British Columbia Specific Information
Meningitis is an inflammation of the protective lining around the brain and spinal cord. It is a type of meningococcal infection that is usually caused by a virus or bacteria. In British Columbia, there are 2 vaccines that can help protect against meningitis: the Meningococcal C Conjugate vaccine and the Meningococcal Quadrivalent vaccine.
The Meningococcal C Conjugate vaccine is provided free. It is recommended for children at 2 and 12 months of age. For more information, see HealthLinkBC File #23a Meningococcal C Conjugate Vaccine and the B.C. Immunization Schedules.
As of September 2016, the Meningococcal Quadrivalent Vaccine will be offered to all students in grade 9 as part of the routine immunization program in B.C. This will replace the current booster dose provided in grade 6. For more information, see HealthLinkBC File #23b Meningococcal Quadrivalent Vaccines. To learn more about both vaccines, visit ImmunizeBC.
Who Is At Risk
In New Zealand, infants and children aged under 5 years and adolescents aged 1519 years have an increased risk of meningococcal disease. Mori, particularly infants aged under 1 year, and Pacific peoples have a higher risk of meningococcal disease than other ethnic groups. Over 20182019, a high rate of group B and groups C, Y and W disease cases were also seen in young adults aged 2029 years.
What To Think About
The menigococcal vaccine can be given at the same time as other routine childhood vaccinations.
The conjugate meningococcal vaccines may be used during pregnancy when the benefits of getting the vaccine outweighs the risk.
The conjugate and multi-component vaccines may be given to women who are breastfeeding.
No evidence has shown that Canadian university students who live in dormitories or residence halls are at higher risk of getting meningococcal disease.footnote 2
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Why It Is Used
Meningitis is an infection of the fluid that surrounds the brain and the spinal cord. Meningococcal disease also causes infections in the blood. These infections can be serious and can even cause death or long-term health problems.
Scientists divide meningococcal bacteria into “groups.” Within each type of vaccine are specific formulas that protect against the different groups of meningococcal bacteria. Just because you’ve been immunized against one group of meningococcal bacteria does not mean you are totally protected against getting meningococcal disease from a different group.
Two types of conjugate meningococcal vaccines and a multi-component meningococcal vaccine are used for routine immunization. The National Advisory Committee on Immunization has made recommendations on who should get each kind of vaccine.footnote 1
- Children ages 2 months to 11 years
- Babies may get the vaccine starting when they are 2 months old, but the age a baby starts getting the vaccine depends on provincial guidelines. The meningitis vaccine is given in several doses spaced over several weeks.
- A dose given at ages 12 to 23 months is recommended for all children.
- Vaccination may be recommended for children up to 11 years of age if they did not get the vaccine as a baby.
Are Students Required To Get Meningococcal Vaccine Before College
Yes. Massachusetts law requires the following students receive quadrivalent meningococcal conjugate vaccine :
- Secondary School : newly enrolled full-time students who will be living in a dormitory or other congregate housing licensed or approved by the secondary school must provide documentation of having received a dose of meningococcal conjugate vaccine at any time in the past.
- Postsecondary Institutions : newly enrolled full-time students 21 years of age and younger must provide documentation of having received a dose of quadrivalent meningococcal conjugate vaccine on or after their 16th birthday, regardless of housing status.
Immunizations should be obtained prior to enrollment or registration however, students may be enrolled or registered provided that the required immunizations are obtained within 30 days of registration. There is no requirement for meningococcal B vaccination. However, adolescents and young adults may also be vaccinated with a serogroup B meningococcal vaccine, preferably at 16 through 18 years of age, to provide short term protection for most strains of serogroup B meningococcal disease.
More information about requirements and exemptions may be found in the MDPH document Information about Meningococcal Disease, Meningococcal Vaccines, Vaccination Requirements and the Waiver for Students at Colleges and Residential Schools.
