Meningitis B

Meningitis B is caused by the bacteria, Neisseria meningitidis Group B.

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There are several different types of this bacteria, but group B is responsible for 80% of cases of bacterial meningitis in the UK. Although it can affect any age group, the incidence of Meningitis B is highest in children under 5 years of age, especially the under 1 year. A second peak in incidence occurs in teenagers between 15 to 19 years of age.


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Transmission

1 in 10 adults and 1 in 4 teenagers carry group B bacteria at the back of their throat. The bacteria can be spread through respiratory droplets by coughing, sneezing or by kissing.

Symptoms

Meningococcal infection can cause meningitis (inflammation of the lining of the brain and spinal cord), septicaemia (blood poisoning) or both. Symptoms can develop within hours and can be non-specific. It is much harder to identify the infection in babies as the typical features tend to be absent.  The rash does not always occur. In children and adults symptoms can include:

  • sudden onset of a high fever
  • a severe headache
  • dislike of bright lights (photophobia)
  • vomiting
  • painful joints
  • fitting
  • drowsiness that can deteriorate into a coma

In babies there may also be:

  • high pitched moaning or whimpering
  • blank starring, inactivity, hard to wake up
  • poor feeding
  • neck retraction with arching of the back
  • pale and blotchy complexion

Septicaemia occurs if the bacteria enter the bloodstream. A characteristic rash develops and may start as a cluster of pinprick blood spots under the skin, spreading to form bruises under the skin. The rash can appear anywhere on the body. It can be distinguished from other rashes by the fact that it does not fade when pressed under the bottom of a glass (the tumbler test).

Treatment

The infection is treatable with antibiotics. Prompt treatment is essential as the bacteria spreads rapidly. Fatality occurs in about 10% of cases of meningitis and up to 50% of cases of septicaemia. Around 10% of survivors have a major disability as a consequence of the infection.

Prevention

Vaccination is now available against the common circulating strains of Neisseria Meningitidis. At CityDoc, we stock the following vaccines:

  • New-Group B Meningitis Vaccine. From 2 months of age.
  • Meningitis ACW135Y vaccine-provides effective protection against the major strains occurring globally and is particularly important when travelling. This vaccine also provides protection against Meningococcal C strain.

The meningitis B vaccine obtained UK approval in 2014 and is since September 2015, it was introduced into the NHS childhood immunisation for babies born from May 2015. Any child born prior to May 2015 will not be eligible for vaccination. At CityDoc, we have been using the vaccine since 2014 and have extensive experience with the vaccine.

There a many different strains of meningitis B bacteria and the vaccine  is effective against 88% of the strains circulating in the UK and 78% of European circulating strains.

The vaccine is inactivated, which means it does not contain any live components of the bacteria and thus, cannot cause active disease in those vaccinated.

Inclusions

The vaccine can be given to anyone from 2 months of age until 50 years of age to provide protection against the majority of meningitis B infections.

Age at first doseMethod of AdministrationNumber of dosesInterval Between DosesBooster Requirement
2-5 monthsIntramuscular injection to the thigh3 dosesAt least 1 month between each doseYes-One further dose given at 12-15 months of age
6-11 monthsIntramuscular injection to the thigh2 dosesAt least 2 months between dosesYes-One further dose given in 2nd year of life, at least 2 months after 2nd dose.
12-23 monthsIntramuscular injection to the thigh or deltoid muscle2 dosesAt least 2 months between dosesYes-One further dose given 1-2 years after the 2nd dose
2-10 years of ageIntramuscular injection to the deltoid muscle2 dosesAt least 1 month between each doseUnknown
Over 11 years of ageIntramuscular injection to the deltoid muscle2 dosesAt least 1 month between each doseUnknown

The vaccine cannot be given:

  • If there is a history of severe allergic reaction to a previous dose of the meningitis B vaccine.
  • If a history of previous severe allergic reaction to any of the ingredients contained in the meningitis B vaccine .
  • In the presence of any illness with a high temperature (above 38.5 degrees Celsius).

