Meningococcal Disease In Australia Research Articles

Meningococcal vaccines in Australia: a 2019 update.

SUMMARYInvasive meningococcal disease is a rare but serious infection caused by Neisseria meningitidisSerogroup B was the predominant serogroup causing invasive meningococcal disease in Australia until 2015. Serogroup W disease has increased substantially since 2014, and in 2017, serogroups B and W caused similar numbers of invasive disease casesVaccines against serogroups A, C, W, Y and B are available for anyone who wishes to reduce the risk of meningococcal diseaseVaccination is strongly recommended for people in high-risk age or population groups. These are children under 2 years, 15–19 year olds, Aboriginal and Torres Strait Islander children, and people with medical, occupational, behavioural or travel-related risk factors for invasive meningococcal diseaseMeningococcal ACWY vaccine is funded under the National Immunisation Program for babies aged 12 months. Since April 2019, it has been funded for year 10 students through a school program. There are additional state and territory-based programs for both meningococcal ACWY and meningococcal B vaccines

B Part of It protocol: a cluster randomised controlled trial to assess the impact of 4CMenB vaccine on pharyngeal carriage of Neisseria meningitidis in adolescents

IntroductionSouth Australia (SA) has the highest notification rate of invasive meningococcal disease in Australia with the majority of cases due to serogroup B. Neisseria meningitidis is carried in the pharynx,...

Prospective Surveillance of Pediatric Invasive Group A Streptococcus Infection.

Invasive group A Streptococcus (GAS) disease has an incidence in high-income countries of 3 to 5 per 100000 per annum and a case-fatality ratio of 10% to 15%. Although these rates are comparable to those of invasive meningococcal disease in Australia before vaccine introduction, invasive GAS disease currently requires reporting in only 2 jurisdictions. Data were collected prospectively through active surveillance at the Royal Children's Hospital, Melbourne (October 2014 to September 2016). Isolation of GAS from a sterile site was required for inclusion. Comprehensive demographic and clinical data were collected, and emm typing was performed on all isolates. Disease was considered severe if the patient required inotropic support or mechanical ventilation. We recruited 28 patients. The median age of the patients was 3.5 years (range, 4 days to 11 years). Ten (36%) patients had severe disease. Fifteen (54%) children had presented to a medical practitioner for review in the 48 hours before their eventual admission, including 7 of the 10 patients with severe GAS infection. Complications 6 months after discharge persisted in 21% of the patients. emm1 was the most common emm type (29%). We found considerable short- and longer-term morbidity associated with pediatric invasive GAS disease in our study. Disease manifestations were frequently severe, and more than one-third of the patients required cardiorespiratory support. More than one-half of the patients attended a medical practitioner for assessment but were discharged in the 48-hour period before admission, which suggests that there might have been a window for earlier diagnosis. Our methodology was easy to implement as a surveillance system.

Genetic characterization of a Neisseria meningitidis cluster in Queensland, Australia.

Neisseria meningitidis serogroups B and C have been responsible for the majority of invasive meningococcal disease in Australia, with serogroup B strains causing an increasing proportion of cases in recent years. Serogroup Y has typically caused sporadic disease in Australia. In 2002, a cluster of 4 cases was reported from a rural region in Queensland. Three of these cases were serogroup C, with 1 case diagnosed by molecular detection only, and the fourth case was identified as a serogroup Y infection. Genomic analysis, including antigen finetyping, multilocus sequence typing (MLST), and core genome MLST, demonstrated that the serogroup Y case, though spatially and temporally linked to a serogroup C disease cluster, was not the product of a capsule switch and that one of the serogroup C isolates had a deletion of the entire porA sequence.

Changing epidemiology of invasive meningococcal disease in Australia 1994–2016

Invasive meningococcal disease (IMD) has a relatively low incidence in Australia, however remains a serious public health issue, with a case fatality rate of approximately 10% despite antimicrobial treatment. IMD is particularly seen in young children, but can affect all age groups. The disease has non-specific early symptoms, rapid clinical progression mainly manifesting as septicaemia and/or meningitis, and has the potential for long term sequelae in the survivors, including skin scarring, amputation, deafness and seizures. There are 13 serogroups, although most invasive infections worldwide are caused by serogroups A, B, C, W, and Y, with some recent outbreaks in Africa caused by serogroup X. The prevalent circulating serogroups can undergo dynamic shifts, generating dramatic changes in IMD epidemiology. Such serogroup shifts have important ramifications for vaccination programs and constant surveillance is crucial.

