Objectives: To describe trends in the age-specific incidence of serogroup B invasive meningococcal disease (IMD) in Australia, 1999–2015.
Design, setting, participants: Analysis in February 2017 of de-identified notification data from the Australian National Notifiable Diseases Surveillance System of all notifications of IMD in Australia with a recorded diagnosis date during 1999–2015.
Major outcomes: IMD notification rates in Australia, 1999–2015, by age, serogroup, Indigenous status, and region.
Results: The incidence of meningococcal serogroup B (MenB) disease declined progressively from 1.52 cases per 100 000 population in 2001 to 0.47 per 100 000 in 2015. During 2006–2015, MenB accounted for 81% of IMD cases with a known serogroup; its highest incidence was among infants under 12 months of age (11.1 [95% CI, 9.81–12.2] per 100 000), children aged 1–4 years (2.82 [95% CI, 2.52–3.15] per 100 000), and adolescents aged 15–19 years (2.40 [95% CI, 2.16–2.67] per 100 000). Among the 473 infants under 2 years of age with MenB, 43% were under 7 months and 69% under 12 months of age. The incidence of meningococcal serogroup C (MenC) disease prior to the introduction of the MenC vaccine in 2003 was much lower in infants than for MenB (2.60 cases per 100 000), the rate peaking in people aged 15–19 years (3.32 per 100 000); the overall case fatality rate was also higher (MenC, 8%; MenB, 4%). The incidence of MenB disease was significantly higher among Indigenous than non-Indigenous Australians during 2006–2015 (incidence rate ratio [IRR], 3.8; 95% CI, 3.3–4.5).
Conclusions: Based on disease incidence at its current low endemic levels, priority at risk age/population groups for MenB vaccination include all children between 2 months and 5 years of age, Indigenous children under 10 years of age, and all adolescents aged 15–19 years. Given marked variation in meningococcal disease trends over time, close scrutiny of current epidemiologic data is essential.
- 1. Halperin SA, Bettinger JA, Greenwood B, et al. The changing and dynamic epidemiology of meningococcal disease. Vaccine 2012; 30 Suppl 2: B26-B36.
- 2. Jafri RZ, Ali A, Messonnier NE, et al. Global epidemiology of invasive meningococcal disease. Popul Health Metr 2013; 11: 17.
- 3. Lahra MM, Enriquez RP. Australian meningococcal surveillance programme annual report, 2015. Commun Dis Intell 2016; 40: E503-E511.
- 4. Sadarangani M, Scheifele DW, Halperin SA, et al. Outcomes of invasive meningococcal disease in adults and children in Canada between 2002 and 2011: a prospective cohort study. Clin Infect Dis 2015; 60: e27-e35.
- 5. Viner RM, Booy R, Johnson H, et al. Outcomes of invasive meningococcal serogroup B disease in children and adolescents (MOSAIC): a case-control study. Lancet Neurol 2013; 11: 774-783.
- 6. Wang B, Afzali HHA, Marshall H. The inpatient costs and hospital service use associated with invasive meningococcal disease in South Australian children. Vaccine 2014; 32: 4791-4798.
- 7. Chiu C, Dey A, Wang H, et al. Vaccine preventable diseases in Australia, 2005 to 2007. Commun Dis Intell Q Rep 2010; 34 Suppl: S1-S167.
- 8. Lawrence G, Wang H, Lahra M, et al. Meningococcal disease epidemiology in Australia 10 years after implementation of a national conjugate meningococcal C immunization programme. Epidemiol Infect 2016; 144: 2382-2391.
- 9. Australian Government, Department of Health. Australian Technical Advisory Group on Immunisation (ATAGI) statement. Advice for immunisation providers regarding the use of Bexsero (March 2014). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/atagi-advice-bexsero (accessed May 2015).
- 10. Australian Government, Department of Health. Multicomponent meningococcal group B vaccine, 0.5 mL, injection, prefilled syringe, Bexsero® — November 2013 [public summary document]. Pharmaceutical Benefits Scheme; updated Mar 2016. http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/psd/2013-11/meningococcal-vaccine (accessed June 2016).