Pregnancy

Generally, vaccinations should be avoided in pregnancy, especially the first 12 weeks and the meningitis B vaccine should only be given in pregnancy if the need for protection is high as determined by a doctor. However, in animal studies and in cases where the vaccine has been given during pregnancy no harmful effects have been demonstrated.

Breast Feeding

Again animal studies do not demonstrate harm to breast fed infants if their mothers have been vaccinated with meningitis B vaccine. Therefore, breast feeding mothers can receive the vaccine if there is deemed a clinical risk of infection.

Common Side Effects

Localised effects at the injection site are common and include pain, redness, swelling and hardness of the skin.

Fever (can be above 38 degrees Celsius) is also a common side effects with the vaccine. When the vaccine is given by itself, the occurrence of fever is the same as with all other vaccines. However, when it is given at the same time as other vaccines, the risk of fever is higher and paracetamol should be considered either immediately before vaccination or after to prevent this from occurring.

Other side effects include poor appetite, vomiting and irritability.

Interactions with other vaccines

Group B Meningitis vaccine can be given at the same time as the following vaccines:

  • MMR (Measles, Mumps, Rubella)
  • Chickenpox
  • Diphtheria/Tetanus/Pertussis
  • Polio
  • Pneumococcal vaccine (conjugated)
  • Hepatitis B vaccine
  • Meningitis ACWY vaccine

It can be given with or any time before or after the routine UK National Childhood immunisations.

When the vaccine is given at the same time as other vaccines, it should be administered in a separate limb and the risk of fever is higher, so giving paracetamol preventatively just before or after vaccination should be considered.  The vaccines should be administered on different limbs.

For all other vaccines, as there is no data, the advice is avoid administering at the same time, and to leave a one week gap. 

1) Who is the manufacturer of your Group B vaccine ?

The vaccine is manufactured by GlaxoSmithKline. This is the only vaccine available in the UK against meningitis B and is used in both private clinics and the NHS.

2) Is the Meningitis B vaccine safe?

The vaccine has been extensively tested for safety concerns prior to getting it’s licence in Europe and the UK. During clinical trials, 8000 people, including 5000 infants and children were given the vaccine without any serious adverse reactions. Additionally, the vaccine was given to 17000 people in an University outbreak in the US without any safety concerns. 45000 people from 2 months to 20 years of age were given the vaccine in Quebec without any serious adverse effects being reported.

The main side effects identified were as discussed in our “Common Side Effects” section and is similar to the side effect profile of other inactivated (non live) vaccines administered during childhood such as meningitis C vaccine.

3) Can my child have the vaccine if they are unwell?

If your child has a fever, then we would not recommend the vaccine is administered until they are well.With regards to minor illnesses without a fever, such as cold or cough, the decision to vaccinate would be made by the clinician following consultation and assessment. As a general rule, the vaccine can b e given in minor infections.

4) My child is due their NHS childhood vaccines at the same time as they are due the Group B vaccine. Can they still have the vaccine?

Group B Meningitis Vaccination can be given at the same time or any time before or after routine childhood immunisations, including MMR and Meningitis C. When given at the same time as other vaccines, there is increased risk of high fever , especially in children under 2 years of age. Therefore, it is recommended that paracetamol is given either immediately before or after the vaccine has been administered to reduce the incidence of high fever.

5) How long does the vaccine take to become effective?

The immune response develops around 2 weeks after administration. This immune response does wane over time and hence the need for further doses. 

7) What is the duration of protection ?

This is currently unknown and studies are ongoing. 

8) What happens if my child cannot get their second or subsequent doses at the recommended time intervals?

We have limited study data on this as it is a new vaccine. However, the DOH advice for inactivated vaccines applies and this states that:

“A vaccine given later than the recommended interval from the last dose will not cause any harm to the individual and, as a rule, there should be no requirement to restart a course of vaccines. It does, however, leave the individual unprotected for a longer period of time and, until the recommended doses have been given, full protection might not be attained”. (DOH, Vaccine Incident Guidance).

Therefore, you would not need to have the first dose repeated and the schedule can be continued from where it was left off. 

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