Meningococcal disease

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:

• Meningococcal B (MenB)
• Meningococcal ACWY

Public information can be found by visiting the NHS inform website.

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.

Five cases of meningococcal disease were reported between October and December 2020 (weeks 40 to 52), bringing the total for the year to 33. This is lower than the number of cases for the previous four years (range 59 to 108), as shown in Figure 1.

Figure 1: Cumulative number of meningococcal disease cases reported to MIDAS, 2016 to 2020 (week 52)

Figure 2 shows number of meningococcal disease cases, according to age group and by quarter from 2001. Of the 33 cases reported to the end of 2020: 

• two (6.1%) were aged under one year
• Four (12.1%) were aged one to four years
• 12 (36.4%) were aged five to 24 years
• 15 (45.5%) were aged 25 years and over

Figure 2: Meningococcal disease cases reported to MIDAS by age group and quarter, 2001 to 2020 (week 52)

Serogroup was identified for 23 (69.7%) of the 33 cases reported in 2020, as shown in Figure 3:

• 17 (51.5%) were serogroup B
• four (12.1%) were serogroup W
• One (3.0%) was serogroup C
• One (3.0%) was serogroup Y

Of the remaining ten (30.3%) notifications, nine were based on clinical diagnosis, with no serogroup likely to become available, while the other was caused by a non-groupable Neisseria meningitidis strain.  

Figure 3: Meningococcal disease cases reported to MIDAS by serogroup, 1999 to 2020 (week 52)

Of the 17 serogroup B cases reported in 2020, four (23.5%) were under five years of age. All 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 eight weeks. One case had received three doses of Men B vaccine according to the childhood vaccination schedule, two cases had received two doses and one case had received one dose.

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. Four serogroup W cases were in 2020, which is lower than the 13 cases reported in 2019. All four serogroup W cases 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. One serogroup C case was reported in 2020, which is lower than the three cases reported in 2019. This case was unvaccinated with Men C vaccine.

Figure 4:  Meningococcal serogroup W cases by age group reported to MIDAS, 2009 to 2020 (week 52)

Information on clinical presentation was available for 32 of the 33 cases:

• 15 (45.5%) were recorded as presenting with meningitis
• ten (30.3%) with septicaemia
• four (12.1%) with meningitis and septicaemia
• one (3.0%) with peri-orbital cellulitis
• one (3.0%) with pyrexia, confusion and dyspnea
• one (3.0%) with a chest infection

Number of deaths from between 2002 and the end of 2020, reported by serogroup is shown in figure 5, and case fatality ratio is shown in Figure 6. Four deaths from meningococcal disease were reported to MIDAS in 2020, with a case fatality ratio of 12.1%. Three deaths occurred in clinically diagnosed cases for whom serogroup was not available, and one occurred in a serogroup B case. 

Figure 5: Meningococcal deaths by serotype reported to MIDAS, 2002 to 2020 (week 52)

Figure 6: Meningococcal disease case fatality ratio, 2002 to 2020 (week 52)