Kiwi Parents Urged to Immunise Infants & Teens Against Meningococcal B with New Vaccine

Kiwi parents of infants, toddlers and adolescents can now immunise their children against the country’s most common type of meningococcal disease (meningococcal B) with the launch of a new vaccine.

Meningococcal disease is an uncommon but life-threatening bacterial infection causing two serious illnesses: meningitis (an infection of the membranes that cover the brain) and septicaemia (blood poisoning)[1],[2].

Even with appropriate medical care, around one in every ten patients who contract the disease will die, and up to one in five survivors will have permanent disabilities; such as brain damage, amputated limbs and hearing loss[2],[3],[4].

In New Zealand meningococcal B can strike at any age, but is most frequent in babies and children under five, followed by teenagers[5],[6]. Māori and Pasifika infants under one year of age have approximately six times higher meningococcal B rates compared to other populations in New Zealand[5],[6].

Vaccinologist, Senior Lecturer in the Department of General Practice and Primary Health Care at Auckland University Dr Helen Petousis-Harris, says meningococcal B is a rapid and unpredictable disease which can cause death within 24 hours[7],[8],[9].

Due to its flu-like symptoms meningococcal B can be difficult to diagnose, but can progress quickly. Along with headaches, fever, and a sore neck, patients may also present with a rash[10].

“Meningococcal B is a disease that every parent knows about and every doctor is terrified of missing, it's a disease we’re all scared of,” she says.

A strain of the disease specific to New Zealand, resulted in a significant and prolonged meningococcal B epidemic between 1991 and 2007 resulting in 6128 cases and claiming 252 lives[11]. In response to the epidemic, a short-term nationwide vaccination programme using a tailor made vaccine (MeNZB) was introduced from 2004-2008[12].

Dr Petousis-Harris says toddlers who were immunised during the last epidemic will now be entering the high risk adolescent age group and will need to be vaccinated again if protection from the disease is to be maintained.

The new vaccine, Bexsero, includes the active component of the MeNZB vaccine, as well as three other antigenic components to help improve strain coverage[13],[14].

Dr Petousis-Harris says infants are one of the most vulnerable groups who need to be immunised against meningococcal B.

“Infants will have not yet developed natural immunity which is gained via the harmless carriage of both meningococcal and other similar bacteria. In other words their bodies have not been educated to protect them against meningococcal disease should the bacteria invade their bloodstream. Children at pre-school or daycare are also at greater risk.

“Once we get older we develop other risk factors. In the case of adolescents it is likely lifestyle factors play a part. Sharing of spit, smoking, drinking, staying up late, perhaps preceding viral infections. We actually have incomplete knowledge about why some people get meningococcal disease, it is an insidious infection,” she says.

Dr Petousis-Harris says as crowding is a major risk factor for the disease it is recommended that those students heading off to university receive the vaccine.

“Students living in hostel accommodation are one of the groups who are at increased risk of meningococcal disease. This is likely because they are in closer contact with a larger number of people.

There is higher carriage of the bug among this group and it is transmitted from person to person through respiratory droplets such as coughs and sneezes,” she says.

There are several different types or serogroups of meningococcal bacteria including groups A, B, C, W and Y, the most common in New Zealand being meningococcal group B with 70 percent of cases caused by this strain in 2016[15],[16].

Dr Petousis-Harris says overcrowding and prior respiratory infections could also be key factors in why Māori are disproportionately affected.

As a parent of a teenager I am considering purchasing a course. We have a great new vaccine that appears broadly protective to combat a really nasty disease”.

Spokesperson for the Meningitis Foundation Aotearoa NZ Andrea Brady says the organisation was founded to promote the prevention, control and awareness of the disease. The Foundation works to support families affected by meningitis and in an advocacy role improving access to vaccines.

“One death from meningococcal disease is one too many, particularly when a protective vaccine is available and has been available in other countries around the world for some time,” says Brady.

“If you talk to any family who has experienced meningococcal disease or meningitis they would say that if a vaccine is available and can save another family from experiencing the heartache or heartbreak that they have gone through, there should be no question about its availability,” says Brady.

Dr Petousis-Harris says unlike diseases like whooping cough which comes in cycles it is hard to predict when a new outbreak of meningococcal disease may occur and it is always lurking around.

Bexsero has recently been funded as part of a meningococcal B immunisation program for children and young people in South Australia and is funded on the National Immunisation Program for infants in the United Kingdom[17],[18]. Bexsero is not currently funded on the NZ National Immunisation Schedule, but is available for private purchase through healthcare professionals.

