Meningococcal B and W. UPDATE JULY 2018

Utter the words “meningococcal disease” and you’re sure to put the fear of God into any parent.  Listen in at any mothers group in the cafe, or scroll through facebook feeds and news outlets, and you’re sure to be left confused.

Just what is all the fuss about?  Dr Sam discusses meningococcal disease and explains exactly what we need to know about the vaccines out there.

Firstly, lets discuss the facts about the disease itself.

Meningococcal disease is caused by the bacteria Nisseria meningitidis, commonly called ‘meningococcus’.  There are 13 different strains, with the most common being A, B, C, W135, and Y.

When meningococcal disease is severe it manifests as:

  • Meningitis,
  • Septicaemia (or ‘sepsis’ – an overwhelming blood infection which leads to the characteristic rash, and makes you bloody sick),
  • Or both

It mainly affects our kids, with peaks in the under fives, and teenagers (15-19 year olds).

Classically outbreaks occur in winter and early spring.  It’s transmitted by sneezing, coughing, kissing, and sharing food and drinks.

What’s all the fuss about?

Meningococcal disease garners such attention because it can be a catastrophic disease.

Whilst most people survive unscathed, it’s fatal in about 5% of cases, and a staggering 30% are left with some sort of permanent disability.  Disabilities include limb deformity, skin scarring, deafness, and other neurological issues.

What’s the current picture in Australia?

Whilst Meningococcal disease is scary, we must remember it’s a rare condition.

Historically, incidence rates hover around 3 cases for every 100,000 Australians, with B and C strains the most common.

Since 2003 we have seen the C strain virtually wiped out – thanks to the inclusion of the C strain vaccine on the national immunisation protocol for all 12 month olds.  This is a simply amazing feat and only proves the effectiveness of immunisations to all the naysayers.

The success of the C vaccine also dropped the overall prevalence of meningococcal disease to a low of 0.6cases/100,000 in 2013.  However, the number of cases is on the rise again, with 2017 (1.6cases/100,000) being the worst year since 2006.

The reason?  A rise in reported cases of the W strain, and to a lesser extent Y strain.  But don’t forget B strain is still out there…

And this now has health authorities across Australia alarmed.  Our vulnerable kids could be in big trouble.

W strain is a more deadly form of the disease, with a higher than usual death rate of 10%.  Plus, W strain infections are usually only experienced by adults – but unfortunately since 2015, it’s the kids who have been suffering – something has changed, and it’s a more virulent strain.

So what’s being done?

Health Departments across Australia have responded to this crisis by introducing ACWY strain vaccination programs.

This year sees a change to the national immunisation schedule, with the replacement of the C strain vaccine at 12 months with an ACWY vaccine.  Teenagers have also been targeted in recent years across Australia with ACWY vaccination programs, as they are most likely to harbour the W strain infection.  By protecting them, health authorities hope to halt the W strain crisis in its tracks, and therefore helping to protect all our kids.

What about our kids? Should I get my little ones vaccinated?

ACWY

For 12 month olds, there’s not much of a decision to be made because the vaccine is now part of the standard immunisation schedule.

For teenagers, I urge all to take advantage of the targeted immunisation programs that have been rolled out across Australia.

For your other kids.  In a nutshell, it’s hard to argue the case NOT to get ALL your kids vaccinated.  Frustratingly at the present time, there are no plans for catch up programs for kids of other ages (ie outside 12months old and teenagers!).  So, you’ll have to fund the vaccine yourself (around $100), with a script from your doctor.

Strain B

A vaccine was released in 2013 – 4CMenB/Bexsero – with much fanfare.  Again, it’s hard to argue the case NOT to get ALL your kids vaccinated.  But, you have to pay for this one too.  Some factors to consider for this vaccine are:

  • It costs approximately $130 per dose, with 3 or 4 doses per child required.
  • It most situations it can be given with other vaccines, including the standard immunisation schedule, however you’ll need to discuss this with your doctor first.
  • Whilst safe, we can’t say for sure how effective the vaccine is yet. But all is looking promising.
  • There is a high rate of fevers in over 50% of babies after the shot. You MUST give your child a dose of paracetamol prior to vaccination.
  • In general, it is recommended for all healthy babies under the age of 2 years, especially those with other medical conditions.
  • It is also recommended for adolescents aged 15 to 19.

“But Dr Sam, what do I DO?? What would YOU do??”

The choice to vaccinate your kids against the B and W strains will remain a personal one for each parent.

Meningococcal disease, no matter which strain is the culprit, is a rare but devastating illness.  There are vaccines available, but they come with costs and some side effects.

I urge you all to see your doctor and have a chat.

But I must admit if you ask me, its bloody hard to argue the case NOT to have ALL available meningococcal vaccines.