Who Should Not Get A Meningococcal Vaccine
Your preteen or teen shouldn’t get the meningococcal vaccine if they:
- Has had a severe, life-threatening allergic reaction to a meningococcal vaccine before or to any vaccine component
- Is moderately or severely ill
- Has ever had Guillain-Barre syndrome
Pregnant women can get the meningococcal vaccine, but it’s only recommended for those with certain immune problems or those likely to be exposed to meningitis. With the newer MCV4 and MenB vaccines, there hasn’t been as much study in pregnant women compared to the MPSV4 vaccine.
Acwy Vaccination Is Free For Some People
In Victoria, immunisation against meningococcal serogroups A, C, W and Y is available for free as part of the National Immunisation Program schedule for:
- children aged 12 months
- children from 13 months to under 20 years of age, who did not have their meningococcal C vaccine at 12 months
- young people in Year 10 of secondary school
- young people not in secondary school, aged 15 to 19 years.
Young people in the 15 to 19 years age group are more likely to spread the disease to others. One in five people in this age group carry the bacteria that cause meningococcal disease. Immunisation experts have advised that immunising this age group can prevent spread to other age groups and protect the wider community.
Eligible young people who are away from school on the day the vaccine was given, or who do not attend secondary school, can attend either a local government community immunisation session, or a general practitioner to receive the free meningococcal ACWY vaccine. The GP may charge a consultation fee.
Contact your local government to find out when and where immunisation sessions are held.
- People with specified medical risk conditions can also receive free meningococcal ACWY vaccine. This includes people with:
- a poorly functioning spleen or no spleen, including sickle cell disease or other haemoglobinopathies
- defects in, or a deficiency of, a complement component, including factor H, factor D or properdin deficiency
- current or future treatment with eculizumab .
How Do Childhood Vaccination Policies Vary Across The World
We recently charted mandatory childhood vaccine policies worldwide as they are becoming an increasingly important policy intervention for governments trying to address low vaccination rates.48
The term mandatory and mandates are taken to mean quite different things across countries. Whilst the term is commonly used it is poorly defined.49 Mandates require vaccination for a certain purpose, most commonly related to school entry for children. While definitional disagreements still persist, it remains important to better understand what policies are in place across countries and the reasons driving changes in policy over time.
Our list indicates whether a country has a mandatory vaccination policy for one or more vaccine and the strictness of the mandate on a scale ranging across three levels: mandatory, mandatory for school entry, or recommended. The childhood vaccines include the vaccines that protect from measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, rabies, hepatitis B, rotavirus, haemophilus influenzae type B, and tuberculosis some of which are administered as combined vaccines. We have classified a country as having a mandatory policy if they mandate for at least one vaccine.
The differences in vaccination policy across the world are shown in the map. By covering 149 countries we could identify some trends around where and why vaccines are mandatory today.
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People With Medical Conditions That Increase Their Risk Of Invasive Meningococcal Disease
People with medical conditions specified in List. Specified medical conditions associated with increased risk of invasive meningococcal disease are strongly recommended to receive MenACWY and MenB vaccines.
- a full primary course of MenACWY vaccine, with ongoing booster doses
- a full primary course of MenB vaccine
People with these specific medical conditions have a higher risk of invasive meningococcal disease. They are recommended to receive extra doses compared with people who do not have these conditions.
The number of doses needed depends on the vaccine brand used and the persons age when they start the vaccine course.
For people aged 2 years receiving MenACWY vaccine, it is preferable to receive either Menveo or Nimenrix, rather than Menactra. If Menveo and Nimenrix are unavailable, Menactra can be given.
There is no preference for either Bexsero or Trumenba for people aged 10 years. For people aged < 10 years, Bexsero is the only registered MenB vaccine available in Australia.
Bexsero and Trumenba are not interchangeable. The same vaccine should be used for both vaccine doses.
Regular booster doses are required for MenACWY vaccines, but not for MenB vaccines.
For more details see:
People who have previously received a meningococcal polysaccharide vaccine
They should receive the 1st dose of MenACWY conjugate vaccine about 2 years after the most recent dose of 4vMenPV, with a recommended minimum interval of 6 months.1-3
Does Vaccine Skepticism Affect Immunization Coverage
The crucial question to ask when considering the importance of vaccine skepticism is: does it actually have an effect on behaviour? Does it really affect the share of children who are vaccinated?
In the chart we see the comparison of vaccination rates here as the share of children who were immunized against diphtheria, pertussis and tetanus in 2015, the latest year available to the share of respondents in a given country who disagreed that vaccines are safe.
You can also see this relationship for measles vaccine coverage.
Overall we see that widespread public concern for vaccine safety does not appear to be strongly correlated with vaccination rates. While one-third of the French public disagrees with their safety, 97% of children in France are vaccinated.
There are numerous other reasons, however, why vaccination rates in some countries are low: in low-to-middle income countries the availability, affordability and access to vaccines can be poor. Having low coverage rates often doesnt reflect the populations view of them. As the chart shows, in many poor countries the situation is the opposite as in France: the vast majority of the population considers vaccine safe, but only about every second child receives the DTP vaccine.
