- Meningococcal infection most commonly leads to meningitis or septicaemia. It can also cause pneumonia, myocarditis, endocarditis, pericarditis, conjunctivitis and cervicitis.
- Serotype C's contribution has fallen since the introduction of childhood vaccination against the disease.
- Serogroup A causes the majority of epidemic meningococcal infection in the African meningitis belt.
- Incidence of meningococcal disease is highest in the under-1s, followed by 1 to 5 year-olds with a second peak of risk occurring in 15 to 19 year-olds (particularly in those living in crowded or closed communities - eg, barracks and student halls).
- Although meningococcal disease occurs more commonly in young children, the mortality rate amongst young adults is higher.
- A conjugate vaccination - meningococcal group C (MenC) - has been adopted in the UK's routine immunisation schedule since November 1999, having demonstrated protective immunity in children aged under 2.
- MenC only confers protection against meningococcal C and not the other serogroups.
- Polysaccharide vaccines are less effective at protecting this age group, due to their immature response to this source of antigen.
- Providing early immunity is important since pre-school children are particularly vulnerable to infection from encapsulated bacteria.
- In addition to direct immunity, MenC has also been shown to have a significant protective effect on herd immunity.
- Conjugate vaccines are expensive which can preclude their use in developing countries.
- There is a vaccine against serotype B, although it is not available in the UK. B-polysaccharide is similar structurally to human neural surface antigens and improving its immunogenicity risks autoantibody induction.
- Meningococcal group C (MenC) conjugate vaccine. There is also a Haemophilus influenzae type b/meningococcal group C (Hib/MenC) conjugate vaccine.
- Quadrivalent (ACW135Y) polysaccharide vaccine (ACWY Vax®). This is an older vaccine and is not recommended for children.
- Quadrivalent (ACW135Y) conjugate vaccine (Menveo®). This is a newer vaccine.
- If a quadrivalent vaccine is to be used, then the Department of Health currently recommends the conjugate vaccine be used in preference to the polysaccharide vaccine because it provides better and longer-lasting protection. Children aged under 5 should always be vaccinated with Menveo® when a quadrivalent vaccine is needed. For babies under 1 year of age, two doses one month apart are needed for protection, but older children and adults should receive a single dose.
- Childhood immunisation (see also separate article Immunisation Schedule UK):
- Meningococcal group C (MenC) conjugate vaccine is part of the primary course of childhood immunisation with a dose at 3 months of age, the combined Hib and MenC conjugate vaccine given between 12 and 13 months and a booster at around 14 years.
- The Hib/MenC vaccine can be given at the same time as the pneumococcal conjugate and MMR vaccines, by separate injections.
- Those aged over 12 months, but under 10 years not previously vaccinated, should receive one dose of either MenC or Hib/MenC if required. Children over 10 years, who have not been previously vaccinated, may receive the booster early.
- Those aged 10-25 years who have never been vaccinated, should receive a single dose of MenC vaccine. If they have received a booster after age 10, no further doses are required. If they were last vaccinated at less than 10 years, the booster dose should be given.
- Asplenia, splenic dysfunction, immunosuppression or complement deficiency:
- MenC and MenACW135Y conjugate vaccine are recommended for patients with asplenia, splenic dysfunction, immunosuppression or complement deficiency.
- Children aged under 1 year should be vaccinated according to the immunisation schedule. A dose of MenACWY conjugated vaccine should be given at least one month after the Hib/MenC vaccine.
- Children over 1 year old should be given a Hib/MenC vaccine and the MenACWY conjugated vaccine one month later.
- Travel immunisation:
- Large epidemics of meningococcal disease have been linked to the Hajj pilgrimage. Current recommendations are that the quadrivalent ACWY vaccination is a compulsory entry requirement into Saudi Arabia for pilgrims on Hajj and Umrah, and for other travellers in Hajj season. Vaccination is also recommended for travel to sub-Saharan Africa and certain other countries, especially if travellers will be living or working with local people or visiting during an outbreak.
- If the person has recently received MenC, an interval of at least two weeks should ideally be allowed before administration of the MenACWY vaccine.
- The risk for meningococcal meningitis is extremely low for tourists but higher for those living or working within local areas in endemic or outbreak areas.
- Contacts of infected individuals:
- Follow the advice of the local Health Protection Team.
- Previously unimmunised family members and very close contacts of individuals with confirmed meningococcal C disease should be offered MenC conjugate vaccination.
- Close contacts of any age who were only immunised in infancy and those who completed the recommended immunisation course (including the 12-month booster) more than one year before should be offered an extra dose of MenC conjugate vaccine.
- Chemoprophylaxis (usually with rifampicin) should also be offered without delay.
