Meningococcal disease

What

Meningococcal disease is caused by the bacterium Neisseria meningitidis. The bacterium is commonly known as meningococcus.

There are 13 known meningococcal serogroups, distinguished by differences in surface polysaccharides of the bacterium’s outer membrane capsule. Globally, serogroups A, B, C, W and Y most commonly cause disease. 

Invasive meningococcal disease (IMD) is a rare but serious disease. It most commonly presents as septicaemia and/or meningitis.

Who

Meningococcal vaccines are recommended for:

• infants, children, adolescents and young adults
• special risk groups, including Aboriginal and Torres Strait Islander people, individuals with certain medical conditions (see List. Specified medical conditions associated with increased risk of invasive meningococcal disease), laboratory workers who frequently handle Neisseria meningitidis, travellers, and young adults who live in close quarters or who are current smokers

How

Several vaccines are available in Australia to reduce the risk of meningococcal disease. However, no single vaccine protects against all serogroups: 

• 2 vaccines protect against meningococcal serogroup B — MenB vaccines.
• 2 vaccines protect against meningococcal serogroup C only — MenC vaccine and Hib-MenC vaccine (combined with Haemophilus influenzae type b).
• 3 vaccines protect against meningococcal serogroups A, C, W and Y — MenACWY (quadrivalent) conjugate vaccines.

Why

Although it is rare, IMD is a serious infection that can cause significant illness, disability and death. Vaccination programs have successfully reduced the incidence of IMD caused by serogroup C. The incidence of IMD caused by serogroups W and Y increased from 2013 and 2015, respectively.

However, the incidence of meningococcal W disease has fallen since state vaccination programs with MenACWY vaccine were introduced in 2017 and subsequently incorporated onto the National Immunisation Program. IMD caused by serogroup B continues to occur in Australia.

See

• Infographic. Meningococcal vaccination for children and adolescents without risk factors
• Infographic. Meningococcal vaccination for people in a special risk group

Meningococcal vaccines available in Australia

The Therapeutic Goods Administration website provides product information for each vaccine.

See also Vaccine information and Variations from product information for more details.

Dose and route

The dose of all meningococcal vaccines is 0.5 mL given by intramuscular injection. Co-administration with other vaccines

Co-administration with other vaccines

MenACWY vaccines

MenACWY vaccines can be co-administered with most other vaccines.

MenACWY vaccines are safe to use with most other vaccines given in childhood^11-21 and adolescence.^22-26 In most studies, the frequency of reactions after vaccination was similar regardless of whether the vaccines were received together or separately. Some studies showed slight increases in mild reactions when vaccines were given together.

If a person needs to receive Nimenrix and a vaccine containing tetanus toxoid (such as Infanrix hexa or Vaxelis), co-administration of these vaccines is preferred. Giving Nimenrix after a vaccine containing tetanus toxoid may interfere with the immune response against some meningococcal serogroups. There is uncertainty about whether this reduced immune response affects clinical protection, and there are no data on the optimal interval between the vaccines. Therefore, Nimenrix should be given as scheduled, even if it is being given shortly after a vaccine containing tetanus toxoid.

MenB and MenACWY vaccines can be co-administered at any age. Clinical studies for concomitant use of MenB vaccines with MenACWY vaccines show non-inferior immune responses and tolerable safety profiles.^27-30

MenB vaccines

Bexsero can be safely given with other routine vaccines.

Children <2 years of age have an increased risk of fever if Bexsero is co-administered with other routine vaccines, compared with when these vaccines are given separately (see Adverse events).

However, this is not a contraindication to co-administration of Bexsero with other vaccines. Children <2 years of age are recommended to receive prophylactic paracetamol if they are receiving Bexsero at the same time as other routinely scheduled vaccines. See Contraindications and precautions.

Children <2 years of age can receive Bexsero separately from other routine infant vaccines, with a minimum interval of 3 days, to minimise the risk of fever. In this case, give routinely recommended vaccines first.

Adolescents can safely receive Trumenba at the same time as other vaccines given in adolescence, including HPV (human papillomavirus) vaccine³¹ and dTpa (reduced antigen content diphtheria-tetanus-acellular pertussis) vaccines.³⁰

MenB and MenACWY vaccines can be co-administered at any age.

Interchangeability of meningococcal vaccines

MenACWY vaccines

If possible, complete the primary course of MenACWY vaccination with the same vaccine brand. If this is not possible, use an alternative brand following the dose recommendations by age. See Recommended dose schedules.

People can receive booster doses using any brand of of MenACWY vaccine.

MenB vaccines

Bexsero (MenB-MC) and Trumenba (MenB-fHBP) are not interchangeable. The same vaccine should be used for all primary vaccine doses as well as any booster.

If an infant or child <10 years of age is inadvertently given a booster dose of Trumenba, repeat the dose with Bexsero. If a person ≥10 years of age receives a booster dose that is a different brand to the primary course, they do not need an extra or repeat dose of the booster vaccine. While it is not preferable as there is no specific data on interchangeability of Bexsero and Trumenba, it will still provide protection.

Contraindications

The only absolute contraindications to meningococcal vaccines are:

• anaphylaxis after a previous dose of any meningococcal vaccine
• anaphylaxis after any component of a meningococcal vaccine

Previous meningococcal disease, regardless of the serogroup, is not a contraindication to receiving any meningococcal vaccine.

Previous vaccination with the strain-specific MenB vaccine used in New Zealand (MeNZB) is not a contraindication to receiving either Bexsero or Trumenba.

Previous vaccination with a quadrivalent polysaccharide meningococcal vaccine (4vMenPV; previously available in Australia but now discontinued) is not a contraindication to receiving any MenACWY vaccine. See ‘People who have previously received a meningococcal polysaccharide vaccine’ in Laboratory workers or Travellers.

Precautions

Prophylactic administration of paracetamol with Bexsero vaccination in children aged <2 years

Children <2 years of age are recommended to receive prophylactic paracetamol with every dose of Bexsero. This is because of the increased risk of fever, including high fever, after receiving Bexsero^32,33 (see Adverse events). This is an exception to the general recommendation to not routinely give paracetamol at the time of vaccination (see Adverse events following immunisation).

The 1st dose of paracetamol (15 mg/kg/dose) is recommended within 30 minutes before, or as soon as practicable after, receiving the vaccine. This is regardless of whether the child has a fever. This can be followed by 2 more doses of paracetamol given 6 hours apart, regardless of whether the child has a fever.

A clinical trial showed that using paracetamol prophylactically in infants reduced the likelihood of high-grade fever by about half after any vaccine dose. This had no overall impact on the immune responses to either Bexsero or other vaccines given at the same time.³⁴

Similarly, prophylactic antipyretics reduced the likelihood of fever in the first 48 hours after the 1st dose of Bexsero by about 50% among more than 1500 children <2 years of age.³⁵ This was seen in a population-based MenB vaccination program using Bexsero in a region of Quebec, Canada (see Adverse events).

Women who are pregnant or breastfeeding

Meningococcal vaccines are not recommended for pregnant or breastfeeding women,^36,37 except in special rare circumstances. See Vaccination for women who are planning pregnancy, pregnant or breastfeeding.

People with latex allergy

The product information for Menveo states that the tip cap of the syringe contains natural rubber. The risk of allergy is lower from natural rubber than from latex. However, consider using an alternative product in people with an allergy or sensitivity to latex.

MenACWY vaccines

Meningococcal ACWY vaccines have been shown to be safe in multiple clinical trials and large population studies (conducted in countries after the vaccines became available) in people of different ages, from infants to adults.^11-15,38-48 Most reactions after vaccination are mild and resolve on their own. Meningococcal ACWY vaccines are safe for use in people with HIV.^49,50

Meningococcal ACWY vaccines can be safely administered at the same time as other routine vaccines provided to young children through the National Immunisation Program. In most studies, the frequency of reactions after vaccination was similar regardless of whether the vaccines were given together or separately. Some studies showed slight increases in mild reactions when vaccines were given together.

Meningococcal conjugate vaccines are not associated with Guillain–Barré syndrome (GBS).

MenQuadfi

Clinical trials do not show any safety concerns for use of MenQuadfi in infants, children, adolescents or adults.^51-56

In infants 12–23 months of age, 9.6% of trial participants reported fever.^51-56 In children 2–9 years of age, 1.9% of trial participants reported fever.⁵³ Most reactions were mild injection site reactions, which occurred in 39–41% of participants.

A study in adolescents and adults showed that most reactions were mild.⁵⁴ The most common adverse events were:

• pain at the injection site (39% of participants)
• myalgia (32%)
• headache (28%)

About 1% of vaccine recipients reported fever.