One country which stands out is Ukraine: there we see that vaccination rates are uncharacteristically low for its income level less than 1-in-4 children receive the DTP vaccine. Skepticism of vaccine safety in Ukraine is high at 15%.
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Persons With Inadequate Immunization Records
Children and adults lacking adequate documentation of immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors. Conjugate meningococcal vaccine, as appropriate for age, may be given regardless of possible previous receipt of the vaccine, as adverse events associated with repeated immunization have not been demonstrated. Refer to Immunization of persons with inadequate immunization records in Part 3 for additional general information.
Smallpox And The Origin Of Vaccination
Vaccination has a long history. An early form of vaccination was referred to as variolation or more broadly as inoculation. Practised for a long time in Asia, this was an ancient technique of deliberate smallpox infection in which dried smallpox scabs were blown up the nose to infect the person with a form of the disease which was often milder. By the 1700s variolation had spread to Africa, India and the Ottoman Empire, followed by the UK and America, where the method of infection more frequently used was a puncture to the skin.
Variolation did work, but there were large risks. Those variolated could contract the more severe form of smallpox and die, and they could also transmit the disease to others.
In 1796 English physician Edward Jenner demonstrated another method of inoculation in which he relied on cowpox. Cowpox is a similar disease to smallpox and it had previously been observed that an infection with cowpox can protect against smallpox. Jenner conducted an experiment using matter from a cowpox lesion to inoculate his gardeners eight-year-old son James Phipps. Two months later Jenner exposed the boy to smallpox lesion matter and when Phipps did not develop smallpox he concluded that he was protected against the disease. Jenner called the procedure vaccination after vacca the Latin word for cow because of the origin of this first vaccination from the cowpox virus.
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What Drives The Introduction Of Mandatory Vaccinations
Overall, we found that the occurrence of recent outbreaks is a major factor in the introduction of mandatory vaccination, particularly for high and upper-middle-income countries in Europe. Germany, for example, made measles vaccination mandatory for school and day-care attendance in 2020 following large outbreaks.52 Similarly, Serbia tightened mandatory vaccination laws following a measles outbreak in 2014 to 2015 by introducing harsher penalties.53 Trends of reported cases of measles can be explored in detail here.
Secondly, many low- and lower-middle-income countries have resorted to mandatory vaccination policies because of a lack of other policy options. Nonetheless, many have still missed their target vaccination rates due to problems with vaccine supply, delivery, and access. In Guyana for example, vaccination is mandatory, yet vaccination coverage is hindered by the management of the supply chain in keeping storage temperatures consistent and the distribution of freeze-sensitive vaccines.54 In Nigeria, vaccination is mandatory, and several states have enacted legislation criminalising vaccine refusal. Yet as Onyemelukwe argues, there are structural, logistical, political, systemic, religious and cultural obstacles to the effective distribution and uptake of vaccines, ranging from cold chain issues, to corruption and security issues.55 There is thus often variation between vaccination in policy compared to in practice.
Meningococcal Vaccine For Teens
Experts recommend the meningococcal conjugate vaccine for children when they are age 11 or 12. Teens who have not yet had this shot also need it. That’s especially the case if they are at risk for getting meningitis or have a weakened immune system. Your child should then have a booster shot at age 16, or 5 years after the first vaccine. If your child gets the first shot at age 16 or older, a booster dose is not needed.
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Why Are Meningococcal Vaccines Recommended
Meningococcal disease is caused by a type of bacteria. It can lead to an infection of the bloodstream or meningitis, or both, and can be life-threatening if not quickly treated. The MenACWY vaccine is very effective at protecting against four strains of the bacteria, while the MenB vaccine protects against a fifth strain.
Diphtheria Tetanus Pertussis Polio Haemophilus Influenzae Type B Vaccine
DTaP-IPV-Hib vaccine given at 2 months, 4 months, 6 months and 18 months
DTaP-IPV-Hib vaccine is a combined vaccine that protects children against five diseases diphtheria, tetanus, pertussis, polio and serious diseases like meningitis caused by haemophilus influenzae type b.
Immunization against diphtheria, tetanus, pertussis and polio is required by law for all children attending school in Ontario, unless exempted.
What is diphtheria?
Diphtheria is a serious disease of the nose, throat and skin. It causes sore throat, fever and chills. It can be complicated by breathing problems, heart failure and nerve damage. Diphtheria kills about one out of every 10 people who get the disease. It is most often passed to others through coughing and sneezing.
What is tetanus?
Tetanus or lockjaw is a serious disease that can happen if dirt with tetanus germ gets into a cut in the skin. Tetanus germs are found everywhere, usually in soil, dust and manure. It does not spread from person to person. Tetanus causes cramping of the muscles in the neck, arms, leg and stomach and painful convulsions which can be severe enough to break bones. Even with early treatment, tetanus kills two out of every 10 people who get it.
What is pertussis?
What is polio?
What is haemophilus influenzae type b disease?
Children under five years are more likely to get Hib disease. Children who attend childcare centres are even more likely to catch it. The Hib germ spreads to others through coughing and sneezing.
