Improving protection against Meningococcal C meningitis and septicaemia (MenC): changes to the timing of immunisations in the UK
Meningitis and septicaemia caused by Group C meningococcal bacteria are life-threatening illnesses which affect mainly babies, young children and teenagers. Nowadays there are just a handful of cases of MenC each year, thanks to the MenC vaccine. Since the vaccine was introduced in 1999 it has prevented over 13,000 cases and 1,300 deaths.
The current immunisation schedule includes a dose of MenC at 3 and 4 months of age with a booster dose at 12-13 months. Although the booster dose prolongs protection, immunity still weakens over time. To maintain protection throughout childhood, the ages when your child has his or her MenC vaccinations are now changing. From June 2013 children will be vaccinated against MenC at 3 months of age, 12-13 months of age and again at around 14 years of age (in school year 9 or 10).
Because MenC can spread rapidly in halls of residence, new starters at university under the age of 25 will also be offered a catch-up vaccination before they enrol on their course starting from late summer 2014.Why does the vaccination programme need to change?
When the vaccine was introduced it was offered to the entire UK population from the age of 2 months to 18 years. The programme was later extended to include everyone under age 25. Since 1999 it has been part of the routine immunisation schedule for babies, directly protecting them from meningitis and septicaemia due to MenC.
We now know that the main factor in the success of the MenC vaccine is that it prevents vaccinated people from carrying MenC bacteria. Teenagers are more likely to carry the bug than any other age group and offering vaccine to all of them in 1999-2001 stopped MenC bacteria from being passed on. This meant that even unvaccinated people were protected from catching the disease – an effect known as herd protection.
Research and careful monitoring of the vaccination programme has taught us that the direct protection young children get from MenC vaccination is relatively short lived1-3
. This means that babies who were vaccinated in 1999/2000 will now be teenagers who are no longer directly protected from disease. So, even though cases of MenC are at a historically low level, it is important to vaccinate this age group to protect these vulnerable teenagers and maintain herd protection amongst the population at large. Will removing the infant vaccine at 4 months put babies at risk?
No. Research has shown that one dose of MenC vaccine in the first year of life provides the same protection as two doses4
. It is more important to maintain herd protection in the population by limiting exposure to the bug. This way, even babies who are too young to be vaccinated will be protected.When will these changes to the timing of MenC vaccination take place?
From 1 June 2013, babies will have two doses of MenC vaccine at 3 months and 12-13 months of age. Starting in the 2013/14 academic year, a booster dose will be offered to school children in years 9 or 10, when they are 13-15 years of age. The catch up vaccination programme for new starters at university will begin from late summer 2014.Why are some children being vaccinated in year 9 and others in year 10?
It is ultimately intended for the vaccine to be administered to children in school year 9 alongside the tetanus, diphtheria and polio (Td/IPV) vaccine booster dose. However, a significant proportion of Td/IPV vaccine is currently given in school year 10. Therefore, for practical reasons there will be flexibility in the timing of areas moving to the new schedule.
What about my 16 year old who will not be eligible for vaccination? Is she at risk?
The vaccine has reduced cases of MenC to an all time low. Since 2008 there have been fewer than 40 MenC cases per year across the UK. In general the risk is small but students in their first year at university are nearly 4 times more likely to catch meningococcal disease than someone in the general population. This is why there will be a catch up vaccination campaign amongst new starters at university.
We know that it is important to adjust the vaccine schedule to prevent the bacteria from circulating otherwise the disease can come back. We learned this from what happened with Hib, which was the most common cause of meningitis in young children before Hib vaccine was introduced in 1992. The Hib vaccine was tremendously successful, and is technically similar to the MenC vaccine. However, the Hib vaccination schedule had to be changed a decade ago after resurgence in cases. This worked so well that now Hib disease has almost vanished. See www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HaemophilusInfluenzaeTypeB/EpidemiologicalData/HibGraph/
. Once my child has been full vaccinated against MenC according to the new schedule, can she still get meningitis?
Unfortunately yes. Although meningitis vaccines are excellent, they do not protect against all strains. For example MenB has been the most common kind of meningitis for decades. There is a new MenB vaccine, and the expert committee that advises government is considering whether it should be introduced. MRF has been campaigning for this and we hope to see it happen in the near future. This should prevent many more cases of meningitis, but even then, there are some kinds of meningitis that cannot be prevented, so it is important to know the symptoms so you can recognise it. Visit our symptoms pageWhere can I go for further information?
More information on the changes to the MenC vaccination programme is available from the following web links:Englandhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/197377/130507_Men_C_changes_FINAL.pdfScotlandhttp://www.sehd.scot.nhs.uk/cmo/CMO(2013)06.pdf.References
- Snape, M.D. and A.J. Pollard, Meningococcal polysaccharide-protein conjugate vaccines. Lancet Infect Dis, 2005. 5(1): p. 21-30.
- Khatami, A., M.D. Snape, T. John, S. Westcar, C. Klinger, L. Rollinson, D. Boutriau, N. Mesaros, J. Wysocki, A. Galaj, L.M. Yu, and A.J. Pollard, Persistence of immunity following a booster dose of Haemophilus influenzae type B-Meningococcal serogroup C glycoconjugate vaccine: follow-up of a randomized controlled trial. Pediatr Infect Dis J, 2011. 30(3): p. 197-202.
- Ishola, D.A., Jr., R. Borrow, H. Findlow, J. Findlow, C. Trotter, and M.E. Ramsay, Prevalence of serum bactericidal antibody to serogroup C Neisseria meningitidis in England a decade after vaccine introduction. Clin Vaccine Immunol, 2012. 19(8): p. 1126-30.
- Findlow, H., R. Borrow, N. Andrews, P. Waight, E. Sheasby, M. Matheson, A. England, D. Goldblatt, L. Ashton, J. Findlow, and E. Miller, Immunogenicity of a single dose of meningococcal group C conjugate vaccine given at 3 months of age to healthy infants in the United Kingdom. Pediatr Infect Dis J, 2012. 31(6): p. 616-22.
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