Meningococcal Disease

What is the 'meningococcus'?

The meningococcus is a bacterium that can be found at the back of the throat or in the nose of up to 20% of the community at any given time. Although the vast majority of people who 'carry' this germ in their throat or nose remain quite well, they are able to spread it to others, a few of whom may subsequently become very ill.

Meningococcal disease is a severe infection that occurs when the meningococcal germ 'invades' the body from the throat or nose. It does not occur in people who carry the germ but rather occurs in people who have very recently (within the previous 7 days) acquired the germ from a healthy 'carrier'.

Young children under 5 years of age, and young adults (15 - 24 years of age) are at highest risk of acquiring the disease, and there is usually a seasonal increase in the winter to early spring months.

Meningococcal disease occurs in two main forms or it can occur as a combination of these two forms:

• Septicaemia – which occurs when the germ invades the bloodstream and causes blood poisoning.
• Meningitis – which occurs when the germ infects and causes inflammation of the outer lining around the brain and spinal cord.

Septicaemia can be very serious and cause death after even a very short illness. The patient usually is:

• Obviously sick 
• Has a fever and may have marked joint or muscle pains
• Often has a rash.

The rash may start anywhere on the body as tiny red or purple spots but they soon spread and enlarge to look like fresh bruises; the rash does not fade when pressure is applied to it, eg. with the thumb. The rash must be taken seriously as the person requires urgent medical attention.

The typical symptoms of meningitis include:

• Fever
• A stiff neck
• Severe headache
• Dislike of bright lights
• Vomiting
• Joint or muscle pains
• Drowsiness, confusion and even coma
• There may also be a rash with the same features as described above.

The symptoms of meningitis in young babies may differ from those detailed above and include: 

• Refusing feeds
• Vomiting
• A high pitched moaning cry
• Irritability and a dislike of being handled
• A blank staring expression
• Lethargy or drowsiness and
• A pale blotchy complexion.

How easy is it to catch the disease?

Although the germ is frequently passed around in the community, it fortunately only causes actual sickness in a very small number of people.

The germ is spread in large droplets that are shed from the nose or throat. Close and prolonged contact with a carrier is usually required for the germ to spread to other people.

The larger droplets from the back of the throat that can carry the organism (e.g. when a person coughs or sneezes) do not travel very far - only 0.5 – 1.0 metres.

Saliva is much less contagious than the large droplets from the very back of the throat.

Saliva has actually been shown to inhibit the growth of the meningococcal germ. Whilst it used to be emphasized that behaviours such as sharing cigarettes or drink bottles were a risk, evidence now indicates that it is prolonged close contact - e.g. families and other groups living together in close quarters -that is more likely to provide the opportunities for large droplets to carry the germ from one person to another.

Furthermore, the meningococcal germ does not survive for long outside the body. In this sense it is quite different from highly contagious diseases such as measles - where there are millions of virus particles in tiny droplets that can also be spread into the atmosphere when an infected person coughs or sneezes. These very small droplets can remain suspended in the air carrying the virus for several hours.

Another big difference between meningococcal disease and infections such as measles is that if a person who has never had measles before is exposed in a household, there is a 95% chance that they will develop the measles illness, whereas there is less than a 5% chance of meningococcal disease occurring in close household contacts, which is reduced to a much lower level again (less than 1%) if the household members are provided with antibiotic clearance.

In other words, the meningococcal germ is frequently acquired but only occasionally invades the body through the membranes of the throat to multiply in the bloodstream and cause sickness.

Certain medical conditions (particularly some uncommon immune deficiencies) can increase the risk for some individuals.

How can the disease be prevented?

Cigarette smoking can increase the risk of a person developing meningococcal disease four-fold, because tobacco smoke contains toxins that damage the natural immune mechanisms in our throat. Passive smoking also appears to increase the risk, so this is yet another reason to stop smoking and to stop adults smoking near young children.

There is a small, but real, risk that those who live in the same house as a person with meningococcal disease will also develop the disease. This is because the carrier who infected the patient is able to spread the germ to others. There is no accurate and quick test to identify the carrier so all of the 'household contacts' of the patient are regarded as potential carriers.

Public health authorities attempt to contact these household contacts to explain to them the nature of the disease and to recommend they consult a medical practitioner and be prescribed a short course of an antibiotic. The purpose of the antibiotic is to eliminate the germ from the nose or throat of the carriers. Cases of disease may occur despite taking the antibiotic so the contacts must also be told to be aware for the symptoms of the disease.

Sometimes other contacts are also identified by public health authorities and given the same advice and are recommended for antibiotic clearance. However it is very important that the public health authorities are involved in the identification of other contacts because the antibiotic should be used very carefully.

Australian public health guidelines for assessing and managing the risk to contacts were recently updated so that ‘antibiotic clearance’ is no longer thought necessary for people who have had only low levels of salivary contact with cases, such as sharing communion chalices, drink bottles or sharing cigarettes and dry lip kissing. Similarly, general social contact, sports, sharing of classrooms and other similar activities have not been shown to present any greater risk for contacts of cases than anyone else in the community.

Is there a vaccine against the disease?

Yes. There are two main vaccine types, one against Group C meningococcal disease, the other against A, C, W135 and Y strains. The latter is used in certain situations but provides shorter-lived protection than the newer Group C vaccine.

There are 3 brands of Group C vaccine available that provide protection against meningococcal group C infection. These are:

•  Meningitec
• Menjugate and
• NeisVac-C.

Only a single dose of these Group C vaccines is required for children 1 year and older. It is safe, and recommended, for children turning 1 year to be immunised with meningococcal vaccine at the same time as their MMR and HIB/Hep B vaccinations.

If given after 12 months of age a single dose of these vaccines appears sufficient to provide long lasting immunity. Further doses of vaccine are not required.

The vaccine against meningococcal group C infection is now funded by the Commonwealth for all children at 12 months of age. In addition, there is a "catch-up" program to immunise all people between the ages of 1 and 19. This vaccine is also provided free of charge (until the program ends in June 2006) although service providers may charge a fee for their service. Vaccine may be accessed by these groups via their GP or council clinic.

Two vaccines (Mencevax and Menomune) are also available, which cover those strains of meningococcal germs that may be encountered in some overseas countries (A, C, Y and W135) – this is recommended for people over 2 years of age who are travelling to certain countries. However, unlike Group C vaccine, the duration of protection is only about 3 years. Vaccine for travel purposes is not provided free of charge.

These short-acting vaccines are the ones used in the recent Tasmanian funded meningococcal vaccination program offered to Health Care Card holders. If you or your child received this vaccine greater than 6 months ago it is safe to have the long lasting vaccine (Meningitec, Menjugate and NeisVac-C).

It should be noted that none of the vaccines currently available protect against the group B strain of the meningococcal germ, which can sometimes be a cause of infection.

You should talk to your doctor or local council about your particular situation if you are interested in immunisation.

For further information access the following resources or contact the Public and Environmental Health Service: Phone: 1800 671 738: 

How can you tell if someone has meningococcal disease?

How can you tell if a baby has meningococcal disease?

Information for schools about preventing the spread of meningococcal disease

Meningococcal Septimcaemia & Meningitis Symptoms Card