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How Common Is Meningococcal Disease
Meningococcal disease is becoming much less common. Over the past 20 years, the overall incidence of meningococcal disease in the US has declined 10-fold. Twenty years ago in Massachusetts there were 80-100 cases of meningococcal disease per year. In contrast, for the past decade the average is approximately 12 cases per year. Declining rates of meningococcal disease may be due in part to the introduction of meningococcal vaccines as well as other factors such as the decline in cigarette smoking, which may impact susceptibility to this disease.
Who Needs To Get Vaccinated For Meningitis
Its especially important for you to keep all of your meningitis vaccinations up-to-date if you fall into a high-risk category for getting the disease. High-risk categories include:
- Certain Ages. Infants less than one-year-old and young adults between the ages of 16 and 21 are the most likely to develop meningitis. Its most important to have all boosters and available vaccinations at these ages.
- Crowded Settings. Large group settings like college campuses are where outbreaks of meningitis are the most common. Get your vaccines up-to-date before entering into these settings for extended periods of time.
- Certain underlying conditions. Some underlying medical conditions can increase your chance of getting meningitis. These include HIV and other conditions that weaken your immune system. Not having a spleen also places you at higher risk.
- Work that involves meningitis-causing agents. Microbiologists and any other researchers that regularly come into contact with the bacteria and viruses that cause meningitis are consistently at risk.
- Travel to certain areas. Some areas in the world like sub-Saharan Africa have higher rates of meningitis and the pathogens that cause it. Check with your doctor before traveling to new parts of the world.
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What Increases The Risks
- Exposure to tobacco smoke, binge drinking, or having another respiratory infection, e.g. influenza.
- Living in close proximity to others, e.g. in a crowded household, at boarding school, in university halls of residence, group accommodation or long-term institutional care.
- Being in a household or other close contact of someone carrying the bacteria or with the disease, e.g. those who have been intimate, or infants and children attending an early childhood education centre.
- Having a medical condition or receiving treatment that affects the immune system, e.g. the person has had their spleen removed, or taking disease modifying immunosuppressive medication.
- Age and ethnicity.
Symptoms And Causative Agent
Neisseria meningitidis bacteria, also called meningococcus , are an important cause of bacterial meningitis and sepsis in the United States. Meningococci can also cause pneumonia, otitis media , arthritis, and other infections, although these are less common. Collectively, the different illnesses caused by N. meningitidis are referred to as meningococcal disease.
Meningococcal meningitis symptoms include fever, headache, confusion and stiff neck, which may also be accompanied by nausea, vomiting, and sensitivity to light. Meningococcal bacteremia symptoms include sudden fever onset and rash. Other forms of meningococcal disease have symptoms related to the organ affected: otitis media has ear pain arthritis has joint pain and swelling.
Invasive meningococcal disease can be fatal survivors may have permanent injury, including brain damage, hearing loss, or loss of a limb.
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Are There Any Adults Who Should Not Get The Meningococcal Vaccine
You shouldn’t get either type of meningococcal vaccine if you:
- Are moderately or seriously ill wait until you recover.
- Have had a serious allergic reaction to a previous dose
- Had a severe reaction to any part of the vaccine
If you are pregnant or have other concerns, ask your doctor which meningitis vaccine is right for you.
Advances In Lipopolysaccharides And Outer Membrane Vesicles As Vaccine Targets
A broadly protective Neisseria vaccine would greatly advance the fight against meningitis. Serogroup-specific vaccines are the only type of vaccines currently available against Neisseria meningitidis. Vaccines with broad protection could target all serogroups by containing an antigen that is shared among them. Common proposed targets have been lipopolysaccharide and outer membrane vesicles. Lipopolysaccharide, also known as LPS or endotoxin, is a lipid and carbohydrate containing molecule anchored in the outer membrane of Gram negative bacteria. It is considered to be a virulence factor in the disease. Lipopolysaccharide contains three components: Lipid A, core oligosaccharides and O-antigen polysaccharide. Neisseria meningitidis contains lipooligosaccharides which contain only Lipid A and core oligosaccharides. These structures are common to all Neisseria species so lipooligosaccharides may be a useful target for the development of a broad vaccine . One potential candidate for exploration comes from the work of Seebergers group . These researchers chemically synthesized a tetrasaccharide from the core oligosaccharide, conjugated it to a carrier protein and assessed the antibody response generated. This work revealed a key tetrasaccharide as a candidate for further study.
