Meningococcal vaccines – frequently asked questions (FAQs)

Meningococcal

Key points

  • Invasive meningococcal disease (IMD) is a serious infectious disease caused by the bacterium Neisseria meningitidis. Meningitis and septicaemia are the two main forms of IMD.
     
  • Meningococcal bacteria are present in saliva and are spread through close or lengthy contact with an infected person (e.g. kissing, living in close quarters).
     
  • Meningococcal infection can progress quickly and requires urgent medical treatment to prevent serious complications or death.
     
  • There are 13 known meningococcal serogroups (strains). The A, B, C, W and Y strains are responsible for most meningococcal disease worldwide.
     
  • Meningococcal vaccination is recommended for anyone who wants to minimise their risk of IMD.
     
  • Individuals considered at highest risk of meningococcal infection include infants under the age of 2 years, adolescents aged 15–19 years and people in special risk groups.
     
  • There are two types of meningococcal vaccines available in Australia: meningococcal ACWY vaccines and the meningococcal B vaccine. Together, these vaccines protect against the five most common disease-causing strains of meningococcal bacteria (A, B, C, W and Y).
     
  • The National Immunisation Program funds meningococcal ACWY and meningococcal B vaccines for certain age groups and for people with medical conditions that increase their risk of meningococcal disease.

FAQs

What is meningococcal disease?

Meningococcal disease is an infection caused by the bacterium Neisseria meningitidis. The two main types of meningococcal infection are: 

  • infections of the lining around the brain and spinal cord (meningitis)
  • bloodstream infections (septicaemia, which can lead to a life-threatening condition called sepsis). 

Together, these are known as invasive meningococcal disease (IMD).

How do you get meningococcal infection?

Meningococcal bacteria are spread through the sharing of respiratory and throat secretions (saliva) via close or lengthy contact with other people, such as via kissing or living in close quarters.

What are the potential complications of invasive meningococcal disease (IMD)?

While IMD is a rare disease, it is serious and causes significant illness, disability and death. IMD can lead to meningitis or sepsis when: 

  • meningococcal disease results in meningitis, a dangerous swelling of the membranes that line the brain and spinal cord
  • a meningococcal bloodstream infection (also called septicaemia) occurs and bacteria enter the blood. This can lead to sepsis, a very serious condition that can cause organ and tissue damage, organ failure and death. 

Around 20 per cent of people who survive IMD have long-term consequences or disabilities. These can include limb deformity or amputation, permanent brain damage, skin scarring, deafness and other neurological complications.

Who is at risk of meningococcal disease?

While anyone can get meningococcal disease, certain people are at an increased risk – including: 

  • infants
  • children
  • adolescents
  • young adults, with the highest risk among those who live in close quarters or who are current smokers
  • Aboriginal and Torres Strait Islander people
  • people with certain medical conditions
  • laboratory workers who handle the meningococcal bacteria Neisseria meningitidis
  • travellers.
Which meningococcal vaccines are available in Australia?

There are three meningococcal vaccines available in Australia to protect against four of the meningococcal serogroups (A, C, W and Y). 

  • MenQuadfi
  • Menveo
  • Nimenrix. 

The above are referred to as quadrivalent conjugate vaccines or MenACWY vaccines.

There is one vaccine available to protect against the meningococcal B (MenB) serogroup: Bexsero. 

There is one monovalent (single-serogroup) vaccine available that protects against serogroup C only: NeisVac-C (MenC). 

Who should be vaccinated against meningococcal disease? 

Any person aged over 6 weeks who wants to reduce their risk of meningococcal disease caused by serogroups A, B, C, W and Y is recommended to receive:

  • MenACWY vaccine
  • MenB vaccine.

Vaccination with both MenACWY and MenB vaccines is recommended for the following groups who have the highest rates of IMD and meningococcal carriage:

  • all infants and young children aged less than 2 years
  • adolescents aged 15–19 years
  • all Aboriginal and Torres Strait Islander people aged 2 months–19 years
  • people with certain medical conditions that increase the risk of meningococcal disease – specifically:
    • defects in, or deficiency of, complement components, including factor H, factor D or properdin deficiency
    • people with acquired complement deficiency due to receipt of complement inhibitor therapy (including, but not limited to, eculizumab, ravulizumab and pegcetacoplan)
    • functional or anatomical asplenia, including sickle cell disease or other haemoglobinopathies, and congenital or acquired asplenia
    • human immunodeficiency virus (HIV) – regardless of disease stage or CD4+ cell count
    • haematopoietic stem cell transplant
  • laboratory personnel who handle the meningococcal bacteria Neisseria meningitidis
  • adolescents and young adults aged 15–24 years who:
    • live in close conditions (e.g. military recruits or people living in residential accommodation), since meningococcal bacteria are carried and spread more frequently in these contexts
    • are current smokers; smokers have a higher risk of carrying the meningococcal bacteria.

