Parents of infants, early childhood educators and healthcare providers are urged to be vigilant in identifying the early stages of meningococcal disease after a rise in case numbers over the past year – which are expected to peak in the upcoming winter season.
The warning comes after data from the Institute of Environmental Science and Research (ESR) shows an increase of over 50% of reported cases on the previous year with 72 cases in New Zealand last year. There was a disproportionate burden in Maori and Pacific peoples which represent 60% of the disease cases during this period.[2]
Over 70% of infant cases were Maori, with Pasifika infants representing a further 18% of cases last year.[3]
Across the regions, Otago/Southland and Bay of Plenty had the highest number of cases, each recording the country’s highest rates of meningococcal disease and accounting for almost a quarter (23%) of cases up to late November 2022.[4]
Northland, Canterbury and Nelson/Marlborough made up 22% of all cases nationwide while Auckland made up a further 20% of cases.[5]
Meningococcal disease is an uncommon but life-threatening bacterial infection causing two serious illnesses: meningitis (an infection of the membranes that cover the brain) and septicaemia (blood poisoning).[6]
Even with appropriate medical care, around one in every ten patients who contract the disease will die, and up to one in five survivors will have permanent disabilities such as brain damage, amputated limbs and hearing loss.[7][8][9]
In New Zealand, meningococcal disease can strike at any age, but is most frequent in babies and children under five, followed by teenagers.[10] Pacific and Maori children have three to five times the rate of meningococcal disease than European/Other children.[11][12] The disease follows a seasonal pattern with case numbers peaking in winter.[13]
New Zealand has a higher rate of invasive meningococcal disease compared with other developed countries, with cases on the rise again post pandemic. [14][15][16][17]
There are several types or serogroups of meningococcal bacteria including groups A, B, C, W and Y. The most common in New Zealand is meningococcal group B, which made up over 80 percent of cases in 2022 that could be typed.[18][19] The meningococcal vaccine, Bexsero, protects against meningococcal group B, and there are other vaccines available to help protect against meningococcal groups A,C, W and Y. There is no single vaccine which covers all the different groups.24
University of Auckland Associate Professor Helen Petousis-Harris says meningococcal disease is a rapid and unpredictable disease that can cause death within 24 hours.[20][21][22]
She says the new data is worrying especially as we head into the winter season where colds and flu can increase the risk for meningococcal disease.
Associate Professor Petousis-Harris says infants along with teenagers are most vulnerable to contracting the disease and families need to be vigilant in identifying the early signs.
“Infants are most at risk and they are unable to communicate with us crucial information about how they are feeling or if they have a headache and report any other symptoms that might help a healthcare professional or parent recognise the presence of meningococcal disease.
In New Zealand for the past two decades meningococcal B has been circulating and continues to be the predominant strain. It is also concerning to see the current pervasiveness of strain B:P1.7-2,4, which caused the meningococcal B epidemic between 1991 and 2007 that resulted in 6128 cases and claimed 252 lives,” she says.[23]
The meningococcal B vaccine, Bexsero, has now been funded as part of scheduled childhood immunisations with a catch-up programme for the next two and a half years to provide vaccination for all children under the age of five, who are at highest risk of meningococcal disease.
It has also been funded for those aged 13-25 in close-living situations such as hostels, boarding schools, halls of residence and military barracks with a one year catch up programme for young people already living in close living environments.
This vaccine was previously only funded for those with reduced immune function or close contacts of a meningococcal case.
It is estimated that around 300,000 Kiwis will be eligible during the catch-up period and around 60,000 new infants and young people each year following.[24]
Brett Marett, medical director at GSK NZ, says it is important to be vigilant in protecting infants who are our most vulnerable.
Marett says he would encourage all parents and health care providers to prioritise vaccinating those at risk of contracting meningococcal disease.
“Hundreds of thousands of Kiwis will now be able to access a nationally funded schedule vaccine that broadly targets meningococcal B for the first time. The widespread uptake of vaccination will significantly help to prevent the incidence of this potentially fatal disease among those most at risk, which can strike rapidly and without warning,” he says.
Notes:
1 Provisional Meningococcal disease 2022. Data source: Episurv as of 8 Feb 2022 and Special Pathogens Unit
2Provisional Meningococcal disease 2022. Data source: Episurv as of 8 Feb 2022 and Special Pathogens Unit
3Provisional Meningococcal disease 1 Jan 0 30 Nov 2022. Data source: Episurv as of 7 Dec 2022 and Special Pathogens Unit
4Provisional Meningococcal disease 1 Jan 0 30 Nov 2022. Data source: Episurv as of 7 Dec 2022 and Special Pathogens
5Ministry of Health website. Meningococcal disease (including meningitis.) Summary Tab. Available here: Accessed 27 Jan 2023.