Studies of concomitant administration in children⁵² and adolescents⁵⁵ showed that MenQuadfi can be safely co-administered with other routine vaccines. In infants aged 12–23 months, a slightly higher frequency of adverse events was observed when MenQuadfi was co-administered with 13vPCV (13-valent pneumococcal conjugate vaccine).⁵² In children and adolescents aged 10–17 years, a slightly higher frequency of adverse events was observed when MenQuadfi was co-administered with dTpa and HPV vaccines.⁵⁵

Menveo

Clinical trials have shown that Menveo is safe to use in infants, children and adolescents. Most adverse events are mild or moderate. Frequencies of any adverse event and of serious adverse events are similar to those reported for other routine childhood vaccines.^12-15,44-46

In infants and children <2 years of age, 3–23% of trial participants reported fever.^14,15,44-46

A large study in adolescents showed that most reactions were mild. The most common adverse events were:⁵⁷

• pain at the injection site (44% of participants)
• headaches (29%) 
• myalgia (19%) 
• erythema (15%)

About 1% of vaccine recipients reported fever.

The frequency of adverse events did not increase when Menveo was administered with other routine vaccines in infants and young children^12-15,44 or adolescents.²² A slightly higher frequency of adverse events was observed when Menveo was co-administered with both HPV and dTpa vaccines in adolescents.

A large post-licensure safety study of adolescent vaccine recipients found a slightly higher risk of Bell’s palsy in vaccine recipients.⁴⁷ However, ongoing analysis of millions of people who received the vaccine did not find any safety signals for facial paresis.

Nimenrix

Clinical trials have shown Nimenrix to be safe for use in infants, children and adolescents.^{11,17,18,23,40-43} Most reactions were mild injection site reactions, which occurred in 30–50% of vaccine recipients. About one-fifth of people who were vaccinated had a mild systemic reaction.

In young children aged 12–23 months, the frequency of mild adverse events was slightly higher when Nimenrix was administered together with other routine childhood vaccines, particularly Infanrix hexa and Vaxelis.^17,18 Studies on co-administration in adolescents did not show any difference in the frequency of adverse events between administration groups.²³

MenB vaccines

Bexsero

Bexsero has an acceptable safety and tolerability profile based on clinical trial data.

In clinical trials, fever was the most notable systemic reaction in infants and young children, particularly those aged 2–12 months. Temperatures were highest 6 hours after vaccination, then decreased on day 2 and generally subsided by day 3.³² More than a quarter (26–41% depending on dose number) of infants who received Bexsero alone developed fever ≥38°C, and 4–8% had fever ≥39°C.³³

In response to a community epidemic in Quebec, Canada, around 44,000 individuals between 2 months and 20 years of age received at least 1 dose of Bexsero. About 15% (112/746) of infants who participated in the vaccine safety surveillance reported fever. Among 112 infants who reported fever, around 26% reported a peak temperature of 39–40.4°C. <1% reported a peak temperature of ≥40.5°C.³⁵

Safety surveillance (from September 2015 to 31 May 2017) of a national routine vaccination program for children aged 2–18 months using Bexsero in the United Kingdom found no unexpected adverse reactions except for reports that described a local reaction with a persistent nodule at the site of injection, usually without other symptoms.⁶⁴ There was no increase in the frequency of febrile seizures or convulsions in infants who received Bexsero.⁶⁵ A later study showed a small but significantly increased risk of febrile seizures in infants aged 1–18 months who received Bexsero in the United Kingdom from 2015 to 2018.⁶⁶ However, it was difficult to attribute the risk directly to Bexsero as the majority of infants receiving Bexsero (93%) also received other vaccinations on the same day.

In a clinical trial, the frequency of fever was about 2 times higher when infants received Bexsero with other infant vaccines, specifically DTPa-hepB-IPV-Hib vaccine and 7vPCV (7-valent pneumococcal conjugate vaccine). 51–62% of these infants reported fever ≥38°C, and 10–15% reported fever ≥39°C within 7 days of any vaccine dose.³³

Prophylactic paracetamol reduced fever in infants who received Bexsero at the same time as other routine infant vaccines.³⁴ (See also Contraindications and precautions.) In clinical studies, fever and other systemic reactions were less common after a subsequent dose of Bexsero received at 12 months of age.

Other common adverse events after receiving Bexsero included:³²

• tenderness, swelling, induration and erythema at the injection site
• irritability
• sleepiness
• unusual crying
• change in appetite

These reactions were reported less often with increasing age.

Adolescents and adults most commonly reported:⁶⁷

• pain at the injection site
• malaise
• headache

Observational studies on booster doses of Bexsero showed that adverse events occurred at rates similar to those following primary vaccination and were generally mild to moderate.^68-74

Trumenba

Several studies report safety and tolerability for Trumenba.^75-78 There was no significant increase in serious adverse events among more than 4250 people aged 10–25 years who received at least 1 dose of Trumenba.

The most common adverse reactions in these studies were:

• pain at the injection site (≥85%)
• fatigue (≥40%)
• headache (≥35%)
• myalgia (≥30%)
• chills (≥15%)

Most reactions were mild to moderate in severity and did not increase with subsequent doses of Trumenba. The safety profiles were similar for the 3-dose and 2-dose schedules.

One observational study on booster doses of Trumenba showed that adverse events occurred at rates similar to those following primary vaccination and were generally mild to moderate.⁷⁹

MenC vaccines

NeisVac-C

Data from clinical trials in England showed that transient headache of mild to moderate severity was the most commonly reported adverse event. This was more common in older adolescents than in younger children in primary school.⁸⁰

Most local reactions were pain or redness at the injection site. These were mostly mild and resolved on their own.

Post-licensure passive safety surveillance data from the United Kingdom showed that the most commonly reported adverse events were:^81-84

• transient headache
• fever
• local reactions
• dizziness

Meningococcal disease is caused by the bacterium Neisseria meningitidis. The bacterium is commonly known as meningococcus.

There are 13 known meningococcal serogroups, distinguished by differences in surface polysaccharides of the bacterium’s outer membrane capsule. Globally, serogroups A, B, C, W and Y most commonly cause disease.

Pathogenesis

Humans are the only reservoir of Neisseria meningitidis.

Some people carry N. meningitidis without developing disease. The prevalence and duration of asymptomatic nasopharyngeal carriage of meningococcus vary over time, and in different populations and age groups. Prevalence of carriage is higher when groups of people occupy small areas of living space.^85,86

The incubation period is between 2 and 10 days, but commonly 3–4 days.⁸⁷

People at increased risk of invasive meningococcal disease

Some medical conditions increase a person’s risk of developing invasive meningococcal disease (IMD). The magnitude of the risk varies with the primary underlying condition.

People with a complement deficiency have up to a 10,000-fold increased risk of meningococcal disease, depending on the specific condition. People with a complement deficiency are also more likely to become infected again.^88-93

People with an absent or dysfunctional spleen have a lifelong increased risk of severe bacterial infection,^94,95 including meningococcal sepsis.

Other immunocompromising conditions that increase the risk of IMD include HIV^96,97 and haematopoietic stem cell transplant.

Other people at greater risk of meningococcal infection include:

• laboratory workers who handle meningococcus
• new military recruits^6,98
• university students living in residential colleges (particularly in their 1st year)^5,7,99,100
• smokers^10,86

A person’s risk of acquiring meningococcal disease can also increase by:^{10,85,86,101-103}

• exposure to cigarette smoke and being a smoker (due to higher rates of carrying meningococcus)
• intimate kissing with multiple partners
• recent or current viral infection of the upper respiratory tract

There is no definitive evidence that there is an increased risk of IMD among men who have sex with men. However, clusters or community outbreaks of serogroup C IMD among men who have sex with men have been reported.^104-108 

Transmission

Meningococcus is transmitted via droplets or direct contact.⁸⁷

Symptoms of meningococcal disease

Neisseria meningitidis can cause invasive meningococcal disease (IMD), which usually presents as meningitis and septicaemia. Septicaemia, either on its own or with meningitis, can be particularly severe.^87,101

The clinical manifestations of meningococcal septicaemia and meningitis may be non-specific.They can include:¹⁰¹

• sudden onset of fever
• rash (petechial, purpuric or maculopapular)
• headache
• neck stiffness
• photophobia
• altered consciousness
• muscle ache
• cold hands
• thirst
• joint pain
• nausea
• vomiting

Not all symptoms or signs may be present at disease onset.

The characteristic rash of meningococcal disease does not disappear with gentle pressure on the skin, but the rash is not always present.

N. meningitidis can also cause other localised infections, although these are less common, including:^86,100

• septic arthritis
• pneumonia
• epiglottitis
• conjunctivitis

These less common presentations are more common among certain serogroups, especially serogroup W.