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You Are Pregnant Or Breastfeeding
- Pregnant women who are at increased risk for serogroup A, C, W, or Y meningococcal disease may get MenACWY vaccines.
- Pregnant or breastfeeding women who are at increased risk for serogroup B meningococcal disease may get MenB vaccines. However, they should talk with a doctor to decide if the benefits of getting the vaccine outweigh the risks.
Shouldnt Meningococcal B Vaccine Be Required
CDCs Advisory Committee on Immunization Practices has reviewed the available data regarding serogroup B meningococcal disease and the vaccines. At the current time, there is no routine recommendation and no statewide requirement for meningococcal B vaccination before going to college . As noted previously, adolescents and young adults may be vaccinated with a serogroup B meningococcal vaccine, preferably at 16 through 18 years of age, to provide short term protection against most strains of serogroup B meningococcal disease. This would be a decision between a healthcare provider and a patient. These policies may change as new information becomes available.
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Muslims Undergoing The Hajj Or Umrah Pilgrimage
Pilgrims to Saudi Arabia are especially at risk of contracting meningococcal infection. There have been outbreaks in recent years. A proof of immunisation is needed to obtain a visa to go to Saudi Arabia for this purpose.
Note: some pilgrims may have been immunised in the past with an older vaccine which only protected against groups A and C. If you travel to Saudi Arabia again you should have an injection of the newer MenACWY vaccine. Proof of immunisation with MenACWY vaccine given within the preceding three years is now needed to get a new visa to visit Saudi Arabia.
Meningococcal Acwy Vaccine Side Effects
The meningococcal ACWY vaccine is effective and safe, although all medications can have unwanted side effects.
Side effects from this vaccine are uncommon and are usually mild, but may include:
- localised pain, redness and swelling at the injection site
- occasionally, an injection-site lump that may last many weeks
- low-grade temperature
- children being unsettled, irritable, tearful, or generally unhappy, drowsy and tired.
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Who Is At Most Risk For Meningococcal Disease
High-risk groups include anyone with a damaged spleen or whose spleen has been removed, those with persistent complement component deficiency , HIV infection, those traveling to countries where meningococcal disease is very common, microbiologists who routinely work with the bacteria and people who may have been exposed to meningococcal disease during an outbreak. People who live in certain settings such as college dormitories and military housing are also at greater risk of disease from some serotypes.
Perspectives And Future Outlook
Targeted vaccines have been effective at reducing the public health burden of meningococcal meningitis across many regions of the globe. Glycoconjugate and now protein/OMV-based vaccines target most serogroups of N. meningitidis that cause disease. The work of basic researchers and clinical researchers have helped advance the field. This review has sought to describe the current meningococcal vaccines and new approaches for the future. Recent protein-based vaccines now target N. meningitidis serogroup B. A suitable strategy for this serogroup has been elusive for so long. Future work in protein-based vaccine discovery seeks to discover broadly protective protein targets. Lipooligosaccharides and outer membrane vesicles are also under investigation for new targets for a broadly protective vaccine. A number of glycoconjugate vaccines against N. meningitidis A, C, W and Y using conventional methods of vaccine production exist. New discoveries aim to create well-defined homogeneous vaccines for which the carbohydrate antigen structure-immunogenicity relationship can be better determined. These strategies use chemical and/or enzymatic methods to produce carbohydrates. However, to date there is only one glycoconjugate vaccine on the market containing a fully synthetic carbohydrate antigen. Quimi-Hib was licensed in Cuba in 2004 and targets Haemophilus influenza b . Progress in licensing of additional synthetic glycoconjugate vaccines has been slow.
