Meningococcal disease

Summary

Meningococcal disease is a serious and potentially life-threatening illness caused by the bacteria Neisseria meningitides.
Many people carry this bacteria in their nose and throat and it causes no problems.
Serogroup B and C are the most common infecting strains in Ireland at present.
Death from meningococcal disease is relatively rare with an average of six deaths per year since 2001 and an average of fourteen deaths per year in the decade before the vaccine, across all age groups.

Health Freedom Ireland (HFI) encourages you to become fully informed about vaccines and the associated illnesses so that you can give informed consent if you choose to vaccinate yourself or your child(ren). This information is for educational purposes only and is not intended as medical advice. HFI is simply bringing this information to you – we neither recommend nor advise against vaccination.

Does the HSE recommend a vaccine for meningococcal disease?

Five doses are recommended before 13 months of age targeting two out of the thirteen meningococcal serotypes. Each of the vaccines outlined below is covered in detail in the linked Health Freedom Ireland documents (including risks, benefits, ingredients and studies).

Bexsero targets meningococcal B and is recommended at 2, 4 and 12 months of age.
Menjugate targets meningococcal C and is recommended at 6 months of age.
Menitorix targets meningococcal C and is recommended at 13 months of age.

As of 23rd September, 2023, there were 149,295 adverse events reported on the World Health Organisation VigiAccess database for meningococcal vaccines including Bexsero (men B), and Menjugate (men C), and 2,131 for hib/meningococcal vaccine including Menitorix (men C).

Does the meningococcal vaccine guarantee protection?

No your baby can still get meningococcal disease after vaccination. These vaccines include 2 of the 13 serotypes/strains of meningococcal disease.

Note
The Joint Committee on Vaccination and Immunisation (JCVI) in the UK have recommended the withdrawal of the Menitorix vaccine and to end the Men C vaccine in the childhood schedule. There is evidence that the teenage MenACWY vaccination is protecting all age groups so Menitorix is therefore no longer necessary.

What is meningococcal disease?

Invasive meningococcal disease (IMD) is caused by a bacterium called Neisseria meningitidis. There are several different types of the bacterium including groups A, B, C, W135 and Y. Group B and C are the most common forms in Ireland. These bacteria are common and live naturally in the back of the nose and throat. According to the Health Protection Surveillance Centre (HPSC), up to one in ten people carry the bacteria. According to this study, it is estimated that 10% – 35% of young adults carry the bacteria in their nose/throat and that most people are colonised with the bacteria at one time or another during their life. Carrying the bacteria harmlessly in the nose is known as carriage and those who carry the bacteria develop immunity to it as can be seen from the following information from the HPSC:

“Carriage is typically followed by the development of immunity. Only a small minority of carriers will develop meningitis or septicaemia after an incubation period of 2-3 days. Why some people develop meningitis and others don’t is not fully known but it is believed that on occasion the bacteria can overcome the body’s immune system and cause meningitis and meningococcal septicaemia.”

Similarly, the National Immunisation Advisory Committee (NIAC) in Ireland say:

“Approximately 10% of the population are asymptomatic nasal or rarely throat carriers, and most develop immunity.”

The medical literature does have some information on why this bacteria that so many carry harmlessly can go on to cause serious illness in a small minority. One paper states:

“Like many other diseases, the immune system plays a very important [role] in protecting the host. Conditions that compromise the human immune system increase the risk of contracting meningococcal disease, including meningococcemia and or meningitis. These diseases include human immunodeficiency (HIV) infection, acquired immunodeficiency disease syndrome (AIDS), asplenia, and complement deficiency.”

Other factors are overcrowding associated with poverty and university residence halls.

Meningococcal disease is not easily spread and requires one to be susceptible to the infection and to have regular close contact with a person who is colonising the bacteria. Outbreaks of meningococcal disease are rare, but can occur in settings where people group together, such as college campuses.

In the rare cases where it progresses to invasive meningococcal disease, it can then cause meningitis (swelling in the brain) and septicaemia (blood poisoning) or both. At first, meningitis symptoms may appear mild and similar to cold or flu symptoms and may include headache, fever, aches, and pains. As the illness progresses, additional symptoms can include skin rash, severe headache, stiff neck, nausea, vomiting, inability to look at bright lights, mental confusion and irritability, extreme fatigue/sleepiness, convulsions, and unconsciousness. In babies, symptoms can include a high-pitched moaning cry, difficulty or refusal to feed, and the fontanel (the soft area on the top of the head) may be bulging. The HPSC advises seeking medical help immediately as the sooner treatment with antibiotics begins the greater the chance the person will make a full recovery.

What is the risk of my child getting meningococcal disease in Ireland?

The risk for all age groups of getting meningococcal B in Ireland between 2011 and 2019 was extremely rare at 1 in 88,295 (0.001%) and 1 in 401,942 (0.0002%) for meningococcal C.

Meningococcal B & C cases
Year	2011	2012	2013	2014	2015	2016	2017	2018	2019
Meningococcal B Cases	84	58	68	69	43	48	29	46	33
Meningococcal C Cases	2	0	1	6	11	22	30	20	13
average population 2011 – 2019 = 4,689,331 average annual risk of getting meningococcal B during this period is 1 in 88,295 (0.001%) average annual risk of getting meningococcal C during this period is 1 in 401,942 (0.0002%)

Data source: Table 3. Number of cases, deaths, percentage of total cases and case fatality ratios (%CFR) by year for meningococcal B, C, W and Y diseases, Ireland, 1999-2018

The following shows cases of invasive meningococcal disease for serogroup b (SgB), serogroup c (SgC) and other serogroups not covered by the vaccines. While the percentage of serogroup b cases has dropped other serogroups have risen since the introduction of the vaccine for men b.

Data source: HPSC -Invasive Meningococcal Disease (IMD), in Ireland, 2022

*Data source:* HPSC – Figure 2. Number of IMD cases by gender and age group in Ireland, 1999-2018

What is the risk of dying from meningococcal disease in Ireland?

The risk of dying from meningococcal disease in the decade before the vaccine was introduced in 2000 was extremely rare at 1 in 248,848 (0.0004%). The risk of dying during this period for children under 5 was extremely rare at 1 in 612,730 (0.0002%).

Meningococcal deaths in Ireland
	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999
Total Deaths	7	14	16	12	14	21	13	21	15	12
Deaths < 5	5	6	8	5	5	8	6	5	Not available	5
Average population in Ireland from 1990 to 1999 = 3,608,300 Average annual risk of dying from meningococcal disease during this period = 1 in 248,848 (0.0004%) Average annual risk of dying from meningococcal disease during this period (<5s) = 1 in 612,730 (0.0002%)

Data source: CSO annual reports on marriages births and deaths 1864 to 2000 More details on source data