Links to other topics on this page
- Quick answers to frequent meningococcal vaccine questions
- Commentary on meningococcal disease rarity, "catching" meningococcal bacteria, and purchased A, C, Y and W vaccine
- Other resources
- Vaccination recommendations and eligibility
- Key meningococcal messages for primary care and EDs
- Meningococcal disease information and epidemiology
- Which vaccines provide the best protection against meningococcal disease?
⇒ For best protection against meningococcal disease in New Zealand, separate vaccinations against groups A, C, Y and W disease and group B disease are available. Based on disease cases in 2018 where the meningococcal group was identified, the A, C, Y and W vaccines covered around 52% of disease and the group B vaccine around 45% of disease.
⇒ The quadrivalent meningococcal vaccines Menactra® and Nimenrix® protect against meningococcal groups A, C, Y and W. The recombinant meningococcal vaccine Bexsero® protects against meningococcal group B.
⇒ These vaccines are available for purchase by people with an increased risk of exposure to meningococcal bacteria or risk of invasive disease. Menactra is recommended and funded for children from 2 years of age and adults with a condition listed on the Pharmaceutical Schedule (refer to Special groups below).
- Should we recommend an A, C, Y and W vaccine over a B vaccine, or vice versa?
Health professionals are not advised to recommend an A, C, Y and W vaccine over a B vaccine or vice versa, a B vaccine over an A, C, Y and W vaccine. It is not possible for health professionals to accurately predict who will get meningococcal disease. Nor is it possible to predict which meningococcal group could cause disease in any one person.
- Can Menactra or Nimenrix (groups A, C, Y and W) be given at the same visit as Bexsero (group B)?
Yes. Menactra or Nimenrix and Bexsero can be administered at the same visit using different sites.
- Is a minimum interval required between administration of Bexsero and Menactra or Nimenrix?
No. When Menactra or Nimenrix and Bexsero are not coadministered, no minimum interval is required before administration of the subsequent vaccine.
- Is a minimum interval required between administration of Bexsero, Menactra or Nimenrix and any other vaccine?
Menactra** or Nimenrix and Bexsero can be administered at the same visit as any other vaccine or any interval before/after any other vaccine.
**except when Menactra and Prevenar® 13 are being administered, a minimum interval of 4 weeks is required between administration of these two vaccines.
- Is a minimum interval required between administration of NeisVac-C® (meningococcal C only vaccine) and Menactra or Nimenrix?
No minimum interval is required between administration of NeisVac-C and administration of a subsequent Menactra or Nimenrix. However, when Menactra is administered in place of the second NeisVac-C dose in children aged under 12 months a minimum interval of 8 weeks between the first NeisVac-C and administration of Menactra could be considered. In this situation, a second Menactra administered 3 months later would still be recommended to complete the primary vaccine doses for the meningococcal A, Y and W antigens.
- Can we give less doses of Bexsero if a person has a history of MeNZB vaccination?
No. Two doses of Bexsero are recommended for older children, adolescents and adults regardless of a history of MeNZB vaccination.
- Can a pregnant woman receive Bexsero, Menactra or Nimenrix?
Yes. There are no safety concerns around administration of Menactra, Nimenrix or Bexsero at any stage of pregnancy. These are non-live vaccines and the advice is consistent with the recommendation for a pregnant woman to receive non-live vaccines when she has an increased risk of disease, for example influenza vaccination is recommended at any stage of pregnancy because they have an increased risk of influenza disease and complications.
- Which meningococcal vaccine fact sheet should I print first?
Purchase of non-funded meningococcal vaccines
Commentary on meningococcal disease rarity, "catching" meningococcal bacteria, and purchased A, C, Y and W vaccine
With the rise in disease caused by group W, declaration of an outbreak in Northland and a substantial increase in national media coverage of meningococcal disease, many people across New Zealand are asking for meningococcal A, C, Y and W vaccination for their children or themselves. This sudden increase in demand for meningococcal vaccination quickly depletes national vaccine stock available for purchase. Increases in meningococcal disease cases in other countries has increased the demand for meningococcal vaccines and vaccine stock worldwide is limited too.
Supporting health professionals and families who want to do everything they can "just in case" someone enrolled at their practice or in their family were to get meningococcal disease in the future is challenging. Groups for whom meningococcal vaccination is recommended but not funded are described in the meningococcal chapter of the Immunisation Handbook 2017 2nd Edition, e.g. adolescents living in communal accommodation, laboratory workers and travellers to high-risk countries. Plus, we know that children aged under 5 years, adolescents aged 15–19 years, and people who are Māori or Pacific typically have a higher risk of meningococcal disease, and that exposure to tobacco smoke, binge drinking or having another respiratory infection are associated with a higher risk of disease. However, beyond the Handbook advice it is difficult to know who to recommend purchased meningococcal vaccination for even when they are in stock, and there is the issue of how to support equitable access to purchased vaccines. Unfortunately, there are no easy answers.
- We need to remember that meningococcal disease is still rare in New Zealand.
