Meningococcal vaccine for meningitis

All babies are offered the meningococcal vaccine for immunisation against group B and group C meningococcus - with the new MenB vaccine and MenC vaccine. Adolescents are, in addition, offered immunisation against meningococcal group W (MenW) - in MenACWY. Also, if you go to certain countries, in particular Saudi Arabia and countries in sub-Saharan Africa, you should be immunised against various strains of the meningococcus before you travel. You should be immunised at least two weeks before you travel if you need this immunisation.

What is the meningococcus?

Neisseria meningitidis is a germ (bacterium) that can cause meningitis and blood infection (septicaemia). It can also cause other infections - for example, pneumonia, eye infection (conjunctivitis), joint infection (septic arthritis) and inflammation of the heart (myocarditis). It most commonly causes infections in babies under the age of 1 year. It can also cause infections in those aged 1-5 years and those aged 15-19 years.

Some of these infections are very serious and can be life-threatening if not treated quickly. There are different groups (strains or types) of meningococcal bacteria:

• Groups B, C and, more recently, W are the common strains in the UK. Most cases of bacterial meningitis in the UK are caused by group B. Most of the rest are caused by group C (although the number of group C cases has fallen greatly due to immunisation introduced in 1999). Infection caused by group W has increased in the UK in recent years.

• Group A is rare in the UK but more common in certain parts of the world - in particular, sub-Saharan Africa and parts of Saudi Arabia.

• Groups Y, 29E and Z are rare in the UK but group W has been the cause of several recent outbreaks in different parts of the world, including the UK.

Infection with the meningococcus can affect anyone but there is an increased risk to children aged under 5 years (especially babies under 1 year), teenagers and young adults under the age of 25.

Types of meningococcal vaccines

There are four types of meningococcal vaccines that help prevent meningococcal disease:

• One type of vaccine protects against group C only - the MenC vaccine (NeisVac-C® and Menjugate Kit®)

• A combined conjugate vaccine is also available which protects against group C and another bacteria called Haemophilus influenzae, that can also cause meningitis (Menitorix®)

• One type of vaccine called the MenACWY vaccine (Menveo®, MenQuadfi® and Nimenrix®) protects against groups A, C, W and Y.

• One type of vaccine protects against group B only - the MenB vaccine (Trumenba® and Bexsero®).

The vaccine stimulates your immune system to protect you against meningococcal infection should you become infected with the germs (bacteria).

Who should receive the different types of meningococcal vaccine?

Children - the MenC vaccine

The vaccine against group C is offered to all babies as part of their routine vaccinations.

• MenC immunisation has been routine in the UK since 1999. It is given when children are 12-13 months old. A booster (MenACWY) is given at school at around 14 years.

• The first dose is a combined injection with the Hib vaccine (Hib/MenC stands for Haemophilus influenzae type b and meningitis C). The booster also protects against groups A, W and Y (MenACWY) and is given alone.

• Two doses are needed to be given to make sure your child develops a really good immune response to protect them against this disease. It is thought to give lifelong immunity, so booster doses later in life are not needed.

Children - the MenB vaccine

• The vaccine against group B is also offered to all babies as part of the childhood immunisation programme. MenB immunisation has been routine in the UK since 2015. It is given when children are 8 weeks, 16 weeks and 12-13 months of age.

• The first dose is usually given at the same time as the first and third routine DTaP/IPV/Hib vaccine (see above). The third dose is given at the same time as the combined Hib and MenC vaccine (Hib/MenC) at 12-13 months (as a separate injection).

• Three doses are needed to be given to make sure your baby develops a really good immune response to protect them against this disease. A booster when your child is older is not needed.

Older children and the MenACWY vaccine

From September 2015 MenACWY began being routinely offered to schoolchildren aged 14-15. (MenC used to be given at this age). It is also offered to those aged 17-18 and young adults under the age of 25. This is because of a rise in infection with group W meningococcus in this age group.

If you are under the age of 25 and have not been immunised, see your doctor or practice nurse to get immunised. This is particularly important if you are about to start university for the first time, as the risk of infection with group W meningococcus is highest in first-year university students. Just one injection of vaccine is needed if you are over the age of 1 year. This would also be a good time to catch up on any other childhood vaccines that you missed - for example, if your parents did not approve of vaccination. Your GP will always be happy to catch you up on any missed childhood vaccinations.