- For confirmed serogroup A, W135 or Y infections, vaccination with a quadrivalent conjugate vaccine (Menveo®) should be offered to all close contacts of any age (two doses one month apart if aged under one year; one dose in older individuals).
- Laboratory workers handling Neisseria meningitidis should also receive vaccination.
- Acute febrile illness does not preclude vaccination.
- In pregnancy there is no evidence that either vaccine is unsafe but the usual advice is to avoid unless the mother is at high risk of disease.
- The vaccines are safe to give women who are breast-feeding.
- Individuals with a previous hypersensitivity reaction to any component of the vaccine including meningococcal polysaccharide, diphtheria toxoid or the CRM197 carrier protein or tetanus toxoid should not receive vaccination.
For MenC conjugate vaccine:
- Pain, tenderness, swelling or redness at the injection site and mild fevers are common in all age groups.
- In infants and toddlers - crying, irritability, drowsiness, impaired sleep, reduced eating, diarrhoea and vomiting can be common.
- In older children and adults - headaches, myalgia and drowsiness may occur.
- Neurological reactions such as dizziness, febrile/afebrile seizures, faints, numbness and hypotonia following MenC conjugate vaccination are very rare.
For Hib/MenC conjugate vaccine:
- Mild side-effects, such as irritability, loss of appetite, pain, swelling or redness at the site of the injection and slightly raised temperature, commonly occur.
- Crying, diarrhoea, vomiting, atopic dermatitis, malaise and fever over 39.5°C are rare side-effects.
For quadrivalent (ACW135Y) conjugate vaccine:
- Very common or common reported reactions have included injection site reactions including pain, erythema, induration and pruritus.
- Other very common or common reactions may include headache, nausea, rash and malaise.
Giving the vaccines
- Store vaccine at 2-8°C. Do not freeze vaccine or diluent.
- Giving the injection intramuscularly (IM) in the upper arm or anterolateral thigh is recommended.
- A deep subcutaneous route is advised for patients with thrombocytopenia or haemophilia.
- Immunisation with MenACWY should be at least 2-3 weeks prior to travel.
- Booster intervals:
- Children over 1 year of age, who have previously received one, two or three doses of Menveo® as infants, should be given an additional dose of Menveo® if they are travelling to an area that puts them at risk from meningococcal infection.
- The meningococcal ACWY conjugate vaccine is likely to provide longer-lasting protection than the polysaccharide vaccine. However, the need for, and the timing of, a booster dose of Menveo® has not yet been determined.
- Seek urgent medical advice if the patient becomes short of breath, has swelling of the mouth or throat or has a rash within a few days of immunisation.
- Parents should give a dose of paracetamol or ibuprofen if their child develops a fever post-immunisation, keeping the child cool and seeking medical advice if the fever persists after a second dose.
- Travel immunisation for meningococcal meningitis is not routinely available on the NHS and payment is at the discretion of the practice.
Further reading & references
- Immunisation against infectious disease - the Green Book; Dept of Health (latest edition)
- Segal S, Pollard AJ; Vaccines against bacterial meningitis.; Br Med Bull. 2005 Mar 31;72:65-81. Print 2004.
- Makwana N, Riordan FA; Bacterial meningitis: the impact of vaccination. CNS Drugs. 2007;21(5):355-66.
- Ramsay ME, Andrews NJ, Trotter CL, et al; Herd immunity from meningococcal serogroup C conjugate vaccination in England: database analysis. BMJ. 2003 Feb 15;326(7385):365-6.
- Pichichero M, Casey J, Blatter M, et al; Comparative trial of the safety and immunogenicity of quadrivalent (A, C, Y, W-135) meningococcal polysaccharide-diphtheria conjugate vaccine versus quadrivalent polysaccharide vaccine in two- to ten-year-old children. Pediatr Infect Dis J. 2005 Jan;24(1):57-62.
- Prasad K, Karlupia N; Prevention of bacterial meningitis: An overview of Cochrane systematic reviews. Respir Med. 2007 Oct;101(10):2037-43. Epub 2007 Aug 13.
- Cooper B, DeTora L, Stoddard J; Menveo(R)): a novel quadrivalent meningococcal CRM197 conjugate vaccine against Expert Rev Vaccines. 2011 Jan;10(1):21-33.
- Meningococcal meningitis, National Travel Health Network and Centre
- Immunizations - travel; NICE CKS, August 2012
|Original Author: Dr Colin Tidy||Current Version: Dr Louise Newson||Peer Reviewer: Prof Cathy Jackson|
|Last Checked: 11/05/2013||Document ID: 362 Version: 6||© EMIS|
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.