- From 1 January to 31 December 2018 there were120 meningococcal disease cases with 10 deaths across the whole of New Zealand. Northland had the highest rate of disease in 2018, and this is being addressed through a targeted community vaccination programme until 22 February 2019. Two DHBs didn't have any meningococcal disease cases in 2018.a
- From 1 May to 27 August 2017 there were 375 laboratory confirmed influenza disease cases with 12 deaths admitted to Auckland City Hospital, Starship Children's Hospital, Middlemore Hospital or Kidz First Children's Hospital. From 4 January to 27 August 2017 there were 859 laboratory confirmed influenza disease cases across the whole of New Zealand, that was 262 influenza disease cases for every 100,000 people.b
- From 1 January to 31 December 2018 there were countless road related accidents with 379 deaths (234 of these deaths were motor vehicle drivers and 98 were passengers) across the whole of New Zealand. Every region in New Zealand has had between 5–67 road related deaths this year.c
Contact with droplets of saliva or mucous from another person who is carrying meningococcal bacteria in their nose/throat or who has the disease usually has to be quite sustained or intimate to "catch" meningococcal bacteria. Most people who "catch" meningococcal bacteria carry the bacteria in their nose/throat but don't get the disease. Rarely, meningococcal bacteria invade the body rapidly leading to severe disease. The underlying reasons for why invasion occurs in some individuals are not well understood. Some associated factors include smoking and crowded living conditions. The Communicable Disease Control Manuald describes close contacts at risk of "catching" the bacteria as:
- Those sleeping at least one night in the same household, dormitory, military barrack, student hostel bunkroom (not residents of nursing or residential homes who sleep in separate rooms) as the case or who have been in a seat adjacent to the case in a plane, bus or train for more than 8 hours
- Health care workers who have had intensive unprotected contact (not wearing a mask) with a case during intubation, resuscitation or closely examination of the oropharynx
- Exchange of upper respiratory tract secretions, including intimate kissing
- Other contacts as determined by the medical officer of health on a case-by-case basis, such as children and staff attending an early childhood service
Note: Unless one of these criteria is met, low-level salivary contact such as kissing on the cheek or mouth or sharing food or drink does not require public health follow-up or treatment (given evidence that it does not increase risk of transmission).
a. ESR Invasive meningococcal disease report 23 January 2019
b. ESR Recommendation for Seasonal influenza vaccine composition for New Zealand 2018, November 2017
c. Ministry of Transport, Road deaths, webpage last updated 9/1/19, accessed 5/2/19, https://www.transport.govt.nz/mot-resources/road-safety-resources/road-deaths/2018-road-deaths/
d. Ministry of Health, Communicable Disease Control Manual 2012 (updated October 2018), accessed 5/12/18, https://www.health.govt.nz/our-work/diseases-and-conditions/communicable-disease-control-manual
The following resources provide information about meningococcal disease and vaccination.
Meningococcal update webinar November 2018 by Nikki Turner and Emma Best
Ministry of Health Meningococcal disease: Information for general practitioners and emergency departments webpage
Ministry of Health Meningococcal vaccines: Eligibility, recommendations and supply webpage
Ministry of Health media release Increased vigilance needed for meningococcal disease 6 November 2018
Vaccination recommendations and eligibility
Menactra is recommended and funded for children from 2 years of age and adults with any of the following conditions that are listed on the Pharmaceutical Schedule:
- One dose for a close contacts of meningococcal disease case
- Two doses for individuals post-haematopoietic stem cell transplantation; or following immunosuppression due to steroid or other immunosuppressive therapy longer than 28 days
- Up to three doses plus booster doses (as appropriate) for individuals pre- or post-splenectomy; pre- or post-solid organ transplantation; with functional asplenia; complement deficiency (acquired or inherited); or who are HIV-positive
Menactra or Nimenrix (groups A, C, Y, W) and/or Bexsero (group B) are recommended but not funded for:
- Laboratory workers regularly handling meningococcal cultures
- Travellers to high-risk countries or before the Hajj
- Adolescents and young adults living in communal accommodation (e.g. in a hostel or at boarding school, in military accommodation, in correctional facilities or in other long-term institutions)
- A community vaccination programme will operate out of specified drop-in clinics, general practices and some community pharmacies until Friday 22 February inclusively for Northland residents who are:
- children aged 9 months through 4 years, i.e. aged under 5 years, or
- adolescents aged 13 years to through 19 years, i.e. aged under 20 years.
- From Wednesday 19 December to mid-January 2019, seven pharmacies across Northland are offering vaccination for Northland residents aged 13 years to under 20 years.
- From 14–25 January Northland DHB, community and Māori health providers will provide targeted outreach clinics to reach the remaining eligible children aged 9 month to under 5 years and adolescents aged 13 years to under 20 years who have not received a meningococcal A, C, Y, W vaccine dose.
- A secondary school-based programme commencing in early February is also being considered to ensure all eligible adolescents aged 13 years to under 20 years have the opportunity to receive a meningococcal vaccination.
