Meningococcal disease gets a lot of attention. It strikes swiftly, affecting our youngest kids, or teenagers with the world at their feet. It’s a catastrophic illness that spreads indiscriminately and can be fatal.
It’s been around for eons, but with better understanding about how the disease is spread plus how best to treat it, the survival rates have steadily improved. In the last decade there’s been even better news, with the introduction of safe and effective immunisation programs dropping the fatality rate to all time lows. But the news is not all good...
Dr Sam Hay discusses Meningococcal Disease and the resurgence of the W strain.
Firstly, lets look at what Meningococcal Disease really is.
‘Meningococcal disease’ is more of a generic term, describing infection with the bacteria Nisseria meningitidis, commonly called ‘meningococcus’. There are 13 different strains, with the most common being A, B, C, W135, and Y.
Most people don't realise that many of us carry meningococcus in our nose and throat at any one time, but usually the immune system deals with it really easily. Occasionally, a more potent strain circulates, or susceptible people become unlucky. Either way, Meningococcal disease eventuates. When severe, it manifests as:
Adults are rarely affected, with the bug mainly affecting our young ones. The most commonly affected ages being the under fives, and teenagers (15-19 year olds). Transmission occurs when people cough and sneeze. The meningococcus is in saliva too, so that means sharing drinks and kissing is a big risk for teenagers. Classically outbreaks occur in winter and early spring.
Why is Meningococcal Disease so feared?
Death and disability are a major risk for anyone with Meningococcal disease. One in 20 will die from it, but that’s not all. The devastating illness leaves nearly one in three with a degree of permanent disability including limb deformity, skin scarring, deafness, and neurological issues.
Scary stuff isn’t it? But it’s not all doom and gloom, because Meningococcal disease is rare.
Over the last ten to twenty years, Australia has seen a shift in which strains are most commonly detected. Prior to 2003, strain B was most common, accounting for about 50% of cases. C accounted for about 30%, and the other strains made up the difference. But in a major public health initiative in 2003, we saw the rollout of a national immunisation program against strain C. It’s been a massive success, with the strain almost completely wiped out. In addition, there’s been a 99% reduction in reported cases. But the success didn’t stop there. By nearly eradicating strain C through vaccination, the overall prevalence of Meningococcal disease plummeted by 82%! Total Meningococcal disease rates dropped from 3.5/100,000 in 2002 to 0.6/100,000 in 2013.
The bad news… (I did warn you)!
Australia is seeing a resurgence of Meningococcal disease cases, with the rate now over 1.2/100,000 due mostly to a rise in W strain cases. Rates of W strain doubled from 2014 to 2015, then tripled in 2016. It’s now time for parents across Australia to start getting a little worried again, and that’s because our doctors are.
W strain is a more deadly form of Meningococcal disease, with a higher than usual death rate of 10%. W is proving to be a more virulent strain. It’s usually only experienced by adults but since 2015, the kids have been far more at risk. No one really knows why W strain rates are on the rise. It’s likely to be due in part to the success of the C and new B strain vaccines (allowing the W strain to run a little more rampant), plus the emergence of the new more virulent W strain.
What do you need to do?
The bottom line is, we need to prevent spread of Meningococcal disease; and W strain is your highest priority now. The simple hygiene techniques need adhering to. Cover up when you sneeze and cough, wash your hands, and definitely don’t share foods and drinks.
Kissing? Yep, that needs tempering too – but I’ll leave that up to you to address with the teenagers!
Then there are vaccinations. Health Departments across Australia have responded to this crisis by introducing W strain vaccination programs in the last year. Teenagers are the immediate priority for the immunisation program at the moment because they harbor the infection, and are therefore deemed critical for transmission. By protecting them first, we hope to halt the spread of W strain and hence protect our most vulnerable little kids.
Many parents ask if they can protect their youngest kids and whether I recommend it. There are vaccines available on script, but they're expensive at about $120 a pop, and in short supply at the moment. W strain vaccines come in a combined vaccine covering strains A, C, W, and Y and they can be given to babies as young as two months. They are safe, and proven to be effective. The decision to vaccinate your kids against the W strain of meningococcus will remain a personal choice for each parent. But it’s not an easy straight forward one. On one hand it’s a catastrophic disease, but that’s countered by the fact that it’s rare. There are vaccines available but they come with costs and some side effects, so please discuss this in detail with your own doctor. But if you’re asking me, I find it very hard to argue the case NOT to have all available Meningococcal vaccines.
Did you know free Meningococcal vaccines are being provided for 15-19 year old teenagers by the WA State Government until December 2017? This vaccine will protect this high risk group against 4 strains of this deadly disease. School children can access the vaccine at their school, and university students through their uni. Teenagers not at school or university are still eligible for the free vaccine and can contact the Central Immunisation Service to find out where to get vaccinated. You can find more information on this here: Healthy WA. If you're not in WA, speak to your doctor to find out your options.