MenACWY vaccine is also recommended for people travelling to countries where there is an increased risk of exposure to meningococcal A, C, W or Y disease, such as: 

Which MenACWY vaccines are available for each age group in Australia?

There are three brands of MenACWY vaccine available for use in Australia; each of these brands is registered for use in a different age group:

  • Nimenrix (Pfizer): Registered for use in people aged 6 weeks and over
  • Menveo (GlaxoSmithKline): Registered for use in people aged 2 months and over
  • MenQuadfi (Sanofi Pasteur): Registered for people aged 12 months and over. 

MenQuadfi and Nimenrix are funded under the National Immunisation Program for eligible groups (see Who is eligible to receive a free MenACWY vaccine under the National Immunisation Program (NIP)? ). 

How many doses of MenACWY vaccine are required?

The number of doses of MenACWY vaccine required varies according to: 

Nimenrix and Menveo are registered for infants aged over 2 months but can be used in infants from 6 weeks of age. 

MenQuadfi should only be used for children aged 12 months and over. 

While MenACWY vaccine is included on the NIP schedule at 12 months of age, if it is requested earlier, more doses are recommended and will need to be paid for privately.

Infants aged less than 12 months can receive two of the three brands of MenACWY vaccine (Menveo and Nimenrix). For children aged 12 months and over, there is no preference between MenACWY vaccine brands (MenQuadfi, Menveo or Nimenrix).

For clinical recommendations on booster doses for MenACWY vaccine, see Are booster doses of meningococcal vaccines recommended?

Who is eligible to receive a free MenACWY vaccine under the National Immunisation Program (NIP)?

The MenACWY vaccine is available for free under the NIP for:

  • children at 12 months of age (Nimenrix)
  • adolescents aged 14–16 years (MenQuadfi)
  • all people with certain specified medical risk conditions (Nimenrix) – specifically:
    • inherited defects or deficiency of properdin or complement components
    • current or future treatment with eculizumab
    • functional or anatomical asplenia.
Which MenB vaccines are available in Australia?

One meningococcal B (MenB) vaccine is available in Australia: Bexsero (GlaxoSmithKline).

Bexsero (4CMenB) can be given from 6 weeks of age. It is funded under the NIP for eligible groups (see Who is eligible to receive a free MenB vaccine under the NIP?).

How many doses of MenB vaccine are needed?

The number of doses of MenB vaccine required varies according to the age at which vaccination commences and the presence of medical conditions that increase the risk of IMD: 

  • Infants starting vaccination at 6 weeks–11 months of age require a three-dose schedule.
  • Infants starting at 6 weeks to 5 months of age who have an increased risk of IMD are recommended a four-dose schedule.
  • Individuals commencing their primary course aged 12 months and over require two doses, given eight weeks apart, regardless of the presence of medical conditions that increase the risk of IMD.

For clinical recommendations on booster doses for MenB vaccine, see Are booster doses of meningococcal vaccines recommended?

Who is eligible to receive a free MenB vaccine under the NIP?

The MenB vaccine is available for free under the NIP for:

  • Aboriginal and Torres Strait Islander infants from 6 weeks of age, with a catch-up program for infants and young children aged less than 2 years
  • all Aboriginal and Torres Strait Islander people with any of the following specified medical risk conditions:
    • inherited defects or deficiency of properdin or complement components
    • current or future treatment with eculizumab
    • functional or anatomical asplenia
    • HIV, regardless of disease stage or CD4+ cell count  
    • haematopoietic stem cell transplant
  • all non-Indigenous people with certain specified medical risk conditions:
    • inherited defects or deficiency of properdin or complement components
    • current or future treatment with eculizumab
    • functional or anatomical asplenia.

Some states and territories also have their own funded MenB vaccination programs – check with your local health authority.

Are booster doses of meningococcal vaccines recommended? 

MenACWY

In people of any age without medical risk conditions, routine booster doses of MenACWY vaccine after vaccination with an age-appropriate number of doses are not recommended. 

Regular booster doses of MenACWY vaccine are recommended for people who are at increased risk of meningococcal infection – specifically: 

  • people with certain medical conditions
  • laboratory personnel who handle the meningococcal bacteria Neisseria meningitidis
  • people who frequently travel to areas where there is an increased risk of exposure to meningococcal disease. 