People without a spleen or whose spleen does not work properly

If you do not have a spleen, or your spleen does not work properly, or you have a weakened immune system then it is likely to be recommended to you that you receive the MenB and the MenACWY vaccines. The timing of your vaccines will depend on your age. You may need more vaccines than the average person and you should ask your specialist to advise on this. In particular, those people who have an illness to do with complement (part of the immune system) which is being treated with a drug called Eculizumab® are at increased risk and may need extra vaccinations.

Travellers

You should be immunised with the MenACWY vaccine if you intend to travel to areas where meningococcal infection is a risk. This includes areas of sub-Saharan Africa (particularly in the dry season) and areas of Saudi Arabia. The risk for meningococcal meningitis is extremely low for tourists but higher for those living or working within local areas in endemic or outbreak areas. Your doctor or practice nurse can advise if you should have this immunisation for your travel destination.

The MenACWY vaccine is thought to provide good protection within a couple of weeks or so of the injection. Patients should make an appointment at least 2-3 weeks before travel in order to have had the immunisation no less than 10 days before travel. You should receive the MenACWY vaccine if you are travelling and have only received the MenC vaccine in the past.

Immunity after the MenACWY vaccine does not last as long in children under 5 years old. For babies under 1 year of age, two doses one month apart are needed for protection, but older children and adults should receive a single dose.

Muslims undergoing the Hajj or Umrah pilgrimage

Pilgrims to Saudi Arabia are especially at risk of contracting meningococcal infection. There have been outbreaks in recent years. A proof of immunisation is needed to obtain a visa to go to Saudi Arabia for this purpose.

Note: some pilgrims may have been immunised in the past with an older vaccine which only protected against groups A and C. If you travel to Saudi Arabia again you should have an injection of the newer MenACWY vaccine. Proof of immunisation with MenACWY vaccine given within the preceding three years is now needed to get a new visa to visit Saudi Arabia. (Both MenACWY vaccines have been certified as Halal.)

Contacts

Close contacts of a person with meningococcal infection may be offered immunisation. The vaccine used depends on the meningococcal group causing the illness. (Close contacts are likely to also be advised to take antibiotic medicines for a few days.)

Are there any side-effects of the meningococcal vaccines?

Most people have no side-effects after the meningococcal vaccine. A mild high temperature (fever) may develop for a short time after baby injections. Some babies cry more and become irritable for a short time after the injection.

Occasionally they may be sick (vomit) or have diarrhoea. Slight swelling, pain and redness at the injection site may occur. Headache and muscle aches for a short time can occur in some older children.

None of the above side-effects is serious, and they soon settle. It is a good idea to give your baby a single dose (60 mg) of liquid infant paracetamol at the time of their MenB vaccines at 8 and 16 weeks, or soon after, as a high temperature is a little more common after this vaccine. If necessary, you can give paracetamol or ibuprofen to children to ease pain as well as fever following immunisation. Serious reactions such as an allergic reaction are rare.

Uncommon side-effects, described in up to 1 in 100 people, are high fever, seizures (including febrile seizures), vomiting (after booster) dry skin, itchy rash, skin rash, and paleness (rare after booster).

Rare side-effects (may affect up to 1 in 1,000 people) include Kawasaki syndrome (a rare condition that mainly affects children under the age of 5 years. It is also known as mucocutaneous lymph node syndrome).

Who should not get the meningococcal vaccine?

• There are very few people who cannot be given meningococcal vaccines.

• Immunisation should be postponed if a child has a high temperature (fever) or serious infection. Minor infections such as coughs, colds and snuffles are no reason to postpone immunisation.

• The vaccine should not be given if there has been a severe reaction to a previous dose of vaccine (which is extremely rare). Also, it should not be given if a person is known to have a severe allergy to any of the ingredients in the vaccine.

• The vaccines are safe if you are breastfeeding.

• Pregnant women and those who are breastfeeding can have the vaccine if indicated.

Are you still at risk of meningitis after the immunisation?

Yes. However, the MenC vaccine has greatly reduced the number of cases of meningitis and blood infection (septicaemia) since it was introduced in 1999 and the MenB vaccine is expected to be as effective.

Note: other groups of meningococcus, and other germs (bacteria) can still cause meningitis.

You should get medical help immediately if you suspect that your child, or someone you know, has meningitis or septicaemia. The earlier the treatment of meningitis or septicaemia, the better the chance of recovery and preventing complications or death. See the separate leaflet called Meningitis. See also the separate leaflets called Sepsis (Septicaemia) and Meningitis Symptoms Checklist for more details about the symptoms of meningitis and septicaemia.