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What causes invasive meningococcal disease (IMD)?

Meningococcal disease is rare, but is easily misdiagnosed, unpredictable, and potentially deadly.12

The disease can progress from initial nonspecific symptoms, such as fever and irritability, to death in as few as 24 hours. 2, 3, 4

Bexsero Disease Progress

A serious threat with serious consequences 1, 4, 5

The consequences of meningococcal disease can be devastating 1, 4, 5

consequences

The signs and symptoms of invasive meningoccal disease (IMD)

Because early signs and symptoms of meningococcal disease are difficult to distinguish from those of more common but less serious illnesses, appropriate and potentially life-saving treatment options may be delayed. 1, 3, 6

The early signs and symptoms of IMD include fever, irritability, cold-like symptoms, headache, loss of appetite, nausea and vomiting, resemble those of common viral disease 3, 6, 7

The lack of distinct IMD specific early signs and symptoms often results in initial misdiagnosis 3

Intervention often does not occur until identification of later symptoms that are IMD specific, such as haemorrhagic rash (i.e., rash associated with bleeding under the skin surface) or neck stiffness 3

Epidemiology of Invasive Meningococcal Disease (IMD)

There are several known disease-causing serogroups of N. meningitidis with the majority (more than 90%) of invasive disease is caused by six serogroups, namely A, B, C, W, X, and Y. 6

IMD can strike at any age but is most frequent in babies, infants and young people. 4

Surveillance data from Ireland in 2018 have shown the highest frequency of disease in <1s, 1-4 year olds and 15-19 year olds. 8

MenB disease was most commonly notified serotype in 2018 in Ireland at 51.7% of notifications. 8

Distribution of MenB notifications in Ireland, 1999-2018.

HSE Health Protection Surveillance Centre. Invasive Meningococcal Disease, In Ireland, 2018.
Dublin: HSE HSPC; 2019
ⓒ HSE Health Protection Surveillance Centre, 2019. Reproduction is authorised, provided source is acknowledged.

Figure 1: Distribution of MenB disease in Ireland 1999-2018 8

Invasive Meningococcal Disease (IMD): Adolescents are at risk.

In Ireland in 2018, 21% of cases of IMD were in individuals 15-24 years of age 9

Since September 2019, school children in Ireland who are in their first year of secondary school are offered a dose of MenACWY vaccine. 10

The MenACWY vaccine does not protect against MenB disease 10

Sharing and group activities leave adolescents vulnerable to meningococcal disease 11, 12

These include:

Sharing and group activities

Prevention of Invasive Meningococcal Disease (IMD)

Keeping up to date with recommended immunisation is the best defence against meningococcal disease. Maintaining healthy habits like getting plenty of rest and not coming into close contact with people who are sick can also help 15

The risk of infection can be reduced in the following ways:

Wash Hands

Washing hands carefully and regularly.

Avoid Sharing

Avoid sharing drinks, food, straws, eating utensils and cosmetics with anyone else.

Cover Mouth and Nose

Cover mouth and nose when coughing and sneezing

Vaccinations

Ensure all vaccinations are up to date.

MenB vaccination as a preventative measure

Bexsero is a meningococcal group vaccine Bexsero contains four different components from the surface of the group B N. meningitidis bacteria. 19
Bexsero is given to individuals from 2 months of age and older to help protect against disease caused by Neisseria meningitidis group B bacteria.

Bexsero: The only MenB vaccine with real world evidence demonstrated in a broad population 10, 17

Impact of BEXSERO on MenB incidence after a regional vaccination program in Canada 17

Reduction in incidence

Reduction in MenB during the BEXSERO MenB program vaccination in the targeted age groups in Saguenay-Lac-Saint-Jean (Quebec, Canada). From May through December 2014, an estimated 83% of 59,500 residents aged 2 months 20 years of age received at least 1 dose of Bexsero. 17

Many major universities have relied on BEXSERO for vaccination during campus outbreaks 18

The fastest MenB vaccine series completion 17, 19

vaccine series completion

*2-dose schedule (0, 1 months). n=638-639 for fHbp, NadA, and PorA P1.4; n=46 for NHBA. 19

Note during the assessment period MenB disease also decreased in the other regions where no vaccination took place; the magnitude of that decrease in younger and older age groups was over 50%. Taking into account the decrease in MenB incidence at provincial level, the overall campaign impact in the SLSJ was 86% [95% CI: -2%,98%]. The campaign impact was mostly seen in the target age-group suggesting no herd effect among unvaccinated older adults.