6 Thompson MJ, et al. Lancet 2006; 367(9508): 397–403.
7Immunisation Advisory Centre. Bexsero: A vaccine to protect against Meningococcal group B disease Fact Sheet. Available at here. Accessed 15 September 2018
8 Rosenstein NE, et al. N Engl J Med 2001; 344(18): 1378–88
9Provisional Meningococcal disease 2022. Data source: Episurv as of 8 Feb 2023 and Special Pathogens Unit
10Ministry of Health website. Meningococcal disease (including meningitis.) Summary Tab. Available here: Accessed 25 Jan 2023.
11of those cases that could be typed
12Pharmac decision document. Available here.
13Martin, D. and L. Lopez, The epidemiology of meningococcal disease in New Zealand in 2007. May 2008: Wellington.
14Ministry of Health. Immunisation Handbook 2020 (2nd Edition, March 2018). Available here. Accessed 27 Jan 2023.
15Ministry of Health Meningococcal Brochure 2013. Available here. Accessed 27 Jan 2023.
16Villena R et al. Hum Vaccin Immunother. 2018;14(5):1042-1057
[1] The Institute of Environmental Science and Research. Meningococcal Disease Report Nov 2022. Available here. Accessed 29 Mar 2023.
[2] The Institute of Environmental Science and Research. Meningococcal Disease Report Nov 2022. Available here. Accessed 29 Mar 2023.
[3] The Institute of Environmental Science and Research. Meningococcal Disease Report Nov 2022. Available here. Accessed 29 Mar 2023.
[4] The Institute of Environmental Science and Research. Meningococcal Disease Report Nov 2022. Available here. Accessed 29 Mar 2023.
[5] The Institute of Environmental Science and Research. Meningococcal Disease Report Nov 2022. Available here. Accessed 29 Mar 2023.
[6] Ministry of Health website. Meningococcal disease (including meningitis.) Summary Tab. Available at: https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/meningococcal-disease-including-meningitis Accessed 17 October 2018
[7] Thompson MJ, et al. Lancet 2006; 367(9508): 397–403.
[8] Immunisation Advisory Centre. Bexsero: A vaccine to protect against Meningococcal group B disease Fact Sheet. Available at http://www.immune.org.nz/sites/default/files/resources/Written%20Resources/NonprogrammeVaccineBexseroImac20180912V01Final.pdf. Accessed 15 September 2018
[9] Rosenstein NE, et al. N Engl J Med 2001; 344(18): 1378–88
[10] The Institute of Environmental Science and Research. Meningococcal Disease Report Nov 2022. Available here. Accessed 29 Mar 2023.
[11] Meningococcal disease notifications | New Zealand | Instant Atlas Reports Available here: https://urldefense.com/v3/__https://www.ehinz.ac.nz/assets/Factsheets/Released_2022/Meningococcal-disease-notifications-_-082022.pdf__;!!AoaiBx6H!xb-Z925cMRroFaPyLyhEukxcQyBDcrB6Cpe4I126AjoOasS6cl5DF_Vg7MVKCZl7HeqDE3qHmcfJNJbvhaRw$ Accessed May 2023
[12] Thompson MJ, et al. Lancet 2006; 367(9508): 397–403.
[13] The Institute of Environmental Science and Research. Meningococcal Disease Report Nov 2022. Available here. Accessed 29 Mar 2023.
[14] The Institute of Environmental Science and Research. Meningococcal Disease Report September 2019. Available at https://surv.esr.cri.nz/surveillance/Meningococcal_disease.php Accessed 28 October 2019.
[15] Australian Government Department of Health. Invasive Meningococcal Disease National Surveillance Report Quarter 4 2018. Available here. Accessed 7 November 2018.
[16] CDC. Enhanced Meningococcal Disease Surveillance Report, 2017. Available here. Accessed 1 April 2019.
[17] England ref: Public Health England. Invasive Meningococcal Disease in England: annual laboratory confirmed reports for epidemiological year 2017 to 2018. Available here. Accessed 1 April 2019.
[18] The Institute of Environmental Science and Research. Meningococcal Disease Report Nov 2022. Available here. Accessed 29 Mar 2023.
[19] Thompson MJ, et al. Lancet 2006; 367(9508): 397–403.
[20] Rosenstein NE, et al. N Engl J Med 2001; 344(18): 1378–88
[21] Pelton SI. J Adolesc Health 2010; 46(2suppl2): S9-15
[22] Thompson MJ, et al. Lancet 2006; 367(9508): 397–403.
[23] Thompson MJ, et al. Lancet 2006; 367(9508): 397–403.
[24] Rosenstein NE, et al. N Engl J Med 2001; 344(18): 1378–88
24 Immunisation Advisory Centre (IMAC). Bexsero: A vaccine to protect against Meningococcal group B disease Fact Sheet. Available at: 63fd5e47fb70d812b11dd246_NonprogrammeVaccineBexseroImac20210701 v6.pdf (website-files.com) [Accessed May 2023]
