Meningococcal B claims another life

9 August 2006

Meningococcal B claims another life

The recent death from epidemic strain Meningococcal B of a fully immunised Waikato child is a sobering reminder to remain vigilant for the disease and seek treatment as soon as possible.

This is the first confirmed fatality from the epidemic 'B' strain of the Meningococcal disease of someone who was fully immunised.

Waikato Medical Officer of Health Dr Anita Bell says the parents did all they could for their child by participating in the immunisation programme and seeking help as soon as they could.

"While the immunisation programme is effective protection for most, there will be a few who remain vulnerable. The reasons for this are unclear, and impossible to predict from person to person. For this reason, it is important we remain vigilant for the early warning signs and seek medical assistance as soon as possible. Not only for the 'B' strain, but also for the other strains of meningococcal disease which are rarer but just as potentially devastating," Dr Bell says. National Meningococcal B Immunisation Programme Director, Dr Jane O'Hallahan, says this tragedy should strengthen our resolve to complete the immunisation programme.

"This tragedy is a reminder of why we developed a vaccine and launched New Zealand's largest immunisation programme. Meningococcal B has already had a devastating effect on society, and while the immunisation programme has done much to reduce the number of cases nationally, the disease is still present.

"Our focus must remain on breaking the natural cycle of this disease epidemic through the immunisation programme, and saving lives where we can. Preliminary results from an independent effectiveness study show the vaccine works. Those who are not fully immunised have a five times greater risk of getting the disease. While it is not a guarantee for everyone, the vaccine remains our most effective weapon in the war against meningococcal B.

"We know that the highest rates of meningococcal disease are in those under five and the younger the child, the higher risk of the disease. It is important that children and young people complete all three doses," Dr O'Hallahan says. For young babies who began their vaccinations before they were six months old, it is critical that they have all four doses.

Under-20s have until the end of the year to complete all three doses, while newborns and under-fives will continue to be offered the programme until 2009, or until disease rates indicate we can end the programme sooner.

No vaccine provides 100 per cent protection. Most people who are immunised with MeNZB(tm) vaccine are protected against the epidemic strain, but the vaccine may not protect every person who receives the full course. The MeNZB(tm) vaccine will not protect against other strains of meningococcal disease and there is also up to a 28-day delay after the full course is completed for immunity to develop.

Parents need to be vigilant about the signs and symptoms of meningococcal disease. In the early stages the disease may look like influenza. It can progress very quickly and is difficult to diagnose. A baby or child might have a fever, be crying or unsettled, refuse drinks or feeds, vomit, be sleepy, floppy or hard to wake, dislike bright lights or have a rash or spots. An adult may have a fever or headache, a stiff neck, joint pain and aching muscles, vomit, be sleepy, confused, delirious or unconscious, dislike bright lights, have a rash or spots.

If you are concerned that you or someone in your household has meningococcal disease, ring a doctor or medical centre urgently.

QUESTIONS AND ANSWERS

What is meningococcal disease?

Meningococcal disease is a bacterial infection. It causes severe illnesses including meningitis (an infection of membranes that cover the brain) and septicaemia (a serious infection in the blood). There are several strains of bacteria which cause meningococcal disease including A, B and C. MeNZB(tm) vaccine was developed to protect against the strain of meningococcal B causing the New Zealand epidemic. Everybody in New Zealand is at risk of contracting the disease, however about half of epidemic strain cases in New Zealanders under 20 years old were in children aged under five years. Meningococcal disease rates for Mäori and Pacific peoples are particularly high.

What proportion of New Zealanders in the eligible age group have received the MeNZB(tm)vaccine?

As at 2 July 2006, 87 per cent of all those eligible for the vaccine had completed their first dose, with 80 per cent having completed all three doses.

Does the MeNZB(tm)vaccine work?

Yes. Preliminary results from the study confirm that the vaccine is 80 per cent effective. The study also shows that children and young New Zealanders who are not immunised against the epidemic strain of group B Meningococcal disease have a five times higher risk of getting it than those who are fully-immunised.

How many meningococcal disease deaths have there been this year?
Updated figures show we have had six deaths from meningococcal disease so far this year. Three could not have been prevented by the vaccine programme as they were outside the age range for vaccine and of the three, only one was epidemic strain.

There were three deaths in under 20-year-olds, the age group eligible for vaccination. For one the strain cannot be confirmed. One was epidemic strain but in a child so young they were only partially vaccinated. The third death, the most recent, was also epidemic strain but fully vaccinated.

How many epidemic strain Meningococcal B confirmed cases have occurred in under 20-year-olds?

In the five years before the introduction of the vaccine there was an average of 213 cases and seven deaths per year in under 20 year olds from the epidemic strain. In 2005 there were 82 epidemic strain cases and one death in this age group. In 2006, to date there have been 28 cases and two deaths.

How many vaccine breakthroughs have there been since the programme started?
A vaccine breakthrough is an individual who has become sick from the epidemic strain up to 28 days or more after the third dose. It is believed that it takes up to 28 days after the third dose for the vaccine to confer immunity. There have been 24 vaccine breakthroughs since the programme started in July 2004. Of these 24 vaccine breakthroughs, two were in infants who were overdue for their fourth dose.

When is the MeNZB(tm) vaccine given?

It is recommended that babies begin their MeNZB(tm) vaccinations at six weeks of age, followed by a second dose at 13 weeks or three months, a third dose at 21 weeks or five months and a fourth dose at 43 weeks or 10 months. For all other ages, three doses should be given at six-weekly intervals.

Is the MeNZB(tm)vaccine safe?

Yes. There are no live meningococcal bacteria in MeNZB(tm) vaccine and it is not possible to catch the disease, or to become a carrier of the disease, from the vaccine. The vaccine has been manufactured to international standards. Extensive safety data collected during the programme was reviewed by an Independent Safety Monitoring Board (ISMB). The ISMB has stated that based on the data it has seen, it has no concerns regarding the safety of the MeNZB(tm) vaccine. Serious side effects are very rare however some people experience a mild temporary reaction such as redness at the site of the injection, a headache, nausea, a slight fever, feeling unwell, drowsy or irritable.

ENDS

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