Complications of meningococcal disease

Meningococcal infections can progress rapidly to serious disease or death in previously healthy people. The overall mortality risk for IMD is high (5–10%), even if the person receives appropriate antibiotic therapy.

Around one-third of children and adolescents who survive IMD develop permanent complications. These can include:¹⁰¹ 

• limb deformity
• skin scarring
• deafness
• neurologic deficits

Around 30–40% of people who survive IMD have long-term consequences or disabilities. Patients and caregivers can also have psychological symptoms due to these complications.^109-111

Meningococcal disease in Australia

Meningococcal disease can occur sporadically or in epidemics. In Australia, most cases occur during winter and early spring. Other countries with temperate climates also have this seasonal trend.¹¹²

The meningococcal serogroups that cause meningococcal disease have changed over time. A meningococcal C vaccine was introduced on the National Immunisation Program in 2003 and has resulted in a large reduction in meningococcal C disease incidence.^112,113

From 2013, the incidence of meningococcal W disease increased rapidly and the incidence of meningococcal Y disease increased steadily from 2015.¹¹⁴ Several states and territories introduced vaccination programs with MenACWY vaccine in 2017 to manage this disease. MenACWY vaccine was introduced on the National Immunisation Program in 2018 for toddlers aged 12 months, and in 2019 for adolescents. The incidence of meningococcal W disease have fallen with widespread use of the MenACWY vaccine in these age groups.^114,115

Meningococcal B continues to cause most meningococcal disease in Australia.¹¹³

A state-funded MenB vaccination program was introduced in South Australia from 2018. Refer to the South Australian Health Department website for further details. There has been a reduction in meningococcal B disease in South Australia since this vaccination program began.^117,118

Risk by age group, and by Aboriginal and Torres Strait Islander status

Children aged <2 years

Children aged <2 years have the highest incidence of meningococcal cases. The disease occurs most often in infants aged 3–5 months.

Adolescents aged 15–19 years

A high number of meningococcal disease cases occurs among adolescents and young adults aged 15–24 years, with peak rates of disease occurring in 18–20-year-olds. Adolescents and young adults have the highest rate of meningococcal carriage and are thought to play an important role in transmitting the bacteria in a community.⁴

Adolescents and young adults in this age bracket who have a higher risk of acquiring the meningococcal bacteria are:

• people who live in close quarters, such as new military recruits and students living in residential accommodation
• people who have prolonged contact with a person who is carrying meningococcal bacteria^5-7
• people who are smokers^8-10 

Aboriginal and/or Torres Strait Islander people

Aboriginal and Torres Strait Islander people have much higher incidence rates of meningococcal disease than non-Indigenous Australians.¹¹³ This is particularly among children aged <15 years for the 2 most common meningococcal serogroups: B and W.^{112,115,121,122}

Between 2006 and 2015, rates of meningococcal disease caused by serogroup B disease were reported as being 3.4 times and 3.8 times higher among Aboriginal and Torres Strait Islander infants aged <12 months and children aged 1–4 years, respectively, compared with non-Indigenous infants and children of the same age.¹¹³

Invasive meningococcal disease (IMD) is a rare condition. Because of this, studies to assess the effectiveness of a vaccine in preventing IMD are not feasible because very large numbers of people would need to be vaccinated and followed up over long periods of time.

As an alternative, studies measure the immune response to meningococcal vaccines, which indicates how effective the vaccine is likely to be. An immune response is considered to have occurred if antibodies are detected above a standard threshold that is likely to be protective against the disease.

Meningococcal B vaccines

Bexsero (MenB-MC)

Bexsero induces bactericidal antibodies specific to the 4 vaccine antigens in infants, children, adolescents and younger adults. Antibody levels correlate with protection against clinical disease.^{29,30,59,102,103}

Bexsero is expected to protect against most circulating meningococcal B strains. Specialised laboratory testing (Meningococcal Antigen Typing System, or MATS) has predicted that around 75% of all meningococcal B strains that caused disease in Australia from 2007 to 2011 would have been susceptible to effective killing by vaccine-induced antibodies.¹⁰⁵

Data on vaccine effectiveness are available from the United Kingdom, where a routine infant program using a reduced dosing schedule was introduced in 2015. The vaccine effectiveness of 2 doses given at 2 and 4 months of age was 82.9%.¹⁰⁵

Studies on booster doses of Bexsero in healthy people show that a booster dose has a moderate effect on protective immune responses.^68-74

Trumenba (MenB-fHBP)

People aged 11–18 years show good immune responses after receiving 2 doses of Trumenba 6 months apart. They also show good immune responses after receiving 3-dose schedule of Trumenba at 0, 1–2 and 6 months.⁷⁶ 

Protective immune responses were seen in: 

• 82–83% of trial participants after 3 doses received at 0, 1 and 6 months, or 0, 2 and 6 months 
• 73.5% of participants after 2 doses received at 0 and 6 months

Several clinical trials in people aged 10–25 years have also shown that both 3-dose and 2-dose schedules are safe and can be administered with other vaccines.^75-78,124

Studies on booster doses of Trumenba in healthy people show that a booster dose has a moderate effect on protective immune responses.⁷⁹

Meningococcal conjugate vaccines

Conjugate meningococcal vaccine formulations contain meningococcal serogroup antigens that are joined (conjugated) to a carrier protein. Because each of the 3 MenACWY vaccines contains different conjugate carrier proteins, they produce different levels of immune response. It is not known whether these differences affect a person’s protection against meningococcal disease. However, a stronger immune response, measured by antibody levels, is likely to predict better protection against the disease.

MenQuadfi (MenACWY-TT)

MenQuadfi induces an immune response against serogroups A, C, W and Y after a single dose in infants 12–23 months of age,^51,52,55 children 2–9 years of age,53 and adolescents and adults aged ≥10 years. ^54-56

Among infants aged 12–23 months, seroprotection was high (84–99%) for all serogroups⁵¹ after vaccination with MenQuadfi. Similarly, when MenQuadfi was co-administered with routine vaccines, seroprotection was 89–100% for all serogroups.⁵²

Children aged 2–9 years who received MenQuadfi produced a good immune response after a single dose. More than 85% of children developed protection against all 4 serogroups.

Seroprotection induced by MenQuadfi in adolescents and adults has been assessed in a number of studies.^54-56 All clinical trials found that MenQuadfi produced an immune response against all serogroups. Co-administration of MenQuadfi with dTpa and HPV vaccines to adolescents aged 10–17 years produced similar antibody responses to those produced when MenQuadfi was administered alone.⁵⁵

Menveo (MenACWY-CRM)

Menveo is safe to use in children from 2 months of age.^12-14,44 When given in a 3-dose schedule at 2, 4 and 12 months of age, more than 99% of children in a clinical trial developed protection against meningococcal W and Y after they completed the course.¹⁴

For children who start vaccination at age 6 months to <12 months, a 2-dose schedule with Menveo produces a good immune response. In a large study with more than 1600 participants, more than 96% of children who received 2 doses of Menveo at age 7–9 months and 12 months developed protection against meningococcal C, W and Y.¹⁵

Another smaller study showed that 100% of children who received Menveo at 6 and 12 months of age produced an immune response against meningococcal C, W and Y after the 2nd dose.⁴⁶

Although Menveo is registered in a 2-dose schedule from 7 months of age, data from these clinical trials showed that the immune response in children who started vaccination at 6 months of age was similar.

97% of children aged 12–23 months who received Menveo developed a protective immune response to all 4 meningococcal serogroups after 2 doses.⁴⁴

2 large studies in adolescents showed good immunity after vaccination with Menveo.^22,57 Supporting studies in adolescents and adults also found that more than 80% of people developed an immune response to all 4 meningococcal serogroups.^22,48,129

Nimenrix (MenACWY-TT)

When Nimenrix was given in a 3-dose schedule at 2, 4 and 12 months of age in a clinical trial, more than 99% of children developed protection against all 4 meningococcal serogroups after completion of the course.²⁰

In another study of Nimenrix given at 6 and 15–18 months of age, 94% of children developed an immune response against all 4 meningococcal serogroups after the 1st dose at 6 months, and all but 1 out of 139 vaccinated subjects had a protective response to all 4 serogroups after the booster dose in the 2nd year of life.²¹ In another study, a 2-dose schedule of Nimenrix given at 9 and 12 months of age produced immune responses against all 4 serogroups in 98% of vaccinated infants after the 1st dose and in all children after the 2nd dose.¹⁹

1 dose of Nimenrix produces a strong immune response in children aged 12–23 months. More than 97% of children developed an immune response against all 4 serogroups (A, C, W and Y).^11,17,18,40

A large trial in adolescents showed that 85.4–97.4% of participants had a vaccine response following vaccination with Nimenrix, depending on the serogroup. Almost all participants had evidence of immunity against the 4 vaccine serogroups.⁴³ Other studies have also demonstrated good immune responses after vaccination with Nimenrix, either alone or with other vaccines.^23,41,42,130

NeisVac-C (MenC-TT)

Most clinical trials of NeisVac-C involved co-administration with other routine vaccinations. These trials demonstrate that NeisVac-C induces a good immune response against serogroup C.⁸⁰

Post-licensure data from the United Kingdom MenC vaccination program show that 1 dose in young children is 83–100% effective.^81,141 This program used a combination of MenC vaccines.