Booster doses should be administered every 3–5 years in accordance with Australian Immunisation Handbook recommendations. 

Serological testing to determine immune status is not needed or recommended.
 

MenB

Routine booster doses of MenB vaccine are not currently recommended in Australia for healthy people of any age, with the exception of some laboratory personnel. 

People at increased risk of meningococcal disease – specifically, people with certain medical conditions and some laboratory personnel – are recommended to receive a single

MenB booster dose, as per Australian Immunisation Handbook recommendations.

What are the vaccine recommendations for people with medical conditions that increase the risk of meningococcal disease?

Additional doses of MenACWY and MenB vaccines are recommended for people with certain medical conditions that increase the risk of meningococcal disease. These conditions include: 

  • inherited defects or deficiency of properdin or complement components
  • current or future treatment with eculizumab
  • functional or anatomical asplenia
  • HIV, regardless of disease stage or CD4+ cell count
  • haematopoietic stem cell transplant. 

The number of doses needed depends on the vaccine brand used and the person’s age when they started the vaccine course. More detailed recommendations can be found in the Australian Immunisation Handbook.

For information on risk conditions funded under the NIP, see Who is eligible to receive a free MenACWY vaccine under the National Immunisation Program (NIP)? and Who is eligible to receive a free MenB vaccine under the NIP?

What are the common side effects after receiving meningococcal vaccines?

Individuals may experience a mild fever, injection site reaction, general tiredness or muscle aches after vaccination. These symptoms are usually mild and resolve on their own.

A moderately higher rate of fever has been observed in infants and young children following receipt of the MenB vaccine (Bexsero). Prophylactic use of paracetamol (i.e. a preventative dose given 30 minutes before vaccination and up to twice after vaccination at six-hourly intervals [PDF], whether or not fever is present) reduces the risk of fever and is recommended with every dose of Bexsero in those aged less than 2 years. 

More information about common side effects can be found in the Australian Government Department of Health, Disability and Ageing resource Following vaccination – what to expect and what to do.

Additional details on adverse events following meningococcal vaccination can be found in the Australian Immunisation Handbook.

Are there any contraindications or precautions in relation to use of meningococcal vaccines?

The only absolute contraindications for meningococcal vaccines are: 

  • past anaphylaxis following a previous dose of the relevant vaccine
  • past anaphylaxis due to any component in the meningococcal vaccine. 

Previous meningococcal disease (regardless of serogroup) is not a contraindication to vaccination.

To prevent fever, prophylactic administration of paracetamol before and after Bexsero vaccination is recommended for infants and young children aged less than 2 years.

If an adolescent has previously received MenACWY and MenB vaccinations as an infant or child, should they still receive the adolescent dose?

Yes. Healthy adolescents who have received the MenACWY vaccine in the past should receive a single dose of the NIP-funded MenACWY vaccine after they turn 14 years of age. 

Adolescents with medical conditions that increase their risk of IMD who have received the MenACWY vaccine in the past should receive booster doses every 3–5 years in accordance with the Australian Immunisation Handbook recommendations.

Adolescents without medical risk conditions who have received the MenB vaccine in the past should receive a single dose of MenB vaccine after they turn 14 years of age.

Adolescents with medical conditions that increase their risk of IMD who have received the MenB vaccine in the past should receive the equivalent of a full primary course (2 doses) of vaccine.

For both MenACWY and MenB vaccines, the minimum interval between past vaccination and receiving the adolescent dose is 8 weeks. 

Immunogenicity data for MenB and MenACWY vaccination support waiting as long as 5 years between doses; however, it may be preferred to give the vaccine earlier if trying to capture adolescents through attendance at school vaccination clinics. Repeat vaccination can offer a benefit by boosting immunity and does not increase the risk of side effects.

Can a different brand of MenACWY vaccine be used to complete a meningococcal vaccination course?

For MenACWY vaccines, it is preferred that the same vaccine brand is used when giving subsequent doses as part of a primary course, especially for infants and young children.

A different brand can be substituted in cases where the initial brand used is unavailable or not known. 

In clinical trials, where an alternative brand was used as a booster dose in children, equivalent levels of immune response were found in those who had been re-vaccinated with a similar brand and those who had received a different brand.

A different brand of MenACWY vaccine may be used among people who require booster doses every 3–5 years (depending on age at primary course).

If an individual has started MenB vaccination with Trumenba and it is no longer available, what is recommended? 

