Meningococcal disease

Background

Meningococcal disease is an invasive infection of Neisseria meningitidis (N. meningitidis) in:

  • blood
  • 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.

Guidance

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 HPS and the< Scottish Haemophilus Legionella Meningococcus and Pneumococcus Reference Laboratory (external weblink) (SHLMPRL). Surveillance data is from MIDAS informs the epidemiology of meningococcal disease in Scotland.

Surveillance update for January to March 2021

Two cases of meningococcal disease were reported in the first quarter of 2021. This is considerably lower than the number of cases for the previous four years (range 19 to 32), as shown in Figure 1.

Figure 1: Cumulative number of meningococcal disease cases reported to MIDAS, 2016 to 2021 (week 13)

Figure 1 is a series of line graphs showing the cumulative number of meningococcal cases reported to MIDAS per week, by year. Each line represents a different year from 2017 to the end of the first quarter of 2021. The number of cases in for the first quarter of 2021 is lower than for the equivalent period of the previous four years.

Figure 2 is a series of line graphs showing the number of meningococcal cases reported to MIDAS per quarter, by year. The data ranges from 2001 to the end of the first quarter of 2021 and each line on the graph represents number of cases for a specific age group, and there is a line for the total number of cases. Historically, cases were more frequent in the under five age group. However, since 2016 those aged above 25 years have overtaken the under fives as the group with highest number of cases overall.

Figure 2: Meningococcal disease cases reported to MIDAS by age group and quarter, 2001 to 2021 (week 13)

Figure 2 is a series of line graphs showing the number of meningococcal cases reported to MIDAS per quarter, by year. The data ranges from 2001 to the end of the first quarter of 2021 and each line on the graph represents number of cases for a specific age group, and there is a line for the total number of cases. Historically, cases were more frequent in the under five age group. However, since 2016 those aged above 25 years have overtaken the under fives as the group with highest number of cases overall.

One case was serogroup B, while the other was based on clinical diagnosis, as shown in Figure 3.

Figure 3: Meningococcal disease cases reported to MIDAS by serogroup, 1999 to 2021 (week 13)

serogroup, from 1999 to the end of the first quarter of 2021. Until 2001, predominant serogroups were B and C (in addition to clinically diagnosed infections). However, the number of group C infections decreased rapidly after 2001 and since 2012, serogroup B infections comprise the majority of laboratory confirmed cases. In 2016, laboratory reports of serogroup C infection increased, alongside serogroup W infections.

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. There were no serogroup W cases reported in the first quarter of 2021.

Figure 4:  Meningococcal serogroup W cases by age group reported to MIDAS, 2009 to 2021 (week 13)

Figure 4 is a series of line graphs showing the number of serogroup W cases reported from 2009 to the end of the first quarter of 2021, by age group. From 2014 to 2016 there was an increase in serogroup W amongst all age groups with exception of those aged 5 to 14 years. Since 2017, serogroup W case numbers have decreased in those aged under 25 years.

Number of deaths from between 2002 and the end of the first quarter of 2021, reported by serogroup is shown in figure 5, and case fatality ratio is shown in Figure 6. There were no deaths from meningococcal disease reported in the first quarter of 2021.

Figure 5: Meningococcal deaths by serogroup reported to MIDAS, 2002 to 2021 (week 13)

Figure 5 is a bar chart showing the number of deaths from meningococcal cases reported to MIDAS by serogroup, from 2002 to the end of the first quarter of 2021. The overall trend is varied, with the highest number of deaths in 2004 (15 deaths) and the lowest in 2012 (two deaths). There were no deaths in the first quarter of 2021.

Figure 6: Meningococcal disease case fatality ratio, 2002 to 2021 (week 13)

Figure 6 is a line graph showing meningococcal disease case fatality ratio from 2002 to the end of the first quarter of 2021.

Vaccination

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 eight weeks, 16 weeks 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).

Vaccine information

Vaccine uptake statistics

Vaccine uptake statistics are published by Public Health Scotland Data and Intelligence.