Pre-hospital paramedic administration of Ceftriaxone for suspected meningococcal septicaemia in Victoria, Australia

Meningococcal septicaemia is not common in Australia. The disease does however have a rapid onset and relatively high levels of mortality and morbidity, particularly in children and adolescents. An effective vaccine has been introduced to protect against Group C disease, however no commercially available vaccine exists to protect against Group B which accounts for the majority of cases in Australia. Australian authorities recommend the early administration of antibiotics to cases of suspected meningococcal septicaemia. Ambulance services are important providers of primary healthcare with strong clinical governance processes. They are well placed to assist in meeting the goal of early antibiotic therapy particularly in rural and remote areas where there may be prolonged ambulance transport times and variable access to medical practitioners and other primary healthcare providers. In late 2003 Rural Ambulance Victoria introduced clinical practice guidelines which authorised ambulance and intensive care paramedics to administer the antibiotic Ceftriaxone in cases of suspected meningococcal septicaemia. This paper reviews meningococcal disease in Australia, explores the drivers and processes leading to the development of these guidelines, outlines experiences with the program to date, and identifies the need for further research in this area.

MODERN TRENDS IN MORTALITY FROM MENINGOCOCCAL DISEASE IN AUSTRALIA

Between 1979 and 2006, there were 610 deaths recorded as due to meningococcal disease in Australia. Mortality rates per capita consistently increased on average by 6% per annum between 1979 and 2002, but then fell significantly in 2003, coinciding with the introduction of the meningococcal C conjugate vaccine. In 2002, the mortality rate was 0.24 per 100,000. In the 4 years since, it fell progressively to 0.06 per 100,000. Since the introduction of conjugate Hib and pneumococcal vaccines, meningococcal disease has emerged as the number 1 infectious cause of death in children but conjugate meningococcal C vaccine appears to have greatly reduced total meningococcal disease deaths.

Meningowhatal? … Meningococcal disease in the emergency department

The unpredictable environment of an emergency department can often seem daunting to the newly experienced emergency nurse — a role I felt I was “mastering” very well with 18 months experience up my sleeve. The year was 2001 and I was nearing the end of my Graduate Certificate in Emergency Nursing, pleased with the rate to which I was acquiring knowledge and my skill of applying it to practice. I felt confident in the fact that I could assess and prioritise the care of patients at triage, recognise the patient experiencing an acute myocardial infarct, interpret a electrocardiograph, put in a intravenous cannula and efficiently perform in the resuscitation room as part of the trauma team, just to name a few. However, lurking in the subconsciousness of my mind was a disease that I recall I had heard the name of, listened to the lectures on the topic, and knew that it was a disease that had been highlighted recently in the press and which most people feared they may contract. Nothing however prepared me for the day that I came face to face with the deadly disease whilst caring for a patient. The aim of this experiential paper is to discuss the epidemiology of meningococcal disease in Australia and in particular the Central Coast of New South Wales (NSW), its modes of transmission and describe the associated signs and symptoms. The investigations used to diagnose the disease and the subsequent treatment and management will also be discussed. Finally, prevention techniques through the use of chemoprophylaxis and vaccination will be addressed.

Epidemiology of meningococcal disease in Australia.

A review of the epidemiology of meningococcal disease (MD) in Australia was undertaken, with particular emphasis on the 1990s, when national strain differentiation data became available. The data included a review of clinical and laboratory notification data and published reports on clusters and outbreaks. There have been considerable changes in the patterns of MD in the 1990s. In some cases, these changes can be related to the dominance of a particular phenotype. In the early 1990s, widely scattered urban and rural clusters were associated with the phenotype C:2b:P1.2 and strains were closely genetically related. Larger urban clusters and increased numbers of cases in adolescents and young adults were most obvious in New South Wales in the mid-1990s and were associated with a phenotype C:2a:P1.5. This ET-15 clone of the ET-37 complex caused similar patterns of MD to those seen in other countries as part of the global spread of the clone. In contrast, the B:4:P1.4 phenotype, with close genetic similarities to New Zealand strains, did not cause the hyperendemic disease seen in New Zealand this decade. The epidemiology of MD will continue to exhibit considerable variation due, at least in part, to the genetic flexibility of meningococci. Information about strain variation expands our understanding of changing patterns of disease.

Meningococcal disease in Australia

Meningococcal disease in Australia

New guidelines for management and prevention of meningococcal disease in Australia

The incidence of invasive meningococcal disease in Australia has increased over the past decade, and in April 1997 the National Health and Medical Research Council published guidelines for management of patients with meningococcal disease and their contacts. These guidelines emphasise the need for immediate intravenous antibiotic treatment of patients with suspected meningococcal disease, before transfer to hospital or lumbar puncture. When possible, blood for culture should be collected before antibiotic therapy, if this does not delay treatment.