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Meningococcal Disease Guide

Rapid, deadly, preventable – meningococcal disease demands early recognition and vaccination. Here’s what every provider must know.

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Key Summary

  • What it is: Meningococcal disease is a rare but fast-moving infection that can cause death within hours or leave survivors with serious complications.
  • Symptoms: Sudden fever, headache, stiff neck, rash, muscle pain, cold hands/feet, confusion, nausea/vomiting. Atypical presentations (e.g., septic arthritis, pneumonia) occur with MenW.
  • High-risk groups: Infants <5, adolescents 15–24, immunocompromised people (e.g., complement deficiencies, asplenia, HIV, eculizumab), Aboriginal and Torres Strait Islander children/adolescents, those in crowded housing, smokers, and lab workers.
  • Vaccines:
    • MenACWY (Nimenrix, MenQuadfi, Menveo): Funded for children (12m), adolescents (14–16y), and catch-up (15–19y).
    • MenB (Bexsero): Leading cause in Australia; funded for Aboriginal and Torres Strait Islander infants, people with risk conditions, and in some states (SA, NT, QLD).
    • MenC (NeisVac-C): Rarely used since near-elimination after the 2003 program.
  • Effectiveness: MenACWY programs cut cases by up to 85%; MenC program reduced disease by 96%. MenB vaccine covers ~76% of circulating strains.
  • Prevention: Vaccination is key; adolescent programs create herd protection. Early recognition and urgent treatment remain vital.
  • Safety: MenACWY and MenB vaccines are safe; side effects are usually mild (pain, headache, fever). Prophylactic paracetamol recommended with MenB in infants.

About Meningococcal Disease

Meningococcal disease progresses very rapidly. Deaths can occur in as little as a few hours.

The disease is caused by the bacterium Neisseria meningitidis. The most common strains worldwide are A, B, C, W and Y.

Since the introduction of the national meningococcal C vaccination program in 2003, cases of MenC disease have significantly declined, with no reported cases in Australia in 2022.[1] Similarly, the rollout of MenACWY vaccination programs in 2017 and 2018 has led to a marked decrease in MenW and MenY disease incidence.[1] 

Currently, MenB is the leading cause of meningococcal disease in Australia, accounting for 83% of cases in 2022—the highest proportion recorded since 2008–2009.[1] To combat this, state-funded MenB vaccination programs have been introduced in South Australia since 2018, Queensland from 2024, and the Northern Territory from 2025.

This guide provides useful information about clinical features of the disease, as well as information on epidemiology, transmission, and vaccination recommendations.

As healthcare professionals you can help stop the spread of meningococcal disease by:

  • Advising patients and parents about the importance and safety of vaccination
  • Helping to prevent meningococcal disease in adolescents. Vaccine effectiveness of a 4vMenCV adolescent vaccination program in the United States has been estimated at 80 to 85%[2]
  • Helping to prevent the spread of meningococcal disease to the broader community (herd immunity)
  • Considering testing for invasive meningococcal disease in older patients who may have atypical presentations (septic arthritis and epiglottitis)[3]
  • Upon clinical suspicion, take steps to diagnose and provide early management

Meningococcal Symptoms

People with meningococcal disease can become extremely unwell very quickly.

After being infected, it usually takes between 1–10 days for symptoms to appear.[4]

The possible symptoms are: sudden onset of fever, rash of red-purple pinpricks or bruises, headache, neck stiffness, photophobia, muscle aches, cold hands and feet, confusion, irritability, joint pain, nausea and vomiting.[3]

What Causes Meningococcal Disease?

Meningococcal bacteria are only found in humans and are not easily spread as the bacteria do not survive well outside the human body.[5]  Meningococcal disease is transmitted by close, prolonged household and intimate contact. The spread of the disease is through the infected secretions from the back of the nose and throat. 

About 1 in 10 people[6] can have meningococcal bacteria in their throat or nose. These very rarely cause illness but can be transmitted to others who are more susceptible and cause illness in them. Teenagers have the highest carriage rates, peaking in 19-year-olds, and so play an important role in transmission.[7]

Who Is Most Affected?

