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, 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). In 2018, there have been 96 meningococcal diseases cases reported up to 5 November.
In 2018, meningococcal group B is 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 2017, 12 meningococcal group W cases were reported, including three deaths. In 2018, 24 group W cases have been reported up to 5 November, including six deaths. The Northland region has been the most affected in 2018, with seven of the 24 cases reported in this region, including four cases in September and October.
For best protection against all meningococcal disease in NZ,
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.
- 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.
- The antibiotics recommended prior to transfer to hospital are:
|Adults||1.2 g (2 megaunits) IV (or IM)||1–2 g IV (or IM)|
|Children||25–50 mg/kg IV (or IM)||50–100 mg/kg IV (or IM)|
Antibiotics given prior to transfer should be clearly noted on the clinical information that accompanies the patient to hospital.
- Patients with a documented history of anaphylaxis to penicillin and who are suspected of suffering from meningococcal disease should be sent immediately to hospital without pre-admission antibiotics.
- A blood sample should be taken as soon as possible for laboratory testing, but should not delay patient treatment or transfer.
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.
For best protection against all meningococcal disease in New Zealand, separate vaccinations against groups A, C, Y and W disease and group B disease are recommended. 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 but who do not meet the criteria listed on the Pharmaceutical Schedule to receive a funded meningococcal vaccination.
Can Menactra or Nimenrix (groups A, C, Y and W) be given at the same visit as Bexsero (group B)?
Yes. A quadrivalent meningococcal conjugate vaccine such as Menactra or Nimenrix can be coadministered at the same visit as the recombinant meningococcal vaccine Bexsero. Administer in separate syringes at separate sites. If administered into the same limb administer with a minimum of 2 centimetres between injection sites.
What do we recommend if the person only wants to purchase one meningococcal vaccine?
Health professionals are not advised to recommend a quadrivalent A, C, Y and W vaccine over a group B vaccine or vice versa (a group B vaccine over a quadrivalent A, C, Y and W vaccine) UNLESS the person is being vaccinated because they are a close case of a meningococcal disease case and have been advised which vaccine to receive.
Health professionals are advised to refer to the New Zealand specific meningococcal disease information in the Meningococcal disease or Purchase of non-funded meningococcal vaccines fact sheets when discussing the available meningococcal vaccines and encourage the person to make their own choice of which vaccine to purchase. It is not possible for health professionals to accurately predict who will get meningococcal disease. Nor is it possible to predict which meningococcal group is going to cause disease in any one person even though approximately two-thirds of meningococcal disease in New Zealand is caused by group B, approximately 10% caused by group C, 10% by group Y and 10% by group W.
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)
The following resources provide more detailed information about meningococcal disease and vaccination.
Ministry of Health media release Increased vigilance needed for meningococcal disease 6 November 2018