Bexsero® (Multicomponent Meningococcal group B Vaccine) is available as an injection. Bexsero is for immunisation against invasive disease caused by N. meningitidis group B from 2 months of age or as per official recommendations. Bexsero is available as a private-purchase prescription medicine – you will have to pay normal doctor’s visit fees and a prescription charge. A trained pharmacist can also administer Bexsero to a person aged 16 years and older. A 0.5 mL dose contains contains 50mcg of Neisseria meningitidis Group B Neisseria Heparin Binding Antigen fusion protein, 50mcg of Neisseria meningitidis Group B Neisseria Adhesin A protein, 50mcg of Neisseria meningitidis Group B Factor H Binding Protein fusion protein, 25 mcg of Outer membrane vesicles (OMV) from Neisseria meningitidis group B strain NZ98/254 measured as amount of total protein containing the PorA P1.4. Bexsero has risks and benefits. Bexsero should not be administered if you or your child are hypersensitive to any component of this vaccine. Common side effects Infants & Toddlers: eating disorders, sleepiness, unusual crying, diarrhoea, vomiting, rash, fever (≥39.5°C), injection site reactions, irritability, arthralgia. Adolescents & Adults: headache, nausea, injection site reactions, malaise, myalagia, arthralgia. If you or your child have side effects, see your doctor, pharmacist, or health professional. Additional Consumer Medicine Information for Bexsero is available at www.medsafe.govt.nz. Ask your doctor if Bexsero is right for you or your child. Bexsero is a registered trade mark of the GlaxoSmithKline group of companies. Marketed by GlaxoSmithKline NZ Limited, Auckland.
Adverse events involving GlaxoSmithKline products should be reported to GSK Medical Information on 0800 808 500. TAPS NA 10532/18OC/VAC/0031/18

References:

  1. Ministry of Health website. Meningococcal disease (including meningitis.) Summary Tab. Available at: https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/meningococcal-disease-including-meningitis Accessed 17 October 2018
  2. Thompson MJ, et al. Lancet 2006; 367(9508): 397–403.
  3. Immunisation Advisory Centre. Bexsero: A vaccine to protect against Meningococcal group B disease Fact Sheet. Available at http://www.immune.org.nz/sites/default/files/resources/Written%20Resources/NonprogrammeVaccineBexseroImac20180912V01Final.pdf. Accessed 15 September 2018
  4. Rosenstein NE, et al. N Engl J Med 2001; 344(18): 1378–88
  5. The Institute of Environmental Science and Research. The Epidemiology of Meningococcal Disease in NZ 2008-2013 Surveillance Reports. Available at: https://surv.esr.cri.nz/surveillance/Meningococcal_disease.php Accessed: 3rd July 2018.
  6. The Institute of Environmental Science and Research. Notifiable Diseases in New Zealand Annual Surveillance Reports 2014-2016. Available at: https://surv.esr.cri.nz/surveillance/annual_surveillance.php Accessed: 3rd July 2018.
  7. Rosenstein NE, et al. N Engl J Med 2001; 344(18): 1378–88
  8. Pelton SI. J Adolesc Health 2010; 46(2suppl2): S9-15
  9. Thompson MJ, et al. Lancet 2006; 367(9508): 397–403.
  10. Ministry of Health Meningococcal Brochure 2013. Available at https://www.healthed.govt.nz/system/files/resource-files/HE2395-Meningococcal_Brochure-WEB_0.pdf Accessed 21 October 2018.
  11. Martin, D. and L. Lopez, The epidemiology of meningococcal disease in New Zealand in 2007. May 2008: Wellington.
  12. Ministry of Health. Immunisation Handbook 2017 (2nd Edition, March 2018). Available at https://www.health.govt.nz/publication/immunisation-handbook-2017. Accessed 14 August 2018. http://www.immune.org.nz/new-zealand-national-immunisation-schedule Accessed: 16 October 2018.
  13. GlaxoSmithKline NZ. Bexsero Data Sheet 2018. Available at: http://www.medsafe.govt.nz/profs/Datasheet/b/bexseroinj.pdf Accessed: 15 August 2018.
  14. Petousis-Harris H, et al. Lancet. 2017; 390: 1603–10.
  15. Immunisation Advisory Centre. Bexsero: A vaccine to protect against Meningococcal group B disease Fact Sheet. Available at http://www.immune.org.nz/sites/default/files/resources/Written%20Resources/NonprogrammeVaccineBexseroImac20180912V01Final.pdf. Accessed 15 September 2018
  16. The Institute of Environmental Science and Research. Notifiable Diseases in New Zealand Annual Report 2016. Available at: https://surv.esr.cri.nz/
  17. SA health website. Meningococcal B Immunisation Program. Available at: http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/immunisation/immunisation+programs/meningococcal+b+immunisation+program. Accessed 18 October 2018
  18. NHS website. Vaccinations. Available at: http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/immunisation/immunisation+programs/meningococcal+b+immunisation+program. Accessed 18 October 2018