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Persons With Chronic Diseases
Two doses of Men-C-ACYW vaccine are recommended for persons with anatomic or functional asplenia, including sickle cell disease. When elective splenectomy is planned, all recommended vaccines should ideally be completed at least 2 weeks before surgery if only one dose can be given before surgery, the second dose should be given 8 weeks after the first dose, with a minimum interval of 4 weeks. In the case of an emergency splenectomy, two doses of vaccine should ideally be given beginning 2 weeks after surgery but can be given earlier, before discharge, if the person might not return for vaccination after discharge. Persons one year of age and older with asplenia who have not received Men-C-ACYW vaccine should receive two doses administered 8 weeks apart, with a minimum interval of 4 weeks. In addition, 4CMenB or MenB-fHBP vaccine should be offered. Periodic booster doses with Men-C-ACYW vaccine are also recommended.
Refer to Table 1 for vaccination recommendations of high risk individuals due to underlying conditions. Refer to Booster doses and re-immunization for additional information and Immunization of Persons with Chronic Diseases in Part 3 for additional general information.
What Are The Risks From Meningococcal Vaccines
Most people have mild side effects from the vaccine, such as redness or pain where the shot was given. A vaccine, like any medicine, may cause serious problems, such as severe allergic reactions. This risk is extremely small. Getting the meningococcal vaccine is much safer than getting the disease.
You can learn more on the Vaccine Information Statements for meningococcal ACWY and meningococcal B.
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Talk To Your Healthcare Provider
If you have questions about your childs vaccine schedule, talk with your childs healthcare provider. They know your child and will be able to listen to your concerns and offer health advice. If you or your child do not have a primary healthcare provider, consult your local health department with any vaccine questions or needs.
Diphtheria Tetanus And Pertussis Vaccine
Diphtheria, tetanus, and pertussis are all bacterial diseases and a combination vaccine against all three diseases is commonly used.
- Diphtheria primarily infects the throat and upper airways and is fatal in 5 10% of cases.
- Tetanus is not passed person-to-person but through spores of a bacteria living in soil and animal intestinal tracts. These bacteria enter the body through wounds and release a toxin that affects the nerves, which causes muscle stiffness and spasms.
- Pertussis is a highly contagious disease of the respiratory tract, commonly known as whooping cough. Children who contract pertussis tend to have coughing spells that last four to eight weeks, but the highest fatality is in young infants. Vaccinating health workers and pregnant women is the most effective strategy for preventing disease in infants too young to be vaccinated.
The chart shows the progress over time of DTP3 immunization coverage of children around the world. By clicking on any country you can see the change in that country over time.
The WHO reports in 2017 that 85% of infants worldwide received 3 doses of diphtheria-tetanus-pertussis vaccine . Also in 2016 130 countries had reached at least 90% coverage with the DTP3 vaccine.56
If we look at the change over time by world region it is South Asia in particular that stands out. While 85% of one-year-olds today are immunized, that same figure was as low 6% in 1980.
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Vaccine Development In The 1980s Hepatitis B And Haemophilus Influenzae Type B
The vaccine for Haemophilus influenzae type b was licensed in 1985 and placed on the recommended schedule in 1989. When the schedule was published again in 1994, the hepatitis B vaccine had been added.
The hepatitis B vaccine was not new, as it had been licensed in 1981 and recommended for high-risk groups such as infants whose mothers were hepatitis B surface antigen positive, healthcare workers, intravenous drug users, homosexual men and people with multiple sexual partners. However, immunization of these groups didn’t effectively stop transmission of hepatitis B virus. Thats because about one-third of patients with acute disease were not in identifiable risk groups. The change of recommendation to immunize all infants in 1991 was the result of these failed attempts to control hepatitis B by only immunizing high-risk groups. Following this recommendation, hepatitis B disease was virtually eliminated in children less than 18 years of age in the United States.
1985 – 1994 | Recommended Vaccines
* Given in combination as DTP** Given in combination as MMR
How Do Mandatory Vaccination Policies Vary By Region
We found that assessing policies across WHO regions European, Americas, Western Pacific, African, and Eastern Mediterranean was a useful way to break down our analysis of policies worldwide.
In the chart you see a breakdown of the number of countries with a given policy mandate. You can view this by region by using the Change region toggle on the interactive chart.
Europe has a mixture of mandatory and recommended policies. But most European countries 16 out of 28 do not have mandatory vaccination. European countries were among the first to introduce mandatory vaccination for smallpox in the early 19th century, which also led to early push-back. The early introduction and early push-back, along with present-day approaches to foster mutual trust and responsibility between citizens and the health authorities, may be part of the reason why vaccination is often recommended rather than mandated in many European countries.50 Countries of the former-USSR or under the influence of the Eastern Bloc previously had mandatory vaccination, and many kept this policy in the post-USSR era.
Most countries in the Americas 29 out of 35 have mandatory vaccinations. In the USA, vaccination is regulated by individual states though it is mandatory for school entry in all of them. In Canada, only three provinces have legislated mandatory vaccination policies that apply to children enrolling in school.
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