References:

  1. Rosenstein NE, Perkins BA, Stephens DS, et al. Meningococcal disease. N Engl J Med. 2001;344(18):1378–1388.
  2. Pelton, SI. Meningococcal disease awareness: clinical and epidemiological factors affecting prevention and management in adolescents. J Adolesc Health. 2010;46:S9-S15.
  3. Thompson MJ, Ninis N, Perera R, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet. 2006;367(9508):397–403.
  4. World Health Organization (WHO). Meningococcal Meningitis Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/meningococcal-meningitis Updated November 2015. Last accessed April 2020.
  5. Viner RM, Booy R, Johnson H, et al. Outcomes of invasive meningococcal serogroup B disease in children and adolescents (MOSAIC): a case-control study. Lancet Neurol. 2012;11(9):774-783.2020.
  6. Jafri et al. Population Health Metrics, Global epidemiology of invasive meningococcal disease; 2013; 11–17.
  7. CDC. Manual for the surveillance of vaccine-preventable diseases. Available from: http://www.cdc.gov/vaccines/pubs/surv-manual/index.html Last accessed November 2018.
  8. HPSC. Invasive Meningococcal Disease (IMD), Other Bacterial Meningitis, Haemophilus Influenzae & Viral Meningitis Infections in Ireland. 2018. Available from:http://www.hpsc.ie/a-z/vaccinepreventable/bacterialmeningitis/publications/quarterlyreports/2018reports/IMD%20Bacterial%20%20Viral%20Meningitis%20%20Haemophilus%20Rpt-Q1-2018%20v.1.2.pdf, accessed: April 2020.
  9. HSE Annual Report, Invasive Meningococcal Disease, in Ireland, 2018; Health Protection Surveillance Centre, Aug 2018. www.hpsc.ie/a-z/vaccinepreventable/invasivemeningococcaldisease/surveillancereports/meningococcaldiseaseannualreports. Accessed April 2020.
  10. Trumenba Summary of Product Characteristics https://www.medicines.ie/medicines/trumenba-34065/smpc. Accessed: April 2020.
  11. European Centre for Disease Prevention and Control. Invasive meningococcal disease: annual epidemiological report for 2017. Stockholm: ECDC; 2017. Accessed May 2019.
  12. MacLennan J, Kafatos G, Neal K, et al; United Kingdom Meningococcal Carriage Group. Social behavior and meningococcal carriage in British teenagers. Emerg Infect Dis. 2006 Jun;12(6):950-957.
  13. Burman C, Serra L, Nuttens C, et al. Meningococcal disease in adolescents and young adults: a review of the rationale for prevention through vaccination. Hum Vaccin Immunother. 2019;15(2):459-469.
  14. Tully J, Viner RM, Coen PG, et al. Risk and protective factors for meningococcal disease in adolescents: matched cohort study. BMJ. 2006;332:445-450.
  15. Ewald AJ, McKeag DB. Meningitis in the athlete. Curr Sports Med Rep. 2008;7(1):22-27.
  16. CDC webpage: Meningococcal Home/About the Disease. Available from: http://www.cdc.gov/meningococcal/about/prevention.html Last accessed November 2018.
  17. Deceuninck G, Lefebvre B, Tsang R, Betala-Belinga JF, De Serres G, De Wals P. Impact of a mass vaccination campaign against Serogroup B meningococcal disease in the Saguenay-Lac-Saint-Jean region of Quebec four years after its launch. Vaccine. 2019. https://doi.orgt/10/1016/j.vaccine.2019.06.021.
  18. Soeters HM, McNamara LA, Blain AE, et al. University-based outbreaks of meningococcal disease caused by serogroup B, United States, 2013–2018. Emerg Infect Dis. 2019;25(3):434-440.
  19. BEXSERO Summary of Product Characteristics. GSK 2019. www.medicines.ie, accessed August 2020.

Adverse events should be reported to the Health Products Regulatory Authority (HPRA) using an Adverse Reaction Report Form obtained either from the HPRA or electronically via the website at www.hpra.ie. Adverse reactions can also be reported to the HPRA by calling: (01) 6764971. Adverse events should also be reported to GlaxoSmithKline on 1800 244 255.

Bexsero is a registered trademark of the GlaxoSmithKline Group of Companies