Meningococcal Vaccination Update by Dr Sarah Taylor
Updated 04/12/18 ** UPDATE: EXTENSION OF WA GOVERNMENT FUNDED ACWY VACCINATION FOR 1-4 YEAR OLDS FOR 2019**
Confused about the current recommendations and availability of meningococcal vaccinations? Read on…
Meningococcal infection, as most are aware, often has serious consequences including death and significant disability. It can be hard to spot early and can progress rapidly. It is most common in the very young (0-4 years) and in adolescents (15-19 years of age) but can happen to anyone especially those with compromised immune systems. There are many strains – A, B, C, W and Y.
Traditionally, meningococcal B and C strains were the most common causes of meningococcal infection in Australia. Children in Australia have long been vaccinated against meningococcal C at 12 months of age during their routine immunisations. As such meningococcal C has been at an all time low and, as a result, meningococcal B was typically the most prevalent. In 2016 there were 6 cases in WA of meningococcal B and 93 cases in the whole of Australia. There is now a vaccine available against meningococcal B (called Bexsero) but it is not on the schedule. Patients can pay for it themselves. It is around $150 per vaccination (private health funds will often rebate some of this cost) and people over 2 years of age require 2 vaccinations 8 weeks apart. It can be given safely after 2 months of age but more booster doses are required depending upon age. It is safe to be given with the routine vaccinations at 2, 4 and 6 months. The vaccine itself seems to have a higher rate of causing fevers than other vaccinations and predosing with paracetamol is recommended. It has been used in large populations (in Canada and the UK) with no serious safety concerns and, like all immunisations, safety surveillance is ongoing. Immunity does not last forever and it seems that booster doses in the future may be recommended after 3-5 years.
MENINGOCOCCAL A, C, W and Y
To complicate matters you may have heard about meningococcal W recently. In years gone by there was roughly only one case of this strain throughout the whole of Australia each year. As it was so rare routine immunisation was previously not routinely recommended despite a vaccination being available. Vaccines that include the W strain are called Menveo, Menactra and Niminrix, and they contain other strains also (A, C, W and Y). W has been increasing over the last 5 years and in 2016, in WA alone, there were 12 cases. In the whole of Australia there were 110 cases in 2016. Similar increases were seen in 2017 and 2018. This strain can be harder to diagnose and seems to have a higher fatality rate.
There was an outbreak of 6 cases in Kalgoorlie and a targeted government funded vaccination programme was implemented in this area in 2017. Since then, in late 2017, the WA government funded vaccines for 15-19 year olds. Patients in this age range can get their vaccination free of charge through their school or GP. Additionally, in January 2018, the WA government also funded this vaccine for 1 to < 5 year olds. Please ring for an appointment to get your 1-4 year old (inclusive) vaccinated – our reception will check if we have the correct vaccine in stock so you must mention it when booking. We will also offer it at routine 12 month, 18 month and 4 year old scheduled vaccines; although you can bring your child in earlier to get immunity earlier.
Since this announcement the ACWY vaccination has been added to the Australian vaccination schedule at 12 months of age. As it can be given from 8 weeks of age (and under 1 year olds are actually at the highest risk) some people are still choosing to give it earlier than the schedule and paying for this themselves. This requires a number of booster doses rather than just the one at 12 months of age. Please request a script through reception if you would like to do this.
For people outside the scheduled age range ACWY vaccination can be bought privately, which many of our patients have chosen to do, and is safe to give to anyone over 2 months of age. Privately it costs around $100. Younger children need more booster doses so check with our practice nurse or your doctor. The side effects which may occur following administration of this vaccine are no more significant than other vaccinations on the schedule.
To purchase either of these (if you or your child fall outside the government funded age range) you will need to call reception to request a script and then purchase the vaccine from a pharmacy. We should have stock in our fridge for those who qualify for ACWY (1-5 year olds and 15-19 year olds) but please check with reception when the appointment is made. Please note that new information is coming out all the time and we will keep our information as up to date as possible. We hope meningoccal b vaccination may be placed on the schedule at some point, but currently there is no indication that this will happen.
The decision to vaccinate is yours to consider. This quick overview is to arm you with the facts so you can make the right decision for your family. We understand that vaccinating a family can be costly. Remember that meningococcal is very rare – in 2016 there were 1.1 cases per 100 000 people – however the consequences can be significant. If you wish to discuss this further please make an appointment with your doctor. If you would like to get one, or both, of these vaccinations you are welcome to call for a script.