What is the issue?
Between May and November 2017, there have been eight confirmed cases of a closely related strain of Invasive Meningococcal Disease (IMD) serogroup C infection notified across Melbourne, Victoria. Almost all cases are in MSM with evidence of local transmission, increasing in recent weeks. There have been previous clusters of IMD in MSM worldwide including in Berlin, Paris, Chicago and Los Angeles.
IMD is caused by the bacteria Neisseria meningitidis. Approximately 10 per cent of the population are asymptomatic carriers of meningococcal bacteria in the upper respiratory tract; however, IMD can occur in a small number of people.
Four serogroups of meningococcal bacteria (B, C, W and Y) account for most cases of IMD in Australia. Serogroup C cases have declined by 99 per cent since 2003 when the meningococcal C vaccine was added to the National Immunisation Program, to a low of three notified cases in Australia in 2016. Recently, serogroup W has been the most common cause of IMD in Victoria, followed by serogroups B and Y, with meningococcal serogroups A and X rarely diagnosed in Victoria.
Who is at risk?
Gay and bisexual men and MSM who have not received a vaccine against meningococcal serogroup C are at increased risk in this outbreak. In addition to children and travellers attending mass gatherings and sites of current overseas epidemics, the Australian Immunisation Handbook notes that people with the following medical conditions are at increased risk of IMD and should be vaccinated unless there is an absolute contraindication:
- HIV infection regardless of stage of disease or CD4+ count
- functional or anatomical asplenia
- inherited defects in or deficiency of complement components, including factor H, factor D or properdin deficiency
- current or future treatment with eculizumab
- haematopoietic stem cell transplant.
Symptoms and transmission
The most common presentations of meningococcal serogroup C disease in Victoria have been meningitis (infection of the lining of the brain) and sepsis (infection of the bloodstream). Both of these illnesses can progress rapidly with severe consequences, with death in up to 10 per cent of cases and permanent sequelae in up to 20 per cent of survivors. Meningococcal bacteria are difficult to spread and are probably only passed from person to person by close, prolonged contact.
Prevention and treatment
Refer suspected cases of IMD for hospital treatment without delay.
Notify the Department of Health and Human Services immediately on 1300 651 160 (24 hours a day) of all suspected and confirmed cases of IMD.
- Vaccination will reduce the risk of development of IMD in at-risk individuals, and may reduce overall transmission in Victoria through a herd-immunity effect.
- The department has recommended that all gay and bisexual men and MSM who reside in Victoria receive the 4vMenCV (Menactra™). The department does not recommend testing patients for meningococcal bacteria prior to vaccination, and there is no requirement to test for immunity before vaccinating.
- Menactra™ will be made available (free of charge) for this indication from Monday, 11 December 2017 until 31 December 2018 through general practice (GP) clinics and other registered immunisation providers, including all sexual health clinics. GPs and immunisation providers should download the department's updated vaccine order form.
- Practices are requested to bulk-bill patients when providing the free vaccine in order to maximise access to this public health initiative.
- Remember to report the administration of the vaccine to the Australian Immunisation Register. The Register can also be used to check if your patient has recently received a dose through another provider.
Department of Health and Human Services - Meningococcal vaccine program for GBM/MSM
Department of Health and Human Services - Meningococcal disease
NCIRS - Meningococcal vaccines – FAQ (September 2017)
NCIRS - Meningococcal vaccines for Australians: information for immunisation providers (September 2017)
Better Health Channel - Meningococcal ACWY vaccine for men who have sex with men
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