Meningococcal Vaccines Meningococcal disease is a rare but serious infection caused by the bacterium Neisseria meningitidis. There are 13 serogroups; those that most commonly cause disease are A, B, C, W and Y. The incidence of invasive meningococcal disease (IMD) fluctuates naturally over time. The national notification rate declined from 2002 to 2013, but has increased since 2014. Serogroup B disease has been dominant until recently, but has been naturally declining even in the absence of widespread vaccination against this serogroup. There has been a recent increase in serogroup W disease since 2013; this is now the main serogroup causing meningococcal disease (44.5% of cases with identified serogroup) in Australia in 2016. Septicaemia and/or meningitis are the most common clinical manifestations of IMD. The highest incidence of meningococcal disease is in children aged <5 years and adolescents aged 15–19 years. Carriage rates of the bacteria are highestin older adolescents and young adults. Serogroup B disease remains the most common cause of IMD in children, adolescents and young adults. Serogroup W disease occurs over a more diverse age range and may present with less typical clinical manifestations than disease due to other serogroups. Serogroup C has become rare (1.2% of cases with identified serogroup in 2016) since the introduction of the conjugate meningococcal C vaccine to the National Immunisation Program (NIP) in 2003. Vaccines Three types of meningococcal vaccines are available in Australia: meningococcal C conjugate vaccine (MenCCV), available as a single vaccine, NeisVac-C®, or in a combination formulation with the Haemophilus influenzae type b (Hib) vaccine (Hib– MenCCV): Menitorix® multicomponent meningococcal B vaccine (MenBV): Bexsero® quadrivalent (A, C, W, Y) meningococcal conjugate vaccines (4vMenCV): Menactra®, Menveo®, Nimenrix®. (These have replaced quadrivalent polysaccharide vaccines which are now discontinued.) Who should be vaccinated People at increased risk of IMD: Those with complement disorders, asplenia and other immunocompromising conditions, or occupational exposure should be vaccinated with MenBV and 4vMenCV. People within age groups with increased incidence of IMD or high carriage rates of N. meningitidis: Infants and young children particularly those aged =2 years of age: Routine MenCCV at 12 months of age is recommended and funded under the NIP. MenBV is also recommended and 4vMenCV may be offered to protect against A, C, W and Y serogroups. MenBV and 4vMenCV are available through private prescription for this age group, but are not funded. Adolescents and young adults (15–19 years): MenBV is recommended and 4vMenCV may be offered, particularly for those living in close quarters such as new military recruits and students living in residential accommodation. In some Australian states, these vaccines are funded for this age group in response to locally predominant meningococcal B or W disease. Travellers: 4vMenCV is recommended for travellers to certain destinations where there is an increased risk of exposure (including, but not limited to, the ‘meningitis belt’ of sub-Saharan Africa). 4vMenCV is required for pilgrims attending the annual Hajj in Mecca. Anyone wishing to reduce their risk of IMD: Vaccination with MenBV (from 6 weeks of age) and 4vMenCV (from 2 months of age) may be offered and is available through private prescription. Table 1: Current access to meningococcal vaccines in Australia Vaccine Serogroup(s) covered Availability as of March 2017 Combination Haemophilus influenzae type b (Hib) / Meningococcal C conjugate vaccine (Hib–MenCCV) C Recommended and funded under the NIP for 1 dose at 12 months of age in all children nationally Multicomponent meningococcal B vaccine (MenBV) B Available through private prescription, from age 6 weeks. Doses required vary by age.* Funded in South Australia from April 2017 for a 2 year study for students enrolled in years 10, 11 and 12 in 2017.†‡ Quadrivalent meningococcal conjugate vaccines (4vMenCV) A, C, W, Y Available through private prescription. Three vaccine brands for use in different age groups (Table 2). Funded in New South Wales in 2017 from school term 2 for year 11 and 12 students.‡ Funded in Victoria and Queensland in 2017 for adolescents/young adults aged 15–19 years. Funded in Western Australia (2017–2019) commencing with year 10– 12 students and those aged 18–19 years in 2017, and only year 10 students in 2018–2019. ‡ * Refer to The Australian Immunisation Handbook, 10th edition, 2015 update, for dosing guidelines. † Funded doses of MenBV for this age group in South Australia are provided through a population-level study assessing the impact of the vaccine on nasopharyngeal carriage of N. meningitidis and herd immunity. ‡ Consult the respective state or territory health department website for further details. Source: www.ncirs.edu.au meningococcal vaccines fact sheet Index of general public information