The Netherlands and Iceland used NeisVac-C exclusively in their MenC vaccination programs. Data from these countries showed falling rates of serogroup C cases among both vaccinated and unvaccinated people, and no vaccine failures among vaccinated people.^142,143

The population-wide use of NeisVac-C in national vaccination programs has resulted in marked reductions in serogroup C invasive meningococcal disease in the eligible age groups, including in Australia.^81,112,141 Although antibody levels wane after vaccination with meningococcal C conjugate vaccines,^144-146 current serogroup C meningococcal disease epidemiology in Australia suggests ongoing protection in age groups who were previously vaccinated.¹¹²

For all meningococcal vaccines, transport according to National vaccine storage guidelines: Strive for 5.¹²⁸ Store at +2°C to +8°C. Do not freeze. Protect from light.

MenACWY vaccines

MenQuadfi is supplied as a clear, colourless, sterile solution in a vial. It can be stored at temperatures up to 25°C for up to 72 hours.

Menveo must be reconstituted. Add the entire contents of the liquid MenCWY vial to the lyophilised MenA vial and shake vigorously until the powder completely dissolves. Use reconstituted vaccine as soon as practicable. If it must be stored, hold at +2°C to +8°C for no more than 24 hours.

Nimenrix must be reconstituted. Add the entire contents of the pre-filled syringe or ampoule of solvent to the vial and shake well until the powder completely dissolves. Use reconstituted vaccine promptly. Reconstituted vaccine is stable at temperatures up to 30°C for up to 8 hours.

MenB vaccines

Bexsero is supplied as a suspension for injection in a 1.0 mL (Type I glass) pre-filled syringe. A fine off-white deposit may form in the syringe after storage. Shake the vaccine well before use to form a homogeneous suspension.

Trumenba is supplied as a white suspension in a pre-filled syringe. Shake the vaccine vigorously to obtain a homogeneous white suspension. Do not use the vaccine if it cannot be resuspended.

MenC vaccines

NeisVac-C is supplied as a semi-opaque white to off-white suspension in a pre-filled syringe. Shake the vaccine thoroughly to obtain a homogeneous suspension.

Invasive meningococcal disease is a notifiable disease in all states and territories in Australia.

Prompt diagnosis and medical treatment of suspected cases of meningococcal disease are critical.

The Communicable Diseases Network Australia national guidelines for invasive meningococcal disease¹⁴⁸ have details about the management of cases and contacts.

Local and state and territory public health authorities can provide further advice about the public health management of meningococcal disease.

The local, state or territory public health authorities will decide whether vaccination is needed for:

• close contacts of a meningococcal disease case, such as people with household or household-like contact
• people in an institutional or community setting during a meningococcal disease outbreak

These decisions will be made according to the national guidelines.¹⁴⁸

The product information for all meningococcal vaccines states that there are no data on the use of these vaccines in lactating women. The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that breastfeeding women can receive meningococcal vaccines.

MenQuadfi

The product information for MenQuadfi states that a single booster dose can be given to adolescents and adults who have been primed with meningococcal vaccine at least 4 years prior.

ATAGI recommends that people of all ages with ongoing increased risk of invasive meningococcal disease can receive booster doses:

• for people ≤6 years of age when they finished the primary course — 3 years after completing the primary schedule, then every 5 years after that
• for people ≥7 years of age when they finished the primary course — every 5 years after completing the primary schedule

Menveo

The product information for Menveo states that the vaccine is for use in people aged ≥2 months. ATAGI recommends that the vaccine can be given to people aged ≥6 weeks.

MenQuadfi, Menveo and Nimenrix

The product information for MenQuadfi, Menveo and Nimenrix state that vaccine should be administered as a single dose to people aged ≥2 years. 

ATAGI recommends that these vaccines can be given in a 2- or 3-dose primary schedule to people aged ≥2 years who are at increased risk of invasive meningococcal disease according to Table. Recommendations for MenACWY vaccine for people with a specified medical condition that increases their risk of invasive meningococcal disease.

Bexsero

The product information for Bexsero states that this vaccine is for use in people aged ≥2 months. ATAGI recommends that this vaccine can be given to people aged ≥6 weeks.

The product information for Bexsero refers to the final dose of the primary schedule in infants aged 2–11 months as a booster dose. 

The Australian Immunisation Handbook refers to the final dose of the primary schedule for infants aged 2–11 months as a 3rd dose. 

The product information for Bexsero states that for infants aged 2–5 months the 3rd (referred to as a booster dose) should be given in the second year of life (age 12 months or later) with an interval of at least 6 months between the primary vaccination series and the 3rd dose. 

ATAGI recommends that infants aged 6 weeks to 5 months should receive the 3rd dose at age 12 months or 8 weeks after the 2nd dose, whichever is later.

The product information for Bexsero states that for all children aged 12–23 months a booster dose is recommended with an interval of 12–23 months between the primary series and booster dose.

ATAGI recommends that for children aged ≤6 years, only children with specified medical conditions that increase the risk of invasive meningococcal disease should receive a single booster dose 3 years after completing the primary schedule. A booster dose is not recommended for people at standard background risk of invasive meningococcal disease.

The product information for Bexsero states that children aged 2–10 years at the start of the vaccine course should receive 2 primary doses, with an interval not less than 1 month between doses.

ATAGI recommends that children aged 2–10 years at the start of the vaccine course should receive 2 primary doses, with an interval not less than 8 weeks between doses.

The product information for Bexsero states that adolescents and adults aged ≥11 years at the start of the vaccine course should receive 2 primary doses, with an interval not less than 1 month between doses.

ATAGI recommends that adolescents and adults aged ≥11 years at the start of the vaccine course should receive 2 primary doses, with an interval not less than 8 weeks between doses.

Trumenba

The product information for Trumenba states that people aged ≥10 years with a specified medical condition associated with increased risk of meningococcal disease should receive 2 doses, at least 1 month apart, followed by a 3rd dose at least 4 months after the 2nd dose.

ATAGI recommends that people aged ≥10 years with a specified medical condition associated with increased risk of meningococcal disease should receive 2 doses, at least 1 month apart, followed by a 3rd dose at least 6 months after the 1st dose.

The product information for Trumenba states that this vaccine should be administered as a 2-dose primary schedule or a 3-dose primary schedule for individuals at increased risk.

ATAGI recommends that people with specified medical conditions and laboratory workers who are at occupational risk of exposure to Neisseria meningitides and have completed the primary series of Trumenba should receive a single booster dose of Trumenba.

