Meningococcal disease is an invasive infection of Neisseria meningitidis (N. meningitidis) in:
- cerebrospinal fluid (CSF)
- other normally sterile site
Meningococcal disease cases overwhelmingly show symptoms of meningitis (inflammation of the meninges) or septicaemia (blood poisoning). It can also present as a combination of both or as a rarer clinical presentation, such as joint infection. Meningitis can be caused by a variety of viruses or bacteria, of which N. meningitidis is one. Meningococcal disease is a significant cause of morbidity and mortality in children and young adults.
Although approximately 10% of the population are estimated to carry N. meningitidis in the nasopharynx, the vast majority do not have symptoms or develop invasive disease. Invasive cases acquire infection through inhalation of or direct contact with respiratory droplets, from either an infected person or asymptomatic carrier.
N. meningitidis is classified according to its outer membrane characteristics via a process known as serogrouping. There are a number of different serogroups, the most common of which in the UK is B followed by W. Cases of serogroup Y, Z and C disease have also been also reported.
Data and analysis of meningococcal disease is also available on the Public Health England website.
For more information on meningococcal immunisation, including updates, please refer to the PHE Green Book, Chapter 22.
The National Education for Scotland (NES) website provides healthcare professionals with training and educational materials for:
Public information can be found by visiting the NHS inform website.
For all infection prevention and control guidance visit the A-Z pathogens section of the National Infection and Prevention Control Manual.
Data and surveillance
In 1999 the Meningococcal Invasive Disease Augmented Surveillance (MIDAS) system was introduced. The surveillance scheme is managed jointly by ourselves and the Scottish Haemophilus Legionella Meningococcus and Pneumococcus Reference Laboratory (SHLMPRL). Surveillance data is from MIDAS informs the epidemiology of meningococcal disease in Scotland, as analyses can be conducted according to:
- molecular typing
- clinical presentation
Surveillance update for October to December 2019
Between October and December 2019 (weeks 40 to 52), 16 cases of meningococcal disease were reported, bringing the total number of cases in the first three quarters of 2019 to 59. This is lower than the number of cases for the previous four years (range 72 to 108), as shown in figure 1.
Figure 2 shows number of meningococcal disease cases, according to age group and by quarter from 2001. Of the 59 cases reported in 2019:
- eight (13.6%) were aged under one year
- three (5.1%) were aged one to four years
- 18 (30.5%) were aged five to 24 years
- 30 (50.8%) were aged 25 years and over
Serogroup was identified for 51 (86.4%) of the 59 cases reported in 2019, as shown in Figure 3:
- 31 (52.5%) were serogroup B
- 13 (22.0%) were serogroup W
- four (6.8%) were serogroup Y
- three (5.1%) were serogroup C
The remaining eight (13.6%) notifications were based on clinical diagnosis, and no serogroup is likely to become available.
There were 31 cases of serogroup B reported in 2019. Of the 31 serogroup B cases, eight (25.8%) were under five years of age. All eight cases under five years of age were born on or after 1 July 2015, making them eligible for routine immunisation with Men B vaccine at the age of two months. Of these:
- one case had received three doses of Men B vaccine according to the childhood vaccination schedule
- three cases had received two doses of Men B vaccine according to the childhood vaccination schedule
- three cases had received one dose of Men B vaccine according to the childhood vaccination schedule
- one case was unvaccinated against Men B
The Men B vaccine is not expected to protect against all serogroup B strains and further detailed microbiological testing is required in order to evaluate the full impact of the vaccine.
Serogroup W cases continue to be reported separately following introduction of the MenACWY immunisation programme in summer 2015. Figure 4 demonstrates a positive impact of the MenACWY vaccine for the eligible population. Thirteen serogroup W cases were reported in 2019, which is higher than the 11 cases reported in 2018. Of the 13 serogroup W cases, one (7.7%) was in a child aged under five years old, and twelve (92.3%) were in adults aged 25 years and older. There were no serogroup W cases recorded in the 18-24 year age group, who would have been eligible for MenACWY vaccination.
Following introduction of the Men C vaccine, serogroup C cases declined and were rarely reported in Scotland until 2016, when there was an increase. Three serogroup C cases were reported in 2019, which is lower than the five cases reported in 2018. One serogroup C case was fully immunised with Men C vaccine (last dose over five years ago), one was unvaccinated, and vaccination status for the other case was unknown.
Information on clinical presentation was available for all 59 cases:
- 24 (40.7%) were recorded as presenting with septicaemia
- 19 (32.2%) with meningitis
- 11 (18.6%) with meningitis and septicaemia
- one (1.7%) with joint infection
- one (1.7%) with septicaemia and joint infection
- one (1.7%) with chest infection
- one (1.7%) with abdominal pain and pyrexia
- one (1.7%) with pyrexia and tachycardia
Number of deaths from between 2002 and the end of 2019, reported by serogroup and with case fatality ratio is shown in Figure 5. Seven deaths from meningococcal disease were reported to MIDAS in 2019, with an 11.9% case fatality ratio. Three deaths occurred in serogroup W cases. All three were in adults aged over 25 years, two of whom were unvaccinated. Vaccination status was unknown for the other. Three deaths occurred in serogroup B cases, one of whom was partially vaccinated and one was unvaccinated. Vaccination status was unknown for the remaining serogroup B case. One death occurred in a clinically diagnosed case for whom serogroup was not available.
The MenB vaccine was introduced into the routine childhood vaccination programme on 1 September 2015. All children born from 1 July 2015 were offered the Men B vaccine at two, four and 12 months of age, alongside other routine childhood vaccinations. A catch-up programme was rolled out for children born after 1 May 2015. Children born before 1 May 2015 are not eligible to receive the MenB vaccine.
The combined Hib and MenC vaccine given in the UK is called Menitorix® and it's included in the UK childhood immunisation schedule, with routine vaccination recommended between 12 and 13 months of age. Further information about MenC vaccination is available from the NHS inform website.
MenACWY vaccine was recommended by the Joint Committee on Vaccination and Immunisation (JCVI) and offered to 14 to 18 year olds as a measure to address an increasing number of meningococcal serogroup W cases in this age group. A phased catch-up programme also ran in Scotland between August 2015 and March 2016. The vaccine was also offered to students under the age of 25 attending university for the first time from Autumn 2015. MenACWY vaccine continues to be offered routinely to those in secondary school year 3 (S3).
- Addition of MenB to routine vaccinations can be found on the Public Health England website.
- Read a letter from the Chief Medical Officer letter on the changes to the Men C vaccine on the Scottish Executive Health Department (SEHD) website.
Vaccine uptake statistics
Vaccine uptake statistics can be found on the Information Services Division website.