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What Are The Risks From Meningococcal Vaccine
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.
Common And Local Adverse Events
Conjugate meningococcal vaccines
Men-C-ACYW vaccines
Injection site reactions occur in up to 59% of vaccinees. Fever is reported in up to 5% of recipients and systemic reactions, such as headache and malaise, are reported in up to 60% of recipients.
Men-C-C vaccines
Mild reactions, including injection site reactions , occur in up to 50% of vaccine recipients. Irritability occurs in up to 80% of infants and fever in up to 9% when other vaccines were administered. Headaches and malaise occur in up to 10% of older children and adults. These reactions last no more than a few days.
Serogroup B Meningococcal vaccines
4CMenB vaccine
Solicited local and systemic reactions have been commonly reported in clinical trials and include injection site tenderness, induration, sleepiness and irritability. Higher rates of fever have been observed with simultaneous administration of 4CMenB vaccine and routine infant vaccines therefore, routine prophylactic administration of acetaminophen or separating 4CMenB vaccination from routine vaccination schedule has been proposed for preventing fever in infants and children up to three years of age.
MenB-fHBP vaccine
Solicited local and systemic reactions have been commonly reported in clinical trials and include injection site tenderness, induration and irritability.
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How And When Should You Receive The Meningococcal Vaccine
In most cases, adults only need one dose. But if you remain at risk, you may need a booster.
Some adults may need another type of meningitis vaccine, the serogroup B meningococcal vaccine, if they are exposed to this virus through work or travel or if they have a damaged or missing spleen, or certain immune system disorders.
Who Needs A Meningococcal Vaccine
The CDC recommends a meningococcal vaccine for:
- All children ages 11-18 or certain younger high-risk children
- Anyone who has been exposed to meningitis during an outbreak
- Anyone traveling to or living where meningitis is common, such as in sub-Saharan Africa
- Military recruits
- People with certain immune system disorders or a damaged or missing spleen
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Safeguard Your Health With The Meningococcal Meningitis Shot
The vaccine against meningococcal meningitis is injected into the arm muscle in a single dose. It is thought that the immunity conferred by the vaccine lasts about five years, so you may need another shot even if you have been vaccinated against meningococcal meningitis previously. Ask your travel health adviser for confirmation.
Young adults living in the UK may already be vaccinated against meningitis.
If you need a certificate of vaccination against meningococcal meningitis for the Hajj pilgrimage, the shot must be given at no more than five years before and least ten days before you arrive in Saudi Arabia. Same-day travel vaccinations can often be arranged at Global Travel Clinics if you need them.
Problems That Could Happen After Getting Any Injected Vaccine
- People sometimes faint after medical procedures, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell the provider if you or your child feel dizzy, have vision changes, or have ringing in the ears.
- As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.
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Healthy Infants And Children
One dose of Men-C-C vaccine is recommended in unimmunized children less than 5 years of age. One dose of Men-C-C vaccine may be considered for children 5 to 11 years of age if they have not previously been immunized as infants or toddlers. Immunization with 4CMenB vaccine or MenB-fHBP may be considered on an individual basis, depending on individual preferences, regional serogroup B epidemiology and strain susceptibility.
Persons New To Canada
Health care providers who see persons newly arrived in Canada should review the immunization status and update immunization for these individuals. Review of meningococcal vaccination status is particularly important for persons from areas of the world where sickle cell disease is present as persons with sickle cell disease are at risk of serious meningococcal infections. In many countries outside of Canada, conjugate meningococcal vaccines are in limited use. Information on vaccination schedules in other countries can be found on the World Health Organization website. Refer to Immunization of Persons New to Canada in Part 3 for additional general information.
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