1. Granoff DM, Gupta RK, Belshe RB, Anderson EL. Induction of immunologic refractoriness in adults by meningococcal C polysaccharide vaccination. Journal of Infectious Diseases 1998;178:870-4.
2. Artenstein MS, Brandt BL. Immunologic hyporesponsiveness in man to group C meningococcal polysaccharide. Journal of Immunology 1975;115:5-7.
3. Richmond P, Kaczmarski E, Borrow R, et al. Meningococcal C polysaccharide vaccine induces immunologic hyporesponsiveness in adults that is overcome by meningococcal C conjugate vaccine. Journal of Infectious Diseases 2000;181:761-4.
4. Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis. The Lancet Infectious Diseases 2010;10:853-61.
5. Bruce MG, Rosenstein NE, Capparella JM, et al. Risk factors for meningococcal disease in college students. JAMA 2001;286:688-93.
6. Bergman BP, Hayton JC, Green AD. Effectiveness of the meningococcal vaccination programme for British Armed Forces recruits. Communicable Disease and Public Health 2000;3:298-9.
7. Harrison LH, Dwyer DM, Maples CT, Billmann L. Risk of meningococcal infection in college students. [erratum appears in JAMA 2000 May 24-31;283(20):2659]. JAMA 1999;281:1906-10.
8. Soeters HM, Whaley M, Alexander-Scott N, et al. Meningococcal carriage evaluation in response to a serogroup B meningococcal disease outbreak and mass vaccination campaign at a college – Rhode Island, 2015–2016. Clinical Infectious Diseases 2017;64:1115-22.
9. MacLennan J, Kafatos G, Neal K, et al. Social behavior and meningococcal carriage in British teenagers. Emerging Infectious Diseases 2006;12:950-7.
10. Stuart JM, Cartwright KA, Robinson PM, Noah ND. Effect of smoking on meningococcal carriage. The Lancet 1989;2:723-5.
11. Vesikari T, Karvonen A, Bianco V, Van der Wielen M, Miller J. Tetravalent meningococcal serogroups A, C, W-135 and Y conjugate vaccine is well tolerated and immunogenic when co-administered with measles–mumps–rubella–varicella vaccine during the second year of life: an open, randomized controlled trial. Vaccine 2011;29:4274-84.
12. Klein NP, Reisinger KS, Johnston W, et al. Safety and immunogenicity of a novel quadrivalent meningococcal CRM-conjugate vaccine given concomitantly with routine vaccinations in infants. Pediatric Infectious Disease Journal 2012;31:64-71.
13. Nolan TM, Nissen MD, Naz A, et al. Immunogenicity and safety of a CRM-conjugated meningococcal ACWY vaccine administered concomitantly with routine vaccines starting at 2 months of age. Human Vaccines and Immunotherapeutics 2014;10:280-9.
14. Block SL, Shepard J, Garfield H, et al. Immunogenicity and safety of a 3- and 4-dose vaccination series of a meningococcal ACWY conjugate vaccine in infants: results of a phase 3b, randomized, open-label trial. Pediatric Infectious Disease Journal 2016;35:e48-59.
15. Klein NP, Shepard J, Bedell L, Odrljin T, Dull P. Immunogenicity and safety of a quadrivalent meningococcal conjugate vaccine administered concomitantly with measles, mumps, rubella, varicella vaccine in healthy toddlers. Vaccine 2012;30:3929-36.
16. Blanchard-Rohner G, Snape MD, Kelly DF, et al. The B-cell response to a primary and booster course of MenACWY-CRM197 vaccine administered at 2, 4 and 12 months of age. Vaccine 2013;31:2441-8.
17. Knuf M, Pantazi-Chatzikonstantinou A, Pfletschinger U, et al. An investigational tetravalent meningococcal serogroups A, C, W-135 and Y-tetanus toxoid conjugate vaccine co-administered with InfanrixTM hexa is immunogenic, with an acceptable safety profile in 12–23-month-old children. Vaccine 2011;29:4264-73.
18. Ruiz-Palacios GM, Huang LM, Lin TY, et al. Immunogenicity and safety of a booster dose of the 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine coadministered with the tetravalent meningococcal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine in toddlers: a randomized trial. Pediatric Infectious Disease Journal 2013;32:62-71.
19. Klein NP, Baine Y, Bianco V, et al. One or two doses of quadrivalent meningococcal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine is immunogenic in 9- to 12-month-old children. Pediatric Infectious Disease Journal 2013;32:760-7.
20. Merino Arribas JM, Carmona Martínez A, Horn M, et al. Safety and immunogenicity of the quadrivalent meningococcal serogroups A, C, W and Y tetanus toxoid conjugate vaccine coadministered with routine childhood vaccines in European infants: an open, randomized trial. Pediatric Infectious Disease Journal 2017;36:e98-e107.
21. GlaxoSmithKline Study Register. Immunogenicity and safety study of GSK Biologicals' meningococcal conjugate vaccine (GSK 134612) when co-administered with routine vaccines in healthy infants and toddlers. (Study ID: 114858 – MenACWY-TT-087). 2017. (Accessed May 2018). https://www.gsk-clinicalstudyregister.com/study/114858#rs
22. Arguedas A, Soley C, Loaiza C, et al. Safety and immunogenicity of one dose of MenACWY-CRM, an investigational quadrivalent meningococcal glycoconjugate vaccine, when administered to adolescents concomitantly or sequentially with Tdap and HPV vaccines. Vaccine 2010;28:3171-9.
23. Ostergaard L, Silfverdal SA, Berglund J, et al. A tetravalent meningococcal serogroups A, C, W-135, and Y tetanus toxoid conjugate vaccine is immunogenic and well-tolerated when co-administered with Twinrix® in subjects aged 11–17 years: an open, randomised, controlled trial. Vaccine 2012;30:774-83.
24. Aplasca-De Los Reyes MR, Dimaano E, Macalalad N, et al. The investigational meningococcal serogroups A, C, W-135, Y tetanus toxoid conjugate vaccine (ACWY-TT) and the seasonal influenza virus vaccine are immunogenic and well-tolerated when co-administered in adults. Human Vaccines and Immunotherapeutics 2012;8:881-7.
25. Schilling A, Parra MM, Gutierrez M, et al. Coadministration of a 9-valent human papillomavirus vaccine with meningococcal and Tdap vaccines. Pediatrics 2015;136:e563-72.
26. Reisinger KS, Block SL, Collins-Ogle M, et al. Safety, tolerability, and immunogenicity of Gardasil given concomitantly with Menactra and Adacel. Pediatrics 2010;125:1142-51.
27. Findlow J, Bai X, Findlow H, et al. Safety and immunogenicity of a four-component meningococcal group B vaccine (4CMenB) and a quadrivalent meningococcal group ACWY conjugate vaccine administered concomitantly in healthy laboratory workers. Vaccine 2015;33:3322-30.
28. Macias Parra M, Gentile A, Vazquez Narvaez JA, et al. Immunogenicity and safety of the 4CMenB and MenACWY-CRM meningococcal vaccines administered concomitantly in infants: a phase 3b, randomized controlled trial. Vaccine 2018;36:7609-17.
29. Beran J, Dražan D, Enweonye I, Bhusal C, Toneatto D. Immunogenicity and safety of investigational MenABCWY vaccine and of 4CMenB and MenACWY vaccines administered concomitantly or alone: A phase 2 randomized study of adolescents and young adults. mSphere 2021;6:e0055321.
30. Muse D, Christensen S, Bhuyan P, et al. A phase 2, randomized, active-controlled, observer-blinded study to assess the immunogenicity, tolerability and safety of bivalent rLP2086, a meningococcal serogroup B vaccine, coadministered with tetanus, diphtheria and acellular pertussis vaccine and serogroup A, C, Y and W-135 meningococcal conjugate vaccine in healthy US adolescents. Pediatric Infectious Disease Journal 2016;35:673-82.
31. Senders S, Bhuyan P, Jiang Q, et al. Immunogenicity, tolerability and safety in adolescents of bivalent rLP2086, a meningococcal serogroup B vaccine, coadministered with quadrivalent human papilloma virus vaccine. Pediatric Infectious Disease Journal 2016;35:548-54.
32. Vesikari T, Esposito S, Prymula R, et al. Immunogenicity and safety of an investigational multicomponent, recombinant, meningococcal serogroup B vaccine (4CMenB) administered concomitantly with routine infant and child vaccinations: results of two randomised trials. The Lancet 2013;381:825-35.
33. Gossger N, Snape MD, Yu LM, et al. Immunogenicity and tolerability of recombinant serogroup B meningococcal vaccine administered with or without routine infant vaccinations according to different immunization schedules: a randomized controlled trial. JAMA 2012;307:573-82.
34. Prymula R, Esposito S, Zuccotti GV, et al. A phase 2 randomized controlled trial of a multicomponent meningococcal serogroup B vaccine (I): effects of prophylactic paracetamol on immunogenicity and reactogenicity of routine infant vaccines and 4CMenB. Human Vaccines and Immunotherapeutics 2014;10:1993-2004.