- 11. Pharmaceutical Benefits Scheme (PBS). Recommendations made by the PBAC July 2015: subsequent decisions not to recommend. Pharmaceutical Benefits Scheme; updated Dec 2015. http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2015-07/web-outcomes-july-2015-subsequent-decision-not-to-recommend.pdf (accessed June 2016).
- 12. Marshall H, Clarke M, Sullivan T. Parental and community acceptance of the benefits and risks associated with meningococcal B vaccines. Vaccine 2014; 32: 338-344.
- 13. Australian Government, Department of Health. Meningococcal disease (invasive) surveillance case definition — V1.4. Updated Jan 2010. http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-nndss-casedefs-cd_mening.htm (accessed Jan 2014).
- 14. Gibson A, Jorm L, McIntyre P. Using linked birth, notification, hospital and mortality data to examine false-positive meningococcal disease reporting and adjust disease incidence estimates for children in New South Wales, Australia. Epidemiol Infect 2015; 143: 2570-2579.
- 15. Australian Bureau of Statistics. 3101.0. Australian demographic statistics, Jun 2016. Updated 15 Dec 2016. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3101.0 (accessed Mar 2017).
- 16. Australian Bureau of Statistics. 3238.0. Estimates and projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026. Updated Apr 2014. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3238.0 (accessed May 2015).
- 17. Naidu L, Chiu C, Habig A, et al. Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2006–2010. Commun Dis Intell Q Rep 2013; 37 (Suppl): S1-S95.
- 18. Borrow R, Abad R, Trotter C, et al. Effectiveness of meningococcal serogroup C vaccine programmes. Vaccine 2013; 31: 4477-4486.
- 19. Andrews SM, Pollard AJ. A vaccine against serogroup B Neisseria meningitidis: dealing with uncertainty. Lancet Infect Dis 2014; 14: 426-434.
- 20. Vesikari T, Esposito S, Prymula R, et al. Immunogenicity and safety of an investigational multicomponent, recombinant, meningococcal serogroup B vaccine (4CMenB) administered concomitantly with routine infant and child vaccinations: results of two randomised trials. Lancet 2013; 381: 825-835.
- 21. Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62 (RR-2): 1-28.
- 22. MacNeil JR, Bennett N, Farley MM, et al. Epidemiology of infant meningococcal disease in the United States, 2006–2012. Pediatrics 2015; 135: e305-e311.
- 23. Public Health England. Invasive meningococcal disease (laboratory reports in England): 2015/2016 annual data by epidemiological year. Health Protection Report: Weekly Report [online] 2016; 10(37). https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/563949/hpr3716_imd-ann.pdf (accessed July 2017).
- 24. Pollard AJ, Riordan A, Ramsay M. Group B meningococcal vaccine: recommendations for UK use. Lancet 2014; 383: 1103-1104.
- 25. Parikh SR, Andrews NJ, Beebeejaun K, et al. Effectiveness and impact of a reduced infant schedule of 4CMenB vaccine against group B meningococcal disease in England: a national observational cohort study. Lancet 2016; 388: 2775-2782.
- 26. Martin NV, Ong KS, Howden BP, et al. Rise in invasive serogroup W meningococcal disease in Australia 2013–2015. Commun Dis Intell 2016; 40: E454-E459.
- 27. Government of South Australia, University of Adelaide. B part of it [website]. Updated 28 Nov 2016. http://www.bpartofit.com.au (accessed Mar 2017).
- 28. Novartis Vaccines and Diagnostics. Bexsero® suspension for injection [product information]. 2013; updated July 2017. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2013-PI-02131-1 (accessed Mar 2017).
- 29. Poolman JT, Richmond P. Multivalent meningococcal serogroup B vaccines: challenges in predicting protection and measuring effectiveness. Expert Rev Vaccines 2015; 14: 1277-1287.
- 30. Patel MS. Australia’s century of meningococcal disease: development and the changing ecology of an accidental pathogen. Med J Aust 2007; 186: 136-141. <MJA full text>
- 31. Hart JT. The inverse care law. Lancet 1971; 297: 405-412.
- 32. National Centre for Immunisation Research and Surveillance. Meningococcal disease. Meningococcal vaccines for Australians: information for immunisation providers [fact sheet]. Mar 2017. http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf (accessed Aug 2017).
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