand(s) Age < 12 months Age > 12 months
Meningococcal B# Bexsero®¥ Refer to courses outlined above for specific brand and age group advice 2 doses (minimum 8 weeks apart)
Trumenba®* N/R

3 dose course (0, 2 and 6 months) 

[Only for use in ≥ 10 years of age]

Meningococcal A, C, W, Y conjugate Nimenrix, Menveo, Menactra Refer to courses outlined above for specific brand and age group advice 2 doses (minimum 8 weeks apart)

*Trumenba only licensed for use in > 10 years of age (Refer to above Meningococcal B table)
#Meningococcal B brands are not interchangeable
¥Refer to paracetamol advice in those < 4 years of age
N/R- Not recommended in this age group
† There is no registered upper age limit for use of Menveo®. Although both Menactra® and Nimenrix ® are registered for use of up to 55 years of age only, either brands can be give to people over 55 years of age, as per The Australian Immunisation Handbook

Resources

Reviewed by: Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute), Georgie Lewis (Clinical Manager, SAEFVIC, Murdoch Children’s Research Institute) and Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Date: July 2018

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.