35. De Serres G, Gariépy MC, Billard MN, Rouleau I. Initial dose of a multicomponent serogroup B meningococcal vaccine in the Saguenay–Lac-Saint-Jean Region, Québec, Canada: an interim safety surveillance report. Quebec, Canada: Institut National de Santé Publique du Québec; 2014.
36. Letson GW, Little JR, Ottman J, Miller GL. Meningococcal vaccine in pregnancy: an assessment of infant risk. Pediatric Infectious Disease Journal 1998;17:261-3.
37. O'Dempsey TJ, McArdle T, Ceesay SJ, et al. Meningococcal antibody titres in infants of women immunised with meningococcal polysaccharide vaccine during pregnancy. Archives of Disease in Childhood. Fetal and Neonatal Edition 1996;74:F43-6.
38. Keyserling H, Papa T, Koranyi K, et al. Safety, immunogenicity, and immune memory of a novel meningococcal (groups A, C, Y, and W-135) polysaccharide diphtheria toxoid conjugate vaccine (MCV-4) in healthy adolescents. Archives of Pediatrics and Adolescent Medicine 2005;159:907-13.
39. Keyserling HL, Pollard AJ, DeTora LM, Gilmet GP. Experience with MCV-4, a meningococcal, diphtheria toxoid conjugate vaccine against serogroups A, C, Y and W-135. Expert Review of Vaccines 2006;5:445-59.
40. Vesikari T, Forstén A, Boutriau D, et al. Randomized trial to assess the immunogenicity, safety and antibody persistence up to three years after a single dose of a tetravalent meningococcal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine in toddlers. Human Vaccines and Immunotherapeutics 2012;8:1892-903.
41. Baxter R, Baine Y, Ensor K, et al. Immunogenicity and safety of an investigational quadrivalent meningococcal ACWY tetanus toxoid conjugate vaccine in healthy adolescents and young adults 10 to 25 years of age. Pediatric Infectious Disease Journal 2011;30:e41-8.
42. Perrett KP, Snape MD, Ford KJ, et al. Immunogenicity and immune memory of a nonadjuvanted quadrivalent meningococcal glycoconjugate vaccine in infants. Pediatric Infectious Disease Journal 2009;28:186-93.
43. Bermal N, Huang LM, Dubey AP, et al. Safety and immunogenicity of a tetravalent meningococcal serogroups A, C, W-135 and Y conjugate vaccine in adolescents and adults. Human Vaccines 2011;7:239-47.
44. Tregnaghi M, Lopez P, Stamboulian D, et al. Immunogenicity and safety of a quadrivalent meningococcal polysaccharide CRM conjugate vaccine in infants and toddlers. International Journal of Infectious Diseases 2014;26:22-30.
45. Bona G, Castiglia P, Zoppi G, et al. Safety and immunogenicity of a CRM or TT conjugated meningococcal vaccine in healthy toddlers. Vaccine 2016;34:3363-70.
46. Halperin SA, Diaz-Mitoma F, Dull P, Anemona A, Ceddia F. Safety and immunogenicity of an investigational quadrivalent meningococcal conjugate vaccine after one or two doses given to infants and toddlers. European Journal of Clinical Microbiology and Infectious Diseases 2010;29:259-67.
47. Tseng HF, Sy LS, Ackerson BK, et al. Safety of quadrivalent meningococcal conjugate vaccine in 11- to 21-year-olds. Pediatrics 2017;139:e20162084.
48. Reisinger KS, Baxter R, Block SL, et al. Quadrivalent meningococcal vaccination of adults: phase III comparison of an investigational conjugate vaccine, MenACWY-CRM, with the licensed vaccine, Menactra. Clinical and Vaccine Immunology: CVI 2009;16:1810-5.
49. Siberry GK, Warshaw MG, Williams PL, et al. Safety and immunogenicity of quadrivalent meningococcal conjugate vaccine in 2- to 10-year-old human immunodeficiency virus-infected children. Pediatric Infectious Disease Journal 2012;31:47-52.
50. Siberry GK, Williams PL, Lujan-Zilbermann J, et al. Phase I/II, open-label trial of safety and immunogenicity of meningococcal (groups A, C, Y, and W-135) polysaccharide diphtheria toxoid conjugate vaccine in human immunodeficiency virus-infected adolescents. Pediatric Infectious Disease Journal 2010;29:391-6.
51. van der Vliet D, Vesikari T, Sandner B, et al. Immunogenicity and safety of a quadrivalent meningococcal tetanus toxoid-conjugate vaccine (MenACYW-TT) vs. a licensed quadrivalent meningococcal tetanus toxoid-conjugate vaccine in meningococcal vaccine-naïve and meningococcal C conjugate vaccine-primed toddlers: a phase III randomised study. Epidemiology and Infection 2021;149:e50.
52. Dhingra MS, Namazova-Baranova L, Arredondo-Garcia JL, et al. Immunogenicity and safety of a quadrivalent meningococcal tetanus toxoid-conjugate vaccine administered concomitantly with other paediatric vaccines in toddlers: a phase III randomised study. Epidemiology and Infection 2021;149:e90.
53. Baccarini CI, Simon MW, Brandon D, et al. Safety and immunogenicity of a quadrivalent meningococcal conjugate vaccine in healthy meningococcal-naïve children 2-9 years of age: A phase iii, randomized study. Pediatric Infectious Disease Journal 2020;39:955-60.
54. Dhingra MS, Peterson J, Hedrick J, et al. Immunogenicity, safety and inter-lot consistency of a meningococcal conjugate vaccine (MenACYW-TT) in adolescents and adults: A Phase III randomized study. Vaccine 2020;38:5194-201.
55. Chang LJ, Hedrick J, Christensen S, et al. A phase II, randomized, immunogenicity and safety study of a quadrivalent meningococcal conjugate vaccine, MenACYW-TT, in healthy adolescents in the United States. Vaccine 2020;38:3560-9.
56. Áñez G, Hedrick J, Simon MW, et al. Immunogenicity and safety of a booster dose of a quadrivalent meningococcal tetanus toxoid-conjugate vaccine (MenACYW-TT) in adolescents and adults: a Phase III randomized study. Human Vaccines and Immunotherapeutics 2020;16:1292-8.
57. Jackson LA, Baxter R, Reisinger K, et al. Phase III comparison of an investigational quadrivalent meningococcal conjugate vaccine with the licensed meningococcal ACWY conjugate vaccine in adolescents. Clinical Infectious Diseases 2009;49:e1-10.
58. Lagos R, Papa T, Muñoz A, et al. Safety and immunogenicity of a meningococcal (Groups A, C, Y, W-135) polysaccharide diphtheria toxoid conjugate vaccine in healthy children aged 2 to 10 years in Chile. Human Vaccines 2005;1:228-31.
59. 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. Pediatric Infectious Disease Journal 2005;24:57-62.
60. Pina LM, Bassily E, Machmer A, Hou V, Reinhardt A. Safety and immunogenicity of a quadrivalent meningococcal polysaccharide diphtheria toxoid conjugate vaccine in infants and toddlers: three multicenter phase III studies. Pediatric Infectious Disease Journal 2012;31:1173-83.
61. Noya F, McCormack D, Reynolds DL, Neame D, Oster P. Safety and immunogenicity of two doses of quadrivalent meningococcal conjugate vaccine or one dose of meningococcal group C conjugate vaccine, both administered concomitantly with routine immunization to 12- to 18-month-old children. Canadian Journal of Infectious Diseases and Medical Microbiology 2014;25:211-6.
62. Weston WM, Friedland LR, Wu X, Howe B. Immunogenicity and reactogenicity of co-administered tetanus–diphtheria–acellular pertussis (Tdap) and tetravalent meningococcal conjugate (MCV4) vaccines compared to their separate administration. Vaccine 2011;29:1017-22.
63. Hansen J, Zhang L, Klein NP, et al. Post-licensure safety surveillance study of routine use of quadrivalent meningococcal diphtheria toxoid conjugate vaccine. Vaccine 2017;35:6879-84.
64. Bryan P, Seabroke S, Wong J, et al. Safety of multicomponent meningococcal group B vaccine (4CMenB) in routine infant immunisation in the UK: a prospective surveillance study. The Lancet Child and Adolescent Health 2018;2:395-403.
65. Seabroke S, Bryan P. Safety of meningococcal group B vaccine: experience from the UK. Drug Safety 2017;40:1003.
66. Hall GC, Douglas I, Heath PT, et al. Post-licensure observational safety study after meningococcal B vaccine 4CMenB (Bexsero) vaccination within the routine UK immunisation program. Vaccine 2021;39:3296-303.
67. Santolaya ME, O'Ryan ML, Valenzuela MT, et al. Immunogenicity and tolerability of a multicomponent meningococcal serogroup B (4CMenB) vaccine in healthy adolescents in Chile: a phase 2b/3 randomised, observer-blind, placebo-controlled study. The Lancet 2012;379:617-24.
68. Iro MA, Snape MD, Voysey M, et al. Persistence of bactericidal antibodies following booster vaccination with 4CMenB at 12, 18 or 24months and immunogenicity of a fifth dose administered at 4years of age-a phase 3 extension to a randomised controlled trial. Vaccine 2017;35:395-402.
