Meningitis ACYW Vaccination
Meningococcal disease is caused by the bacteria Neiserria Meningitidis, of which there are around 12 strains. Six strains are responsible for epidemics worldwide-A, B. C, W, X and Y. Strains B and C are mainly responsible for outbreaks in industrialised countries, whereas strains A and W135 occur in the “meningitis belt” of Sub Saharan Africa, stretching from Senegal to parts of Ethiopia and causing outbreaks in the dry season annually.
The bacteria is carried at the back of the throat in 1 in 10 people and in 1 in 4 teenagers. It is transmitted through close contact by coughing, sneezing, kissing and sharing food and drinking utensils.
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)
- painful joints
- 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).
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.
There are a number of safe and effective vaccines available against different strains of this bacteria:
- Meningitis B vaccine-approved ion 2014 and introduced into national immunisation programme in 2015
- Meningitis C vaccine-given as part of the childhood immunisation programme for many years
- Meningitis ACWY vaccine-available since 2005. Mainly required for travellers, but since 2015, has been given to 14 years old as part of the childhood programme due to outbreaks of the strain W135 in colleges and universities.
Meningitis ACWY Vaccine
Meningitis ACWY vaccine is an inactivated vaccine that protects against 4 strains of the meningitis bacteria-A, C, W and Y. Prior to 2015, the vaccine was mainly given to travellers to the meningitis belt of Africa and was a mandatory requirement for all pilgrims to Saudi Arabia. However, following an outbreak of Meningitis W, the vaccine was introduced into the UK childhood immunisation programme and is given at 14 years of age.
The vaccine can be given to anyone from birth onward* for the following reasons:
- As an entry requirement to Saudi Arabia for all pilgrims (Hajj/Umrah)
- Travel to Meningitis belt of Africa during outbreaks, especially if the itinerary involves close and prolonged contacts with locals in overcrowded settings, such as schools, hospitals, workplaces.
*Department of Health guidance states that Menveo can be used from birth as there is safety and effectiveness data available for this vaccine.
Additionally, the vaccine is recommended for
- Anyone at risk of meningitis W through college or university entry-Public health England advice that anyone aged up to 25 who is starting university should get vaccinated.
For travel, Department of Health advice the following schedule:
|Age range||Vaccine Brand||Method of Administration||Schedule||Number of doses||Booster|
|From Birth to 1 year*||Menveo Only||Intramuscular injection to the thigh||First Dose Given Day O|
Second Dose Given One Month Later
|From 1 years of age onwards.||Menveo or Nimenrix||Intramuscular injection to the deltoid muscle||One Single Dose||1 dose||Unknown|
*Although the vaccine licence for Menveo is from 2 years, there is sufficient study data showing that the vaccine is safe and effective in babies under 1 year of age. Hence, the Department of Health recommends Menveo can be used from birth.
Pilgrims to Saudi Arabia
Single dose of Meningitis ACWY vaccine given 10 days prior to entry.
General Travellers-the requirement for booster doses for travellers and other at risk groups is currently not know. Clinical study data shows protection lasts for around 5 years following one dose of the ACWY conjugated vaccine.
Pilgrims to Saudi Arabia-For Hajj/Umrah certificate/visa requirements, it is accepted that the vaccine lasts for 5 years (certificate should state conjugate vaccine used). Therefore, further booster would be needed if contemplating pilgrimage after this time period. However, if there is uncertainty as to whether a conjugated vaccine was administererd or ACWY Vax (GSK vaccine) was given, then the validity would be 3 years.
The vaccine should not be given if:
- There a history of severe allergic reaction to previous dose of the vaccine or any of it’s components.
- There is an acute illness with high temperature (greater than 38.5 degrees Celsius).
The vaccine can be given to pregnant women if there is a clinical need to do so. Clinical studies have not been done on the safety of the meningitis vaccines in pregnant women. However, where the vaccine has been given in pregnancy, no harm has been demonstrated. Furthermore, inactivated vaccines in general have not been shown to be harmful during pregnancy.
The vaccine can be given to breast feeding mothers if there is a clinical need to do so. Inactivated vaccines have not been shown to cause harm to breast fed infants when administered to their mothers.
Common Side Effects
Injection site reactions-redness, swelling, itching and tenderness.
Fever, headache, irritability, drowsiness, nausea can also occur.
Interactions with Other Vaccines
The vaccine can be given at the same time or at any time before or after all travel vaccines, including:
- Diphtheria, tetanus, polio vaccine
- Yellow fever vaccine
- hepatitis A and B vaccines
- Typhoid vaccine
- Rabies vaccine
- Cholera vaccine
It can also be given at the same as the common childhood vaccines, such as pertussis, MMR and HiB vaccine.
Frequently Asked Questions
1) Is the vaccine safe?
The vaccine has been rigorously tested prior to obtaining it’s UK licence. Serious neurological complications like seizures (either with fever or without) are extremely rare. The vaccine is also inactivated, which means that it cannot cause the meningitis in the vaccinated individual, nor is the vaccinated individual infectious to others.
2) What are the contents of the vaccine?
Menveo contains in addition to proteins from the 4 strains of the meningitis bacteria the following:
- Potassium dihydrogen phosphate
- Sodium dihydrogen phosphate monohydrate
- Disodium phosphate dihydrate
- Sodium chloride
- Water for injections
The vaccine does not contain:
3) Can my baby have the meningitis ACWY vaccine if they have already had the meningitis C vaccine as part of their childhood immunisation?
If meningitis ACWY is required for travel or as an entry requirement for Umrah/Hajj, it can be given in individuals previously vaccinated with Meningitis C. There is no adverse effects associated with doing this.
4) Am I able to obtain a certificate of vaccination for visa purposes?
You will be provided with your certificate for the Saudi Arabian Embassy immediately after you have received the vaccine. If you have received a conjugated vaccine, then the certificate validity is 8 years.
5) Are you able to provide a duplicate certificate for pilgrimage if I have already had the vaccine?
If you have had either Menveo or Nimenrix within 8 years and have the full details of the vaccine, we can issue a duplicate certificate.
If the vaccine was administered at a CityDoc clinic, we will have the vaccine details already and can issue a duplicate certificate.
If the vaccine was administered at any other clinic, we would require written evidence of the vaccination before we can issue a duplicate. The details required are:
- Date vaccine received
- Vaccine brand
- Batch number
- Expiry date
Please note-if you have previously received ACWY Vax (polysaccharide vaccine) or are unsure which meningitis ACWY vaccine you had, then re-vaccination would be required after 3 years.