This MVEC guideline details our recommendations regarding meningococcal vaccines in those who are considered at higher risk of invasive meningococcal disease (IMD) either due to an underlying medical condition or due to immunosuppressive medication.

In 2018, Meningococcal W and Meningococcal B are still the most commonly circulating sub-types of Meningococcal disease in Australia. There are vaccines available to protect against Meningococcal A, B, C, W and Y. From July 1 2018 Nimenrix® (Meningococcal ACWY) was added onto the National Immunisation Program (NIP) for administration at 12-months of age.

Menactra® (Meningococcal ACWY) is currently funded (time limited program ending December 31 2018) on the Victorian immunisation schedule in the school program for Year 10 students. In April 2019, Meningococcal ACWY vaccines will be on the National Immunisation Program for all adolescents aged 15-19 years.

In Victoria, Meningococcal B vaccine is currently only available for private purchase on a script.

A list of common immune suppressive medications resulting in a patient being at higher risk of IMD can be found in Table 1. Medical conditions such as asplenia, complement deficiency, Eculizumab (anti C5) therapy and HIV are medical conditions which would predispose individuals to IMD.

We recommend administration of both vaccines from 6-weeks of age, or at the time of diagnosis/ commencement of immunosuppressive therapies (see Tables 2 and 3). Immunisation status should be reassessed regularly and as part of the transition to an adult facility, with booster doses to be considered every 5 years.

At the Royal Children’s Hospital, Melbourne these meningococcal vaccines have Drug Utilisation Committee (DUC) approval and funding. There is a pharmaceutical (PBS) fee for these vaccines, which is reduced if the child has a healthcare card.

Table 1: Immunosuppressive medications

Mechanism of action Examples*
Anti-TNF Etanercept Infliximab Adalimumab
IL-1 inhibition Anakinra
Costimulation blockade Abatacept
B-cell depletion/inhibition Rituximab
Immunomodulators (antimetabolites) Azathioprine  6-Mercaptopurine  Methotrexate
Corticosteroids Prednisone
T-cell activation/inhibition Tacrolimus Cyclosporine

*NB: prednisolone doses considered immunosuppressive is > 2mg/kg (or 20mg) for 2-weeks, or 1mg/kg for > 1-month

Table 2: Nimenrix® (Meningococcal ACWY)^

Age at commencement of vaccine course Primary immunisation course Booster dose Adolescent doses

6-weeks to ≤ 5-months

 

3 doses (minimum 8 weeks apart) + 1 booster*#

 

 

5 years following completion of initial course

Even if the primary course has been completed adolescence is a time of increased risk of IMD.

MVEC recommend a booster dose of Nimenrix at 13 years and 18 years of age

6-months to ≤ 11-months

2 doses + 1 booster*#

≥ 12-months

2 doses*# (minimum 8 weeks part)

*Booster dose at ≥ 12 months of age/8 weeks since previous dose (whichever is later)
# A single dose of Nimenrix® is funded on the NIP at 12-months of age
^Note the meningococcal ACWY vaccines are not equivalent- MVEC preferentially recommends Nimenrix® brand

Table 3: Bexsero® (Meningococcal B)^

Age at commencement of vaccine course Primary immunisation course Booster dose Adolescent doses

6-weeks to ≤ 5-months

 

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

 

 

5 years following completion of initial course

Even if the primary course has been completed, adolescence is a time of increased risk of IMD.

MVEC recommend a booster dose of Bexsero® at 13 years and 18 years of age

6-months to ≤ 11-months

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

≥ 12-months

2 doses* (minimum 8 weeks apart)

*Booster dose at ≥ 12 months of age/8 weeks since previous dose (whichever is later)
^ Refer to MVEC: Meningococcal disease and vaccines for advice on Bexsero® and paracetamol administration 
NB: meningococcal B vaccines are not equivalent or interchangeable- MVEC preferentially recommends Bexsero® brand

Resources

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

Date: October 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.