Meningococcal disease

Meningococcal disease is a rare, but potentially devastating infection. It is caused by the bacteria Neisseria meningitidis of which there are 6 disease-causing strains called serogroups (A, B, C, W, Y and X). Approximately 10 percent of the general population of the UK are thought to carry N. meningitidis in the lining of the nose and throat. Spread between individuals occurs through coughing, sneezing, kissing or during close contact with a carrier. Carriers do not have symptoms, but can develop disease when bacteria invade the bloodstream from the nasopharynx (area at the back of the nose and throat). Invasive disease is a rare but serious outcome usually presenting as septicaemia (blood poisoning) or meningitis (infection of the lining of the brain).

In most parts of the world meningococcal disease occurs as occasional cases in individuals or in small clusters. The disease is most common in the ‘meningitis belt’ of sub-Saharan Africa, which extends across the dry savannah regions from Senegal in the west, to Ethiopia in the east. These outbreaks occur particularly during the dry season and are most commonly caused by serogroup A. Following several large outbreaks associated with pilgrimage to the Kingdom of Saudi Arabia all those travelling for the Hajj or Umrah are currently required to show proof of vaccination with quadrivalent vaccine (protecting against the A,C,W and Y serogroups) in order to obtain a visa.

Invasive meningococcal disease usually presents as meningitis or septicaemia. Symptoms of meningitis include: sudden onset of fever, intense headache, neck stiffness, nausea and vomiting. Symptoms of septicaemia include: fever, chills, confusion and a rash. Both conditions may progress rapidly and are serious diseases with high risk of complications and fatality.

Prevention

Individuals should seek advice about their risk of meningitis prior to travel. Meningococcal disease in travellers is primarily a risk for those visiting areas prone to outbreaks or an area where a known outbreak is occurring. Travellers visiting such locations who are at particular risk include:

  • long stay travellers who have close contact with the local population
  • healthcare workers
  • those visiting friends and relatives
  • those who live or travel ‘rough’ such as backpackers
  • individuals with no spleen or a poorly functioning spleen
  • individuals with certain immune deficiencies

Meningococcal disease vaccines

Meningococcal vaccinations are administered as part of the routine NHS vaccination schedule. Meningococcal group C vaccination was the first meningococcal vaccination to be added to the schedule in 1999. Both meningococcal group B (Bexero®) and the quadrivalent meningococcal vaccine (protective against serogroups A,C,W and Y) will be offered to children from Autumn 2015. See NHS vaccination schedule. Travellers visiting higher risk regions are recommended to have the conjugate ACWY vaccine (Menveo® or Nimenrix®) if their planned activities put them at increased risk (see above).

Meningococcal disease vaccination schedules for travel

Age ACWY schedule

Birth to less than one year*

  • First dose of 0.5ml
  • Second dose of 0.5ml one month after the first dose

From one year of age (including adults)

Single dose of 0.5ml

* If the infant has already had two MenC vaccinations then two MenACWY conjugate vaccines should also be given.

 

As of August 2016, Menveo® has a marketing authorisation for use in children from 2 years of age, and Nimenrix® has a marketing authorisation for use in children from 12 months of age. The use of these vaccines in younger children is off-license, following Public Health England, Immunisation against infectious disease (see resources).

Resources