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Should meningococcal B vaccine be added to the NIP?

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Meningococcal serogroups B and W are currently responsible for most meningococcal disease in Australia, with the B strain remaining the most common cause of invasive meningococcal disease in children, adolescents and young adults.
 
Under Australia’s National Immunisation Program (NIP), vaccination against meningococcal B is currently not funded for people over the age of 16 except in South Australia, which welcomed the move in 2019, and for Aboriginal and Torres Strait Islander peoples who became eligible in 2020.
 
The NIP for infants and adolescents covers the ACWY strains, with the B strain being an additional self-funded immunisation for children of normal risk – at a cost of approximately $200–300 for the required two doses.
 
But more meningococcal deaths among young people have prompted calls for a subsidised B strain vaccination to be expanded nationally.
 
Bond University Professor of General Practice and Chair of the RACGP Expert Committee – Quality Care, Mark Morgan, told newsGP that expanding funding could be considered.
 
‘The decision process for funding within the NIP depends on the balance of risk (increasing) – costs – effectiveness of vaccine (76%) and harms (not much),’ he said.
 
Under the NIP, the meningococcal ACWY vaccine is free for:
 

• children aged 12 months
• adolescents aged 14–16 years
• people of all ages with asplenia and hyposplenia, complement deficiency and those receiving treatment with eculizumab

 
Conversely, the meningococcal B vaccine is only free for Aboriginal and Torres Strait Islander children aged two, four, six and 12 months, and people of all ages also with the above conditions.
 
Flinders University Associate Professor John Litt agrees that there are factors to consider in potentially expanding the criteria for the B strain.
 
‘In a nutshell, it probably boils down to cost effectiveness,’ he told newsGP.
 
‘South Australia has quite a high number of meningococcal B cases per population compared with other states, although New South Wales and Victoria have higher absolute numbers.
 
‘Despite the reported numbers, the risk of transmission in the community is low … [but] most clinicians would agree that meningococcal meningitis is a terrible disease with a high fatality rate and considerable subsequent lifelong disability in those who survive.’
 
Quoting the Immunisation Coalition 2023 guide, Professor Morgan said meningococcal B is emerging as a more common cause of death, which may be a result of widespread vaccination against the other strains.
 
The different immunisation programs also appear to be confusing the public, with the family of a  23-year-old woman who recently died after contracting meningococcal B, which caused bacterial meningitis, saying they ‘just assumed she would have been vaccinated for that’.
 
Speaking to the ABC, RACGP Specific Interests Child and Young Person’s Health Chair Dr James Best warned that while all meningococcal disease strains are ‘rare but very terrible’ and require ‘urgent and critical care’, more awareness is needed that protection against meningococcal B requires a different vaccine.
 
‘It comes down to relying on your GP to be able to explain what vaccines are indicated for your particular situation,’ he said.
 
The Australian Immunisation Handbook (AIH) strongly recommends meningococcal B vaccination for infants and young children and for 15–19-year-olds, but Dr Best, echoing Professors Morgan and Litt, said safety, efficacy and cost would all need to be considered for a potential national rollout of fully funded meningococcal B vaccinations.
 
Meanwhile, Professor Morgan said the AIH recommendations remain important as peak infections ‘seem to be’ in young children, followed by a second peak in adolescents.
 
‘The way these diseases are spread in mucus means that it is household members and other close living arrangements or exchange of mucus, eg kissing, that lead to infection,’ he said.
 
‘Some people carry meningococcal bacteria in the back of their noses, but their immune system keeps it in check causing no harm whatsoever.
 
‘These carriers can potentially spread the infection to a different person where the bacteria can wreak havoc. People who don’t have a functioning spleen are particularly at risk.’
 
It is estimated that around one in 10 people can have meningococcal bacteria in their throat or nose.
 
Given the potential seriousness of the infection, Professor Morgan said that treatment should not be delayed.
 
‘Public health response following identification of meningococcal infection is aimed at treating household and close contacts with “clearance antibiotics” using ciprofloxacin,’ he said.
 
In 2019 the meningococcal ACWY vaccine was rolled out through free school-based vaccination programs under the NIP for adolescents aged 14–16 years, with 15–19-year-olds not vaccinated in school able to do so via a GP-based catch-up program. 
 
But despite the potentially deadly consequences, there are no apparent plans to add vaccination for the B strain to the NIP, with the ABC confirming that the Pharmaceutical Benefits Advisory Committee (PBAC) did not recommend it for the general population in 2019 after considering ‘all available evidence’ to support a listing.
 
Professor Litt also says the PBAC ‘have indicated’ they have not been able to reach a price agreement with vaccine supplier GSK.
 
‘Cost effectiveness is likely to become favourable if GSK reduces its price for the vaccine,’ he said.
 
‘[Or] if a second meningococcal B vaccine becomes available in Australia and the case numbers of meningococcal B rise.’
 
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meningitis meningococcal B National Immunisation Program vaccination schedule

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