- Visit the Northland community meningococcal W vaccination programme webpage for more information.
Northland DHB advise that the vaccination programme is targeting children aged under 5 years because they are the population that is generally most affected by meningococcal disease. Vaccinating this age group will reduce their individual risk of disease. The vaccination programme is also targeting adolescents aged 13 to under 20 years because they are the age group that generally carry the bacteria that causes the disease. Vaccinating this age group will reduce their individual disease risk and also lower the number of carriers in Northland. Reducing the number of adolescents carrying the bacteria will help to stop the spread of meningococcal disease across the entire community.
The vaccines being offered will be either Menactra or Nimenrix. These vaccines protect against meningococcal group W and meningococcal groups A, C and Y. They do not protect against meningococcal group B disease. A vaccine to protect against meningococcal group B disease, Bexsero, can be purchased through your family doctor.
- Menactra is the vaccine approved for use in children aged 9 months to under 12 months. Northland drop-in vaccination clinics will need to reserve a supply of Menactra for this age group from 5 December until at least 18 December when the second shipment of Menactra is due to arrive.
- Either Menactra or Nimenrix can be used for children aged 12 months to under 5 years and adolescents aged 13 years to under 20 years.
Visit the Northland community meningococcal W vaccination programme webpage to read the Meningoccal W vaccination programme: Questions and answers.
- GPs and EDs should be aware of that there has been an increase in meningococcal disease, caused by serogroup W in New Zealand over the past two years. They should be aware that this strain presents atypically and keep a high level of suspicion for the disease.
- Because of the fulminant nature of meningococcal sepsis, antibiotics should be administered on suspicion of diagnosis before transferring the patient to hospital.
- GPs do not need to be concerned that administering antibiotics will obscure the diagnosis for hospital clinicians. Over-treatment is acceptable in this case, as failure to treat may be fatal.
Meningococcal disease is caused by the bacterium Neisseria meningitidis. Humans are the only host for these bacteria. At least 12 groups of Neisseria meningitidis have been identified and of these A, B, C, X, Y and W (previously called W-135) are the most likely to cause disease. 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.
The meningococcal group causing the disease was identified for 113 of the 120 cases in 2018:a
- Group B 51 cases (45%)
- Group W 33 cases (29%)
- Group Y 16 cases (14%)
- Group C 10 cases (9%)
- Group X 1 case (1%)
- Non-groupable 2 cases (2%)
In 2018, meningococcal group B was still the most prevalent cause of disease. However, there has been a significant increase in Neisseria meningitidis group W in New Zealand since mid-2017, including cases caused by a very virulent group W sequence type (ST–11). In 2018, 33 meningococcal group W cases were reported up to 31 December with six deaths.
From 1 January 2019 to 18 January 2019, there have been five cases of meningococcal disease and no deaths. Two cases were caused by group B and two cases by group C, the group causing disease in the fifth case has not yet been identified.a
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.
The Ministry of Health advisedf changes to the recommended antibiotic treatment for suspected meningococcal infection (meningitis or sepsis) in primary care on 27 November 2018. This advice, and any updates, will also be published on the Ministry website Meningococcal disease: Information for general practitioners and emergency departments.
- The antibiotics recommended prior to transfer to hospital are:
|Ceftriaxone||2g IV* or IM||100 mg/kg IV* or IM up to a maximum of 2g as a single dose|
|Benzyl-penicillin||2.4g IV* or IM||50mg/kg IV* or IM up to a maximum of 2g|
|*IV administration is preferred to IM (where available and not leading to delays)|
- Early treatment of meningococcal infection with either of these antibiotics is of benefit, especially when there will be a delay for the patient to reach the Emergency Department.
- Ceftriaxone is the preferred first-line treatment for all individuals if it is available without delay. Ceftriaxone can only be given to patients allergic to penicillin who do not have a documented history of anaphylaxis to penicillin.
- There is no routine community treatment recommendation for patients with a documented history of anaphylaxis to penicillin. These patients must be transferred immediately by ambulance to the closest hospital. This hospital should be made aware of the patient transfer. If you are in a remote location or at a significant distance from secondary care, or if there is any delay, you should seek urgent advice from an Infectious Disease Physician regarding treatment options prior to transfer to hospital.
- Please note: PHARMAC has widened funded access to ceftriaxone to enable its use for the treatment of suspected meningococcal disease in the community. This change will be activated from 1 December 2018. Use this link to read the full notification on the PHARMAC website.
- The criteria for subsidy by endorsement will include the treatment of suspected meningococcal disease in any patient.
- The number of vials of ceftriaxone available via a Practitioner’s Supply Order will increase from 5 vials to 10 vials.
- Please note: There are no restrictions on the use of ceftriaxone injection in the hospital setting.
- Antibiotics given prior to transfer should be clearly noted on the clinical information that accompanies the patient to hospital.
- A blood sample should be taken as soon as possible for laboratory testing, but should not delay patient treatment or transfer.