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Medplus Meningitis Update

Feb. 24, 2014


Medplus Meningitis Update

Medplus often fields enquiries about vaccination against meningitis. Unfortunately it is not currently possible to immunise against every type of meningitis.  Children fully immunised in NZ are protected against Hib meningitis, and those children currently under five potentially have also been immunised against pneumococcal disease.  The MeNZB™ vaccine was used in 2004-2008 to control an epidemic of one type of group B meningococcal disease. It is no longer available and its duration of protection was short so vaccinated persons are no longer expected to be immune to this type of meningococcal meningitis.  There are some immunisations available to protect against some strains of meningococcal meningitis, but there is no public health campaign advising immunisation at this time. We have been aware that some universities are recommending vaccination against group C meningitis if students are living in halls of residence.  In order to decide whether immunisation is right for you or your family you need to understand the types of meningitis that can occur and understand the differences between immunisations on offer.  Medplus has put together the following information to guide you, but we do welcome you to come in and discuss this with your GP.  We do not carry all of these vaccinations in stock, but we can order in the vaccination for you if not. The prices are listed below include the giving fee by the nurse. There is currently no funded immunisation against meningococcal disease.

Meningitis and meningococcal septicaemia

Meningitis is inflammation of the meninges, the linings surrounding the brain. Meningitis can be caused by bacteria, amoeba and viruses. Septicaemia is blood poisoning caused by bacteria entering the bloodstream and multiplying uncontrollably. Children under five years are more at risk, though all age groups can be affected. There can be serious complications and urgent medical treatment is needed.

Bacterial meningitis and meningococcal septicaemia

Bacterial meningitis of any type and meningococcal septicaemia are very serious and need urgent treatment with antibiotics. Meningitis is mainly caused by the meningococcal bacteria (Neisseria meningitidis), but can also be caused by the pneumococcal, Haemophilus influenzae b (Hib) and tuberculosis (TB) bacteria among others.

Escherichia coli (E. coli) and group B streptococcal bacteria can also cause meningitis in newborn babies.

The meningococcus (Neisseria meningitidis) has five main groups - A, B, C, W135 and Y. In New Zealand, group B meningococcal disease accounts for the majority of cases, with group C being the second most common. Groups Y and W135 are not common here. Group A has caused some outbreaks in the past.

Meningococcal disease predominantly affects children, adolescents and young adults with highest rates in infants under one, followed by children up to 5 years. Carriage is common, particularly in adolescents. Invasive disease is uncommon, but there is a high case-fatality rate: in 2011 there were 119 cases and 13 deaths.

There are five major groups of meningococcal bacteria: A,B,C,Y,W-135. Predominant groups in NZ are B and C.

In NZ about 62% of disease was caused by group B and 38% by group C in 2011.

Amoebic meningitis

Amoebic meningitis is a very serious and very rare illness that, sadly, nearly always ends in death. It is caused by an amoeba that can live in geothermal pools and can be picked up through the nose when a person puts their head under the water.

Viral meningitis

Viral meningitis is more common than bacterial meningitis. It is rarely life-threatening, but it can make people very weak. Viral meningitis can be caused by many different viruses. Some are spread by people coughing and sneezing, or through poor hygiene or sewage-polluted water.

How do you get bacterial meningitis or meningococcal septicaemia?

The bacteria are very common and live naturally in the back of the nose and throat. They normally spread between people in close and prolonged contact by coughing, sneezing and intimate kissing. They do not live for very long outside the body, so can't be picked up from water supplies, swimming pools or buildings.

People of any age can carry the bacteria for days, weeks or months without becoming ill and carrying the bacteria can help to make you more immune to meningitis. Occasionally, the bacteria overcome the body's defences and cause meningitis and septicaemia. The bacteria which can cause meningitis in newborn babies are commonly found in the intestine and vagina.

Signs and symptoms of meningitis

Meningitis and meningococcal septicaemia may not always be easy to spot at first, because the symptoms can be similar to those of flu.  They may develop over one or two days, but sometimes develop in a matter of hours.

The incubation period is between two and 10 days. Symptoms do not appear in any particular order and some may not appear at all. It is important to remember that other symptoms may occur and that the patient may be confused or disoriented.

Vaccines against meningococcal meningitis

There is NO group B vaccine in NZ. There is an assortment of vaccines available against non B groups – all with slightly different characteristics.

Menactra protects againstGroups A, C, Y and W-135. It is a conjugate vaccine and gives longer lasting protection than the polysaccharide vaccines. For those aged 2 to 55 years only one dose is required to acquire immunity and it needs boosting every 5 years. It can be used off license for those between 9 and 23 months, but requires 2 doses separated by 3 months and then a booster at 3 years, followed by 5 yearly boosters. It can also be used off license for those over 55 years.  It is the most expensive option but covers a wide range and for the longest term, and also only one dose is needed.  Cost per dose at Medplus is $165.

Meningitec and NeisVac-C protect only against group C. They are licensed in use from 6 -8weeks of age, and for those over 1 year only 1 dose is required. For those over 6 years boosters are every 5 years – under 6 years of age the boosters are every 2-3 years.  Cost per dose of Meningitec is $80.

Mencevax ACWY and Menomune cover four groups: A, C, Y and W-135. They are ineffective in children under 2 years and have a short duration of protection (influenced by age at vaccination), of approximately 2 to 5 years. It is not possible to boost protection at a later date as no immune memory is generated, vaccination has to begin again.  We can supply Menomune for $50.

Which would we choose for our families? If money is no object then Menactra appears to give the most cover for the longest period. However, it must be remembered that it only protects against Meningitis C, and not the more common Meningitis B.