69. Martinón-Torres F, Carmona Martinez A, Simkó R, et al. Antibody persistence and booster responses 24-36 months after different 4CMenB vaccination schedules in infants and children: A randomised trial. Journal of Infection 2018;76:258-69.
70. Nolan T, Santolaya ME, de Looze F, et al. Antibody persistence and booster response in adolescents and young adults 4 and 7.5 years after immunization with 4CMenB vaccine. Vaccine 2019;37:1209-18.
71. Sadarangani M, Sell T, Iro MA, et al. Persistence of immunity after vaccination with a capsular group B meningococcal vaccine in 3 different toddler schedules. Canadian Medical Association Journal 2017;189:E1276-e85.
72. Snape MD, Philip J, John TM, et al. Bactericidal antibody persistence 2 years after immunization with 2 investigational serogroup B meningococcal vaccines at 6, 8 and 12 months and immunogenicity of preschool booster doses: a follow-on study to a randomized clinical trial. Pediatric Infectious Disease Journal 2013;32:1116-21.
73. Snape MD, Saroey P, John TM, et al. Persistence of bactericidal antibodies following early infant vaccination with a serogroup B meningococcal vaccine and immunogenicity of a preschool booster dose. Canadian Medical Association Journal 2013;185:E715-24.
74. Szenborn L, Block SL, Jackowska T, et al. Immune responses to booster vaccination with meningococcal ABCWY vaccine after primary vaccination with either investigational or licensed vaccines: a phase 2 randomized study. Pediatric Infectious Disease Journal 2018;37:475-82.
75. Folaranmi T, Rubin L, Martin SW, Patel M, MacNeil JR. Use of serogroup B meningococcal vaccines in persons aged ≥10 years at increased risk for serogroup B meningococcal disease: recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR. Morbidity and Mortality Weekly Report 2015;64:608-12.
76. Vesikari T, Østergaard L, Diez-Domingo J, et al. Meningococcal serogroup B bivalent rLP2086 vaccine elicits broad and robust serum bactericidal responses in healthy adolescents. Journal of the Pediatric Infectious Diseases Society 2016;5:152-60.
77. MacNeil JR, Rubin L, Folaranmi T, et al. Use of serogroup B meningococcal vaccines in adolescents and young adults: recommendations of the Advisory Committee on Immunization Practices, 2015. MMWR. Morbidity and Mortality Weekly Report 2015;64:1171-6.
78. Patton ME, Stephens D, Moore K, MacNeil JR. Updated recommendations for use of MenB-FHbp serogroup B meningococcal vaccine – Advisory Committee on Immunization Practices, 2016. MMWR. Morbidity and Mortality Weekly Report 2017;66:509-13.
79. Vesikari T, Østergaard L, Beeslaar J, et al. Persistence and 4-year boosting of the bactericidal response elicited by two- and three-dose schedules of MenB-FHbp: A phase 3 extension study in adolescents. Vaccine 2019;37:1710-9.
80. Borrow R, Findlow J. Prevention of meningococcal serogroup C disease by NeisVac-CTM. Expert Review of Vaccines 2009;8:265-79.
81. Campbell H, Borrow R, Salisbury D, Miller E. Meningococcal C conjugate vaccine: the experience in England and Wales. Vaccine 2009;27 Suppl 2:B20-9.
82. Pöllabauer EM, Petermann R, Ehrlich HJ. Group C meningococcal polysaccharide-tetanus toxoid conjugate vaccine: a meta-analysis of immunogenicity, safety and posology. Human Vaccines 2005;1:131-9.
83. Rüggeberg J, Heath PT. Safety and efficacy of meningococcal group C conjugate vaccines. Expert Opinion on Drug Safety 2003;2:7-19.
84. Report of the Committee on Safety of Medicines Expert Working Group on Meningococcal Group C Conjugate Vaccines. 21 May 2002. (Accessed May 2018). http://webarchive.nationalarchives.gov.uk/20141205150130/http://www.mhr…
85. Robinson P, Taylor K, Nolan T. Risk-factors for meningococcal disease in Victoria, Australia, in 1997. Epidemiology and Infection 2001;127:261-8.
86. McCall BJ, Neill AS, Young MM. Risk factors for invasive meningococcal disease in southern Queensland, 2000–2001. Internal Medicine Journal 2004;34:464-8.
87. Centers for Disease Control and Prevention (CDC). Meningococcal disease. In: Hamborsky J, Kroger A, Wolfe C, eds. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington, DC: Public Health Foundation; 2015. https://www.cdc.gov/vaccines/pubs/pinkbook/index.html
88. Ross SC, Densen P. Complement deficiency states and infection: epidemiology, pathogenesis and consequences of Neisserial and other infections in an immune deficiency. Medicine 1984;63:243-73.
89. Figueroa J, Andreoni J, Densen P. Complement deficiency states and meningococcal disease. Immunology Research 1993;12:295-311.
90. Figueroa JE, Densen P. Infectious diseases associated with complement deficiencies. Clinical Microbiology Reviews 1991;4:359-95.
91. Lundbo LF, Harboe ZB, Sandholdt H, et al. Comorbidity increases the risk of invasive meningococcal disease in adults. Clinical Infectious Diseases 2021.
92. Taha MK, Weil-Olivier C, Bouée S, et al. Risk factors for invasive meningococcal disease: a retrospective analysis of the French national public health insurance database. Human Vaccines and Immunotherapeutics 2021;17:1858-66.
93. Ladhani SN, Campbell H, Lucidarme J, et al. Invasive meningococcal disease in patients with complement deficiencies: a case series (2008-2017). BMC Infectious Diseases 2019;19:522.
94. Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. British Journal of Surgery 1991;78:1031-8.
95. Francke EL, Neu HC. Postsplenectomy infection. Surgical Clinics of North America 1981;61:135-55.
96. Cohen C, Singh E, Wu HM, et al. Increased incidence of meningococcal disease in HIV-infected individuals associated with higher case-fatality ratios in South Africa. AIDS 2010;24:1351-60.
97. Miller L, Arakaki L, Ramautar A, et al. Elevated risk for invasive meningococcal disease among persons with HIV. Annals of Internal Medicine 2014;160:30-7.
98. D'Amelio R, Molica C, Biselli R, Stroffolini T. Surveillance of infectious diseases in the Italian military as pre-requisite for tailored vaccination programme. Vaccine 2001;19:2006-11.
99. Froeschle JE. Meningococcal disease in college students. Clinical Infectious Diseases 1999;29:215-6.
100. Neal KR, Nguyen-Van-Tam J, Monk P, et al. Invasive meningococcal disease among university undergraduates: association with universities providing relatively large amounts of catered hall accommodation. Epidemiology and Infection 1999;122:351-7.
101. Harrison LH, Granoff DM, Pollard AJ. Meningococcal capsular group A, C, W, and Y conjugate vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
102. Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP). Updated recommendations for use of meningococcal conjugate vaccines – Advisory Committee on Immunization Practices (ACIP), 2010. MMWR. Morbidity and Mortality Weekly Report 2011;60:72-6.
103. Tully J, Viner RM, Coen PG, et al. Risk and protective factors for meningococcal disease in adolescents: matched cohort study. BMJ 2006;332:445-50.
104. Simon MS, Weiss D, Gulick RM. Invasive meningococcal disease in men who have sex with men. Annals of Internal Medicine 2013;159:300-1.
105. European Centre for Disease Prevention and Control. Rapid risk assessment: invasive meningococcal disease among men who have sex with men. Stockholm: ECDC; 2013. http://www.ecdc.europa.eu/en/publications/Publications/rapid-risk-asses…
106. Marcus U, Vogel U, Schubert A, et al. A cluster of invasive meningococcal disease in young men who have sex with men in Berlin, October 2012 to May 2013. Eurosurveillance 2013;18(28):pii=20523.
107. Schmink S, Watson JT, Coulson GB, et al. Molecular epidemiology of Neisseria meningitidis isolates from an outbreak of meningococcal disease among men who have sex with men, Chicago, Illinois, 2003. Journal of Clinical Microbiology 2007;45:3768-70.
108. Tsang RS, Kiefer L, Law DK, et al. Outbreak of serogroup C meningococcal disease caused by a variant of Neisseria meningitidis serotype 2a ET-15 in a community of men who have sex with men. Journal of Clinical Microbiology 2003;41:4411-4.
109. Vyse A, Anonychuk A, Jäkel A, Wieffer H, Nadel S. The burden and impact of severe and long-term sequelae of meningococcal disease. Expert Review of Anti-Infective Therapy 2013;11:597-604.
110. Borg J, Christie D, Coen PG, Booy R, Viner RM. Outcomes of meningococcal disease in adolescence: prospective, matched-cohort study. Pediatrics 2009;123:e502-9.
111. Viner RM, Booy R, Johnson H, et al. Outcomes of invasive meningococcal serogroup B disease in children and adolescents (MOSAIC): a case-control study. The Lancet Neurology 2012;11:774-83.