Most meningococcal disease occurs in children aged less than 5 years and adolescents aged between 15 and 24 years.[5]

Meningococcal serogroup B (MenB) disease remains the most common cause of IMD in children, adolescents and young adults.[8]

MenW also has its peak in these age groups, however it has a diverse age range.[9]

Risk Factors

Individuals at greater risk of meningococcal infection:[3][10]

  • Immunocompromised due to certain disorders of the immune system (particularly complement deficiencies) – HIV infection, haematopoietic stem cell transplant
  • Certain medical treatments (e.g. eculizumab)
  • Asplenia
  • Occupational exposure in laboratories
  • Exposure to smokers (who are more likely to be carriers)
  • Crowded living conditions
  • Intimate kissing
  • Recent or current viral infection
  • Aboriginal and/or Torres Strait Islander people (up to 19 years of age)

Complications

A common presentation of MenW in Australia has been severe sepsis. MenW disease has been associated with atypical presentations, such as septic arthritis, pneumonia and epiglottitis, in up to 20% of cases.[11]

Some people may experience permanent brain damage, and 1 in 10 may die.[12] 1 in 5 people who recover may have lingering health problems such as:[12]

  • Skin scarring
  • Limb deformity
  • Limb loss
  • Deafness
  • Impaired vision
  • Learning difficulties[13]

Quadrivalent Meningococcal Vaccine

4vMenCV for serogroups A, C, W and Y – Nimenrix and MenQuadfi# are available on the NIP for 14-16 year olds and 14-19 year olds as a catch-up program.

Trade Name/ Age availableAge AvailableNIP Age AvailableFormulation
MenQuadfi [#]From 12 months onwards14–16 years

Those aged 15–19 years on catch-up schedules		Quadrivalent tetanus toxoid conjugate
MenveoFrom 2 months onwards[*]Not available on the NIPQuadrivalent CRM 197 conjugate
NimenrixFrom 6 weeks onwards[*]12 monthsQuadrivalent tetanus toxoid conjugate

[#] Added to the NIP on 1 July 2024.

[*] ATAGI recommends Menveo and Nimenrix can be given from 6 weeks of age.

Who Should Be Vaccinated?

  • Vaccination may be offered to anyone aged 6 weeks or older wishing to reduce the risk of Men A, C, W and Y
  • Those with increased medical, occupational or other exposure including travel risks of meningococcal disease caused by serogroups A, C, W and Y
  • Infants and children aged <2 years. See Table. Recommendations for immunisation of infants and children aged <2 years using meningococcal ACWY vaccines, by age and vaccine brand for more details.
  • Healthy adolescents aged 15–19 years
  • Adolescents and young adults (aged 15–24 years) who live in ‘close quarters’, including new military recruits and students living in residential accommodation.
  • Adolescents and young adults (aged 15–24 years) who are current smokers.

See Immunisation Handbook for more details. 

Availability

Funded for adolescents or children (for varying and limited periods of time [*]):

  • Nimenrix funded on NIP for children 12 months of age
  • MenQuadfi funded on NIP for adolescents aged 14–16 years, and those aged 15–19 years on catch-up schedules
  • Funded on NIP through school-based program for 14–16 yr olds
  • Funded through NIP for people with certain medical conditions at increased risk of IMD. (See Immunisation Handbook for details)
  • Menveo is not funded on the NIP but is available on private script where stock is available.

The vaccines are otherwise available on private prescription. 

Contact your state or territory health department for more information.

Administering Quadrivalent Meningococcal Vaccines

MenQuadfi is in a liquid form and simply drawn up and administered to the individual.

Menveo and Nimenrix consist of a powder and a liquid which need to be combined before they are administered.

Vaccine Safety

Clinical trials confirm the safety of MenQuadfi, Menveo, and Nimenrix across all age groups, with most reactions being mild.[14]

For MenQuadfi, common adverse events include injection site pain, myalgia, and headaches, and fever. In infants aged 12–23 months, a slightly higher rate of adverse events was observed when co-administered with 13vPCV, and in adolescents aged 10–17 years when given with dTpa and HPV vaccines.[15]

Menveo is well-tolerated, with injection site pain, headaches, and myalgia being the most frequent side effects. Fever occurred in 3–23% of infants and 1% of adolescents. Co-administration with routine vaccines did not increase adverse events, though a slightly higher frequency was noted with HPV and dTpa vaccines in adolescents.[16] 

Nimenrix has a strong safety profile, with mild injection site reactions in 30–50% of recipients. About 20% experienced mild systemic reactions. In infants, mild adverse events were slightly more frequent when co-administered with Infanrix hexa or Vaxelis, though no differences were observed in adolescents.[17]

Meningococcal B Vaccine

MenBV for serogroup B

Trade NameFormulation
Bexsero

In South Australia: Bexsero for childhood program

Bexsero for school immunisation program and under 21 catch-up program		Recombinant multicomponent
MenB

Who Should Be Vaccinated?

Vaccination can be offered to anyone aged 6 weeks [3] or older who wants to reduce the risk of MenB disease.

Infants and young children, particularly those <2 years, adolescents and those with increased medical or occupational exposure risks of MenB disease.

