Meningococcal disease is an invasive infection of Neisseria meningitidis (N. meningitidis) in:
- cerebrospinal fluid (CSF)
- other normally sterile site
Meningococcal disease cases overwhelmingly show symptoms of meningitis (inflammation of the meninges) or septicaemia (blood poisoning). It can also present as a combination of both or as a rarer clinical presentation, such as joint infection. Meningitis can be caused by a variety of viruses or bacteria, of which N. meningitidis is one. Meningococcal disease is a significant cause of morbidity and mortality in children and young adults.
Although approximately 10% of the population are estimated to carry N. meningitidis in the nasopharynx, the vast majority do not have symptoms or develop invasive disease. Invasive cases acquire infection through inhalation of or direct contact with respiratory droplets, from either an infected person or asymptomatic carrier.
N. meningitidis is classified according to its outer membrane characteristics via a process known as serogrouping. There are a number of different serogroups, the most common of which in the UK is B followed by W. Cases of serogroup Y, Z and C disease have also been also reported.
Data and analysis of meningococcal disease is also available on the Public Health England website.
For more information on meningococcal immunisation, including updates, please refer to the PHE Green Book, Chapter 22.
The National Education for Scotland (NES) website provides healthcare professionals with training and educational materials for:
Public information can be found by visiting the NHS inform website.
For all infection prevention and control guidance visit the A-Z pathogens section of the National Infection and Prevention Control Manual.
Data and surveillance
In 1999 the Meningococcal Invasive Disease Augmented Surveillance (MIDAS) system was introduced. The surveillance scheme is managed jointly by ourselves and the Scottish Haemophilus Legionella Meningococcus and Pneumococcus Reference Laboratory (SHLMPRL). Surveillance data is from MIDAS informs the epidemiology of meningococcal disease in Scotland, as analyses can be conducted according to:
- molecular typing
- clinical presentation
Surveillance update for April to June 2019
Between April and June 2019 (weeks 14 to 26), 11 cases of meningococcal disease were reported, bringing the total number of cases in the first to quarters of 2019 to 32. This is lower than the number of cases for the same period in the previous four years (range 37 to 59), as shown in figure 1.
Figure 2 shows number of meningococcal disease cases, according to age group and by quarter from 2001. Of the 32 cases reported in the first two quarters of 2019:
- five (15.6%) were aged under one year
- two (6.3%) were aged one to four years
- 10 (31.3%) were aged five to 24 years
- 15 (46.9%) were aged 25 years and over
Serogroup was identified for 26 (81.3%) of the 32 cases reported in the first two quarters of 2019, as shown in Figure 3:
- 14 (43.8%) were serogroup B
- nine (28.1%) were serogroup W
- two (6.3%) were serogroup Y
- one (3.1%) was serogroup C
The remaining six (18.9%) notifications were based on clinical diagnosis, and no serogroup is likely to become available.
There were 14 cases of serogroup B reported to the second quarter of 2019.Of the 14 serogroup B cases, five (35.7%) were under five years of age. All five cases under five years of age were born on or after 1 July 2015, making them eligible for routine immunisation with Men B vaccine at the age of two months. Of these:
- one case had received three doses of Men B vaccine according to the childhood vaccination schedule
- one case had received two doses of Men B vaccine according to the childhood vaccination schedule
- two cases had received one dose of Men B vaccine according to the childhood vaccination schedule
- one case was unvaccinated against Men B
The Men B vaccine is not expected to protect against all serogroup B strains and further detailed microbiological testing is required in order to evaluate the full impact of the vaccine.
Serogroup W cases continue to be reported separately following introduction of the MenACWY immunisation programme in summer 2015. Figure 4 demonstrates a positive impact of the MenACWY vaccine for the eligible population. Nine serogroup W cases were reported to the second quarter of 2019, which compares to ten cases for the same period in 2018. Of the nine serogroup W cases, one (11.1%) was in a child aged under five years old, and eight (88.9%) were in adults aged 25 years and older. There were no serogroup W cases recorded for the group eligible for MenACWY vaccination (18 to 24 years).
Following introduction of the Men C vaccine, serogroup C cases declined and were rarely reported in Scotland until 2016, when there was an increase. One serogroup C case was reported in the first two quarters of 2019. This compares to three serogroup C cases for the same period in 2018. The serogroup C case was fully immunised with Men C vaccine.
Information on clinical presentation was available for all 32 cases:
- 14 (43.8%) were recorded as presenting with septicaemia
- ten (31.3%) with meningitis
- five (15.6%) with meningitis and septicaemia
- one (3.1%) with joint infection
- one (3.1%) with septicaemia and joint infection
- one (3.1%) with chest infection
Number of deaths between 2002 and March 2019, reported by serogroup and with case fatality ratio is shown in Figure 5. Four deaths from meningococcal disease were reported to MIDAS between January and June 2019, with a 12.5% case fatality ratio. Two deaths occurred in serogroup W cases. Both were in adults aged over 25 years, one of whom was unvaccinated. Vaccination status was unknown for the other. One death occurred in a serogroup B case who was partially vaccinated. One death occurred in a clinically diagnosed case for whom serogroup was not available.
The MenB vaccine was introduced into the routine childhood vaccination programme on 1 September 2015. All children born from 1 July 2015 were offered the Men B vaccine at two, four and 12 months of age, alongside other routine childhood vaccinations. A catch-up programme was rolled out for children born after 1 May 2015. Children born before 1 May 2015 are not eligible to receive the MenB vaccine.
The combined Hib and MenC vaccine given in the UK is called Menitorix® and it's included in the UK childhood immunisation schedule, with routine vaccination recommended between 12 and 13 months of age. Further information about MenC vaccination is available from the NHS inform website.
MenACWY vaccine was recommended by the Joint Committee on Vaccination and Immunisation (JCVI) and offered to 14 to 18 year olds as a measure to address an increasing number of meningococcal serogroup W cases in this age group. A phased catch-up programme also ran in Scotland between August 2015 and March 2016. The vaccine was also offered to students under the age of 25 attending university for the first time from Autumn 2015. MenACWY vaccine continues to be offered routinely to those in secondary school year 3 (S3).
- Addition of MenB to routine vaccinations can be found on the Public Health England website.
- Read a letter from the Chief Medical Officer letter on the changes to the Men C vaccine on the Scottish Executive Health Department (SEHD) website.
Vaccine uptake statistics
Vaccine uptake statistics can be found on the Information Services Division website.