112. NNDSS Annual Report Working Group. Australia's notifiable disease status, 2014: annual report of the National Notifiable Diseases Surveillance System. Communicable Diseases Intelligence 2016;40:E48-145.
113. Archer BN, Chiu CK, Jayasinghe SH, et al. Epidemiology of invasive meningococcal B disease in Australia, 1999–2015: priority populations for vaccination. Medical Journal of Australia 2017;207:382-7.
114. Lahra MM, George CRR, Shoushtari M, Hogan TR. Australian Meningococcal Surveillance Programme Annual Report, 2020. Commun Dis Intell (2018) 2021;45.
115. Patel C, Dey A, Wang H, et al. Summary of national surveillance data on vaccine preventable diseases in Australia, 2016-2018 final report. Commun Dis Intell (2018) 2022;46.
116. Australian Government Department of Health. Invasive meningococcal disease national surveillance report with a focus on MenW. 31 October 2017. (Accessed May 2018). http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-menin…
117. McMillan M, Wang B, Koehler AP, Sullivan TR, Marshall HS. Impact of meningococcal b vaccine on invasive meningococcal disease in adolescents. Clinical Infectious Diseases 2021;73:e233-e7.
118. Wang B, Giles L, Andraweera P, et al. Effectiveness and impact of the 4CMenB vaccine against invasive serogroup B meningococcal disease and gonorrhoea in an infant, child, and adolescent programme: an observational cohort and case-control study. The Lancet Infectious Diseases 2022;22:1011-20.
119. Martin NV, Ong KS, Howden BP, et al. Rise in invasive serogroup W meningococcal disease in Australia 2013–2015. Communicable Diseases Intelligence 2016;40:E454-9.
120. Lahra MM, Enriquez RP. Australian Meningococcal Surveillance Programme annual report, 2015. Communicable Diseases Intelligence 2016;40:E503-11.
121. Sudbury EL, O'Sullivan S, Lister D, Varghese D, Satharasinghe K. Case manifestations and public health response for outbreak of meningococcal W disease, Central Australia, 2017. Emerging Infectious Diseases 2020;26:1355-63.
122. Flood L, McConnell M, Molchanoff L, et al. Lessons from a community vaccination programme to control a meningococcal disease serogroup W outbreak in remote South Australia, 2017. Western Pacific Surveillance and Response Journal : WPSAR 2021;12:26-31.
123. Northern Territory Government Department of Health. Update – meningococcal outbreak in Central Australia [media release]. 10 October 2017. (Accessed May 2018). http://mediareleases.nt.gov.au/mediaRelease/23779
124. Ostergaard L, Vesikari T, Absalon J, et al. A bivalent meningococcal B vaccine in adolescents and young adults. New England Journal of Medicine 2017;377:2349-62.
125. Toneatto D, Ismaili S, Ypma E, et al. The first use of an investigational multicomponent meningococcal serogroup B vaccine (4CMenB) in humans. Human Vaccines 2011;7:646-53.
126. Kimura A, Toneatto D, Kleinschmidt A, Wang H, Dull P. Immunogenicity and safety of a multicomponent meningococcal serogroup B vaccine and a quadrivalent meningococcal CRM197 conjugate vaccine against serogroups A, C, W-135, and Y in adults who are at increased risk for occupational exposure to meningococcal isolates. Clinical and Vaccine Immunology: CVI 2011;18:483-6.
127. GlaxoSmithKline Australia Pty Ltd. Product information: Bexsero® suspension for injection. 2017. (Accessed May 2018). https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI?OpenForm…
128. Parikh SR, Andrews NJ, Beebeejaun K, et al. Effectiveness and impact of a reduced infant schedule of 4CMenB vaccine against group B meningococcal disease in England: a national observational cohort study. The Lancet 2016;388:2775-82.
129. Jackson LA, Jacobson RM, Reisinger KS, et al. A randomized trial to determine the tolerability and immunogenicity of a quadrivalent meningococcal glycoconjugate vaccine in healthy adolescents. Pediatric Infectious Disease Journal 2009;28:86-91.
130. Borja-Tabora C, Montalban C, Memish ZA, et al. Immune response, antibody persistence, and safety of a single dose of the quadrivalent meningococcal serogroups A, C, W-135, and Y tetanus toxoid conjugate vaccine in adolescents and adults: results of an open, randomised, controlled study. BMC Infectious Diseases 2013;13:116.
131. Pichichero M, Papa T, Blatter M, et al. Immune memory in children previously vaccinated with an experimental quadrivalent meningococcal polysaccharide diphtheria toxoid conjugate vaccine. Pediatric Infectious Disease Journal 2006;25:995-1000.
132. Sanofi Pasteur. Study of a tetravalent meningococcal diphtheria toxoid conjugate vaccine in toddlers 9 to 18 months of age. (Study ID: MTA26). 2014. (Accessed May 2018). https://clinicaltrials.gov/ct2/show/NCT00643916
133. Lujan-Zilbermann J, Warshaw MG, Williams PL, et al. Immunogenicity and safety of 1 vs 2 doses of quadrivalent meningococcal conjugate vaccine in youth infected with human immunodeficiency virus. Journal of Pediatrics 2012;161:676-81.e2.
134. Mahler MB, Taur Y, Jean R, et al. Safety and immunogenicity of the tetravalent protein-conjugated meningococcal vaccine (MCV4) in recipients of related and unrelated allogeneic hematopoietic stem cell transplantation. Biology of Blood and Marrow Transplantation 2012;18:145-9.
135. Cohn AC, MacNeil JR, Harrison LH, et al. Effectiveness and duration of protection of one dose of a meningococcal conjugate vaccine. Pediatrics 2017;139:e20162193.
136. MacNeil JR, Cohn AC, Zell ER, et al. Early estimate of the effectiveness of quadrivalent meningococcal conjugate vaccine. Pediatric Infectious Disease Journal 2011;30:451-5.
137. MacNeil J, Cohn A, Anderson R, et al. The effectiveness of quadrivalent meningococcal conjugate vaccine (MenACWYD) – a matched case-control study [abstract O40]. Presented at: XVIIIth International Pathogenic Neisseria Conference (IPNC); September 2012; Würzburg, Germany. http://neisseria.org/ipnc/2012/IPNC_2012_abstracts.pdf
138. Baxter R, Baine Y, Kolhe D, et al. Five-year antibody persistence and booster response to a single dose of meningococcal A, C, W and Y tetanus toxoid conjugate vaccine in adolescents and young adults: an open, randomized trial. Pediatric Infectious Disease Journal 2015;34:1236-43.
139. Halperin SA, Gupta A, Jeanfreau R, et al. Comparison of the safety and immunogenicity of an investigational and a licensed quadrivalent meningococcal conjugate vaccine in children 2–10 years of age. Vaccine 2010;28:7865-72.
140. Baxter R, Reisinger K, Block SL, et al. Antibody persistence and booster response of a quadrivalent meningococcal conjugate vaccine in adolescents. Journal of Pediatrics 2014;164:1409-15.e4.
141. Campbell H, Andrews N, Borrow R, Trotter C, Miller E. Updated postlicensure surveillance of the meningococcal C conjugate vaccine in England and Wales: effectiveness, validation of serological correlates of protection, and modeling predictions of the duration of herd immunity. Clinical and Vaccine Immunology: CVI 2010;17:840-7.
142. de Greeff SC, de Melker HE, Spanjaard L, Schouls LM, van DerEnde A. Protection from routine vaccination at the age of 14 months with meningococcal serogroup C conjugate vaccine in the Netherlands. Pediatric Infectious Disease Journal 2006;25:79-80.
143. Árnason S, Thors VS, Guethnason T, Kristinsson KG, Haraldsson A. Bacteraemia in children in Iceland 1994–2005. Acta Paediatrica 2010;99:1531-5.
144. Ishola DA, Jr., Borrow R, Findlow H, et al. Prevalence of serum bactericidal antibody to serogroup C Neisseria meningitidis in England a decade after vaccine introduction. Clinical and Vaccine Immunology: CVI 2012;19:1126-30.
145. Borrow R, Abad R, Trotter C, van der Klis FR, Vazquez JA. Effectiveness of meningococcal serogroup C vaccine programmes. Vaccine 2013;31:4477-86.
146. Khatami A, Peters A, Robinson H, et al. Maintenance of immune response throughout childhood following serogroup C meningococcal conjugate vaccination in early childhood. Clinical and Vaccine Immunology: CVI 2011;18:2038-42.
147. National vaccine storage guidelines: Strive for 5. 3rd ed. Canberra: Australian Government Department of Health and Ageing; 2019. https://www.health.gov.au/resources/publications/national-vaccine-stora…
148. Communicable Diseases Network Australia (CDNA). Invasive meningococcal disease: CDNA national guidelines for public health units. Canberra: Australian Government Department of Health; 2017. http://www.health.gov.au/cdnasongs