Healthy adolescents aged 15–19 years.

Adolescents and young adults (aged 15–24 years) who live in ‘close quarters,’ including new military recruits and students living in residential accommodation.

Adolescents and young adults (aged 15–24 years) who are current smokers.

Funded on NIP for people with medical conditions that increase risk of IMD (i.e. asplenia, hyposplenia, complement deficiency and those receiving treatment with eculizumab).

On NIP for Aboriginal and/or Torres Strait Islander children at 2, 4, and 12 months of age. Including Aboriginal and/or Torres Strait Islander children at 6 months of age with specified medical risk conditions. 

See Immunisation Handbook for more details. 

Availability

Private prescription.

All Aboriginal and Torres Strait Islander children aged 6 months to less than 2 years of age are eligible for meningococcal B vaccines if missed at the recommended schedule points. 

Funded on NIP for all ages with specific risk conditions.

Funded vaccination available in South Australia:[18]

  • 6 weeks–12 months of age: Meningococcal B childhood program commencing October 2018/ongoing
  • Yr 10 MenB vaccination commencing February 2019/ongoing

Funded vaccination available in the Northern Territories:[19]

  • Free for infants under the age of 2, and adolescents aged 15–19 years.
  • It will be part of the:
    • childhood immunisation schedule for infants 6 weeks–12 months
    • school-based vaccination program for Yr 9 students
    • catch up vaccination program for children under 2 years, and adolescents aged 15–19 years

Funded vaccination available in Queensland:

  • All infants and children under the age of 2 years
  • All adolescents aged 15–19 years
  • A part of the Yr 10 school immunisation program

The MenB vaccine, Trumenba, is now unavailable in Australia. If a person did not complete a primary course of Trumenba, they should restart their primary course and receive 2 doses of Bexsero, 8 weeks apart. If a person who received a primary course of Trumenba now requires a booster dose, Bexsero can be used and will still provide protection.[20]

Vaccine Effectiveness

Based on laboratory tests, estimated vaccine induces protective antibodies against 76% of MenB strains in Australia.[21]

Vaccine Safety

Fever is the most common side effect in infants and young children especially when given concurrently with other vaccines.[22] Prophylactic paracetamol is recommended with MenBV administration in children aged under 2 years.[23]

Meningococcal C Conjugate Vaccines

MenCCV for serogroup C

Trade NameFormulation
NeisVacCMen C conjugate vaccine

Who Should Be Vaccinated?

Registered for use in children aged ≥8 weeks and in adults.[24]

Availability

Available as a catch-up immunisation on the NIP for people aged 10 to 14 years.[25]

Vaccine Effectiveness

Use from 2003 in Australia resulted in a 96% reduction in MenC invasive disease in all age groups by 2012.[26]

Vaccine Safety

Clinical trials in England found that mild to moderate transient headaches were the most common adverse event, occurring more frequently in older adolescents than in younger children. Most local reactions, such as pain and redness at the injection site, were mild and resolved without intervention. Post-licensure safety surveillance in the UK identified transient headaches, fever, local reactions, and dizziness as the most frequently reported adverse events.[27]

