Rise in unlinked meningococcal cases: what GPs need to know

Emma Tinning

writer

Emma Tinning

Health and Public Policy Adviser

Emma Tinning

Meningococcal B strain is responsible for most recent cases in NSW, but free access to that vaccine is limited

A 50-year-old Sydney resident has died, while a Sydney teenager and a person in their 60s on NSW’s Central Coast are recovering from seemingly unlinked cases of meningococcal disease

So far this year, 19 cases have been reported in NSW, with the majority due to the meningococcal B strain.

Meningococcal is caused by the bacterium Neisseria meningitidis, which is transmitted by close, prolonged household and intimate contact. The disease progresses very rapidly, and deaths can occur within hours if not treated with antibiotics.

Around 1 in 10 cases result in death and one in five cases cause permanent damage including brain damage, deafness, limb deformity and limb loss.

Professor Paul Van Buynder from School of Medicine at Griffith University (and the immediate past Chairman of the Australian Immunisation Coalition) says meningococcal cases are on the rise, as are most infectious diseases after several years of lockdowns due to the pandemic.

However, Professor Van Buynder says cases tend to occur in clusters, making the three recent unlinked cases unusual. He also notes that the age of two of the cases – in their 50s and 60s – is much less common, which highlights the need for all community members and health professionals to be vigilant.

“While meningococcal is most common in infants and adolescents, these recent cases demonstrate that people of all ages may be susceptible,” he says.

Professor Van Buynder recognises that diagnosing meningococcal in primary care can be difficult due to both its rarity and the similarity of early symptoms, such as fever, nausea and vomiting, do other illnesses.

“Meningococcal is the most rapidly fatal disease known and is incredibly difficult to diagnose early. When a patient first presents it can be challenging for GP to differentiate between meningococcal and any other winter virus,” he says.

Professor Van Buynder says GPs should advise people to seek urgent medical help if their condition worsens within hours of seeing them.

Importantly, he says that the consistent increase in meningococcal cases is largely driven by meningococcal B.

Free access to vaccines varies

Vaccination against the most common strains – A, C, W, Y and B – has reduced the number of infections in the community.  However, while meningococcal vaccines for strains ACWY and for strain B are available through national and state-based programs, eligibility for free access varies.

The National Immunisation Program funds the meningococcal ACWY for infants at 12 months and adolescents aged 14-19.  It also funds the meningococcal B vaccine for Aboriginal and Torres Strait Islander children at 2, 4 and 12 months of age.

In addition, the NIP funds the both the ACWY and B vaccines for people of all ages with asplenia and hyposplenia, complement deficiency and those receiving treatment with eculizumab.

However, South Australia is the only state where the meningococcal B vaccine is also funded for all children from 6 weeks to 12 months of age and adolescents in Year 10.

Professor Van Buynder believes the federal government should add the Meningococcal B vaccine to the National Immunisation Program for all children and adolescents to bring it in line with the ACWY vaccine funding.

He also says many parents and adolescents are unaware that the Meningococcal B vaccine is available on private prescription.

And while it’s relatively expensive – requiring three doses at $120-130 per dose – Professor Van Buynder says GPs need to keep patients informed about vaccination options.

“If you’re a GP you must make parents aware that the Meningococcal B vaccine is available. GPs should not assume parents can’t afford it.”

However, even those who are vaccinated may be at risk, so it’s important for health professionals to be vigilant.

If symptoms rapidly worsen, call triple zero or send the person to the nearest emergency department.

 

Symptoms of meningococcal disease

  • Sudden onset of fever
  • rash of red-purple pin pricks or bruises
  • headache
  • neck stiffness
  • photophobia
  • muscle aches
  • cold hands and feet
  • confusion
  • irritability
  • joint pain
  • nausea and vomiting
  • In babies, high-pitched crying

Dr Daryl Cheng explains the role of the MenACWY-TT conjugate vaccine for invasive meningococcal disease, the importance of adolescent vaccination and opportunistic immunisation, and the healthcare professional’s role in improving uptake rates in this age group. Watch the short video here >>

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Emma Tinning

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Emma Tinning

Health and Public Policy Adviser

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