Trumenba is a MenB vaccine that was previously available in Australia but has now been discontinued. If a person did not complete a primary course of Trumenba, they should restart their primary course and receive two doses of Bexsero, eight weeks apart. 

If a person who received a primary course of Trumenba now requires a booster dose, Bexsero can be used and will still provide protection.

Can a person receive other vaccines at the same time as meningococcal vaccine?

Yes, MenACWY and MenB vaccines can be administered at the same time as other routine NIP childhood vaccinations. 

Infants and young children aged less than 2 years have an increased risk of fever if Bexsero is co-administered with other routine vaccines, compared with when these vaccines are given separately. The likelihood of fever can be reduced using prophylactic paracetamol.

For children receiving multiple vaccines at the same time at 12 months of age, it is recommended that Bexsero and 13-valent pneumococcal conjugate vaccine (13vPCV), which can cause relatively higher rates of local reactions than other vaccines, be administered in separate limbs.

What are the recommended sites for administering meningococcal vaccines?

Nimenrix and Bexsero are administered via an intramuscular injection. It is recommended that these vaccines are administered in the vastus lateralis on the anterolateral thigh for infants less than 12 months. 

For individuals aged 12 months and over, it is recommended that the vaccine be administered in the deltoid muscle. 

For young children receiving multiple vaccines at the same time at 12 months of age, it is recommended that Bexsero and 13vPCV (pneumococcal vaccine) be administered in separate limbs. 

Vaccines administered in the same limb should be separated by at least 2.5 cm. For more information, see the NCIRS resource Recommended sites for vaccination.

Can Nimenrix be co-administered with other tetanus toxoid-containing vaccines?

It is recommended that the meningococcal vaccine be co-administered with – or given before – the tetanus toxoid-containing vaccines wherever possible. 

Ideally, giving Nimenrix shortly after a tetanus toxoid-containing vaccine such as Infanrix Hexa or Boostrix should be avoided, due to possible interference with immune response.

Can an infant or child receive Nimenrix if they have recently received the tetanus toxoid-containing vaccine Infanrix Hexa?

There is no need to delay vaccination with Nimenrix if Infanrix Hexa has been given as part of the primary course in infants aged less than 12 months. From 12 months of age, if Infanrix Hexa has already been given MenACWY vaccine should be given as originally scheduled and should not be delayed.

Although the child’s immune response to the MenACWY vaccine may be slightly lower, the child will still have protection against meningococcal disease. Vaccination in this sequential order is still preferred to delaying or missing the dose at an age when the risk of disease is high.

Can adolescents aged 10–19 years who require a catch-up dose of MenC vaccine receive MenACWY vaccine?

Yes – vaccination with MenACWY vaccine provides protection against MenC disease. 

Vaccination with a MenACWY vaccine is funded under the NIP for adolescents aged 14–19 years and for those born after 1 July 2017 who require it as a catch-up for a missed NIP-funded 12-month dose. 

The Australian Immunisation Handbook includes more details on catch-up requirements in people aged 10 years and over.

If a person has been in close contact with someone who has been diagnosed with meningococcal disease, do they require vaccination?

Where a person has been in close contact with an individual diagnosed with meningococcal disease, the healthcare provider of the close contact should approach their relevant state or territory public health authority as soon as possible for: 

  • advice on determining the risk of disease
  • guidance on management, including whether to offer clearance antibiotics or vaccination.
How effective has the meningococcal vaccine program in Australia been at reducing meningococcal disease?

The overall incidence of meningococcal disease has fallen in Australia since the introduction of national meningococcal vaccine programs. 

These programs have successfully reduced the incidence of IMD caused by meningococcal serogroup C. The proportion of IMD caused by serogroups W and Y increased from 2013 and 2015, respectively. However, the proportion of meningococcal W disease has fallen since state and territory  MenACWY vaccination programs were introduced in 2017 and MenACWY vaccine was subsequently incorporated onto the NIP. 

Most IMD in Australia is currently caused by meningococcal serogroup B, for which vaccination coverage is lower and funded vaccines are (except for select groups) less widely available.

How is the safety of meningococcal vaccines monitored?

The Therapeutic Goods Administration (TGA) assesses the quality of every batch of vaccine, including meningococcal vaccine, before it is distributed in Australia. It also collects, analyses and reports data on vaccine side effects once a vaccine is in use. 

Individuals and healthcare providers can also report side effects directly to the TGA. 

Additionally, AusVaxSafety collects information from individuals on side effects experienced after vaccination, including meningococcal vaccination. Experts analyse this information to monitor for any safety problems.

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