References

  1. Australian Technical Advisory Group on Immunisation (ATAGI). Meningococcal disease [Internet]. Canberra: Australian Government Department of Health and Aged Care; [cited 2025 Feb 13]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease#meningococcal-disease-in-australia
  2. MacNeil JR, Cohn AC, Zell ER, et al. Early estimate of the effectiveness of quadrivalent meningococcal conjugate vaccine. Pediatric Infectious Disease Journal 2011;30:451-5.
  3. Australian Technical Advisory Group on Immunisation (ATAGI). Meningococcal disease. In: Australian Immunisation Handbook. Canberra: Australian Government Department of Health; 2024. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease
  4. Healthy WA. Meningococcal disease [Internet]. Perth: Government of Western Australia; [cited 2025 Feb 13]. Available from: https://www.healthywa.wa.gov.au/articles/j_m/meningococcal-disease
  5. Better Health Channel. Meningococcal disease [Internet]. Melbourne: Victorian Government; [cited 2025 Feb 13]. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/meningococcal-disease
  6. Centres for Disease Control and Prevention (CDC) Meningococcal Disease Causes and Transmission (page last updated 8 February 2024) Accessed 19 May 2024.
  7. Christensen H. et al. 2010. Meningococcal carriage by age: a systematic review and meta-analysis. Lancet Infectious Diseases Dec 2010: 853-61.
  8. Department of Health and Aged Care National Notifiable Diseases Surveillance System Meningococcal Disease (invasive) Date last updated September 2023. https://www.health.gov.au/resources/publications/national-notifiable-diseases-surveillance-system-nndss-public-dataset-meningococcal-disease-invasive?language=en
  9. National Notification Disease Surveillance System Annual Report Writing Group. Australia’s notifiable disease status, 2016: Annual report of the National Notifiable Diseases Surveillance System. Communicable Diseases Intelligence 2021; 45. Available from: https://www.health.gov.au/sites/default/files/documents/2021/09/australia-s-notifiable-disease-status-2016-annual-report-of-the-national-notifiable-diseases-surveillance-system-australia-s-notifiable-disease-status-2016-annual-report-of-the-national-interoperable-notifiable-diseases-su.pdf
  10. McCall BJ, Neill AS, Young MM. Risk factors for invasive meningococcal disease in southern Queensland, 2000–2001. Internal Medicine Journal 2004;34:464-8.
  11. Martin NV, Ong KS, Howden BP, et al. Rise in invasive serogroup W meningococcal disease in Australia 2013– 2015. Communicable Diseases Intelligence 2016;40: E454-E9.
  12. Know Meningococcal website. knowmenningococcal.com.au (Accessed 26 May 2024)
  13. Victoria State Government. Health and Human Services. Better Health Channel Meningococcal Disease Fact Sheet. Reviewed on 22 March 2024 (Accessed 26 May 2024).
  14. Australian Technical Advisory Group on Immunisation (ATAGI). Meningococcal disease: Adverse events [Internet]. Canberra: Australian Government Department of Health and Aged Care; [cited 2025 Feb 13]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease#adverse-events
  15. Australian Technical Advisory Group on Immunisation (ATAGI). Meningococcal disease: MenQuadfi [Internet]. Canberra: Australian Government Department of Health and Aged Care; [cited 2025 Feb 13]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease#menquadfi
  16. Australian Technical Advisory Group on Immunisation (ATAGI). Meningococcal disease: Menveo [Internet]. Canberra: Australian Government Department of Health and Aged Care; [cited 2025 Feb 13]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease#menveo
  17. Australian Technical Advisory Group on Immunisation (ATAGI). Meningococcal disease: Nimenrix [Internet]. Canberra: Australian Government Department of Health and Aged Care; [cited 2025 Feb 13]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease#nimenrix
  1. SA Health Meningococcal B Immunisation Program.
  2. Northern Territory Government. Free meningococcal B vaccine now available for infants and adolescents [Internet]. Darwin: Northern Territory Government; 2025 [cited 2025 Feb 5]. Available from: https://health.nt.gov.au/news/2025/free-meningococcal-b-vaccine-now-available-for-infants-and-adolescents#:~:text=From%202025%20onwards%2C%20infants%20aged,the%20NT%20School%20Immunisation%20Program
  3. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook: Meningococcal disease [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2023 [cited 2025 Feb 5]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease#menb-vaccine-1
  4. Therapeutic Goods Administration (TGA) Novartis Vaccines & Diagnostics Pty Ltd. Product information: BEXSERO® suspension for injection. Multicomponent meningococcal group B vaccine (recombinant, adsorbed). 2016.
  5. Australian Technical Advisory Group on Immunisation (ATAGI). Meningococcal disease: Bexsero [Internet]. Canberra: Australian Government Department of Health and Aged Care; [cited 2025 Feb 13]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease#bexsero
  6. South Australian Neonatal Medication Guidelines. Meningococcal group B vaccine Bexsero® (multicomponent, recombinant). Adelaide: Department for Health and Wellbeing, Government of South Australia; 2019. Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/8ee18b8e-3bc9-43ce-8dcf-ca5047eb48b4/Meningococcal+Group+B+Vaccine_Neo_v1_0.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-8ee18b8e-3bc9-43ce-8dcf-ca5047eb48b4-oSqDCh2
  7. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook: Meningococcal disease [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2023 [cited 2025 Feb 5]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease#monovalent-vaccines
  8. Australian Government Department of Health and Aged Care. Catch-up immunisations [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2025 [cited 2025 Feb 5]. Available from: https://www.health.gov.au/topics/immunisation/immunisation-information-for-health-professionals/catch-up-immunisations
  9. Lawrence GL, Wang H, Lahra M, Booy R, McIntyre PB. Meningococcal disease epidemiology in Australia 10 years after implementation of a national conjugate meningococcal C immunization programme. Epidemiology and Infection 2016; 144:2382-91.
  10. Australian Technical Advisory Group on Immunisation (ATAGI). Meningococcal disease: NeisVac-C [Internet]. Canberra: Australian Government Department of Health and Aged Care; [cited 2025 Feb 13]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease#neisvacc

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