UK teenage/fresher MenACWY vaccine


  • Since August 2015 all 14 to 18 years olds in the UK are being offered MenACWY vaccine
  • This is part of a one off catch-up vaccination campaign due to a rapid rise in a harmful strain of meningococcal group W (MenW) disease 
  • The catch up vaccination campaign was completed within one year in Scotland and is being completed within two years in England, Wales and Northern Ireland.
  • Each year children in secondary school will be routinely vaccinated with MenACWY during their third academic year

Why do we need to vaccinate teenagers with MenACWY vaccine?


MenACWY vaccine directly protects vaccinated people from four different strains of meningococcal meningitis and septicaemia (groups A, C, W & Y) and also stops them from carrying the bacteria in the back of the nose and throat. 
 
It is particularly important to protect teenagers because they are at increased risk of disease and are more likely to carry the bacteria than other age groups, so they are key to stopping the spread of infection amongst the wider population.  

Importance of protection against MenW disease

Cases of MenW disease have been rising steeply year on year in England and Wales. Public Health England has shown that in 2014/15 MenW accounted for 24% of cases of meningococcal disease compared to only 1-2% in 2008/9.

This rapid rise in disease incidence is due to a particularly virulent strain of bacteria which is causing severe disease in previously healthy people and has a high death rate. The strain was identified using the MRF Meningococcal Genome Library to be a particular ST-11 strain which has caused high disease rates and very high fatality rates in South America. Vaccinating teenagers with a MenACWY vaccine will protect them and stop the spread of this virulent strain.


Importance of maintaining protection against MenC (meningococcal C meningitis and septicaemia)

Since introduction of the MenC vaccine in 1999-2000, MenC has been nearly eliminated in the UK. The vaccine has prevented over 13,000 cases and 1,300 deaths. The reason for this success was not just because the vaccine directly protected babies from disease, but because it was introduced with a one-off catch up campaign, which extended to teenagers and young adults. This stopped people in this age group from carrying bacteria and reduced the spread of disease amongst the wider population.

Research has shown that the direct protection young children get from MenC vaccination is relatively short lived1-3 which means that teenagers who were vaccinated as babies are no longer directly protected and are vulnerable to carrying these bacteria in the back of the nose and throat. 

Boosting teenagers with a MenC containing vaccine will protect them, which is important as they are entering a higher risk age group for this disease. It also ensures that disease levels amongst the population remain at low levels by stopping the spread of bacteria.

Who is entitled to receive the vaccine and where should they go to get it?

Teenagers

The MenACWY vaccine is now routinely given to children at around 14 years of age along with a vaccine that protects against tetanus, diphtheria and polio. Most teenagers of this age will be vaccinated at school.

A catch up campaign began across the UK in August 2015 to vaccinate older teenagers up to age 18. Where these teenagers go to get their vaccine and when they get it will vary according to their age and where they live (see Box 1).

University freshers in England, Wales and Northern Ireland

Because MenC and MenW can spread rapidly in halls of residence, new starters at university up to age 25 are also being offered a catch-up MenACWY vaccination before they enrol on their course. Ideally first year students should arrange to get MenACWY from their GP at least 2 weeks before they go away to study. Any first-year students not immunised before they started should get the vaccine by registering with their university health centre or other GP practice. 

University freshers in Scotland

Scotland will not be running a Universities Freshers programme this year. Due to the success of their MenACWY programme offered to all 14-18 year olds in Scotland during 2015/16, the majority of Scottish entrants to university will have already been vaccinated and there therefore isn’t a need for a specific freshers programme this year.  

Unvaccinated students coming from other parts of the UK to study in Scotland should ensure they get vaccinated before they travel to Scotland as there is no guarantee the MenACWY vaccine will be available at Scottish university health centres and GP practices.

Box 1: Timing of Vaccinations according to age and location

England
  • Those born between 1st September 1996 and 31st August 1997 should have already been contacted by their GP to get the vaccine. If you have not had your invitation, go to your GP and ask for the vaccine.
  • Pupils currently in years 9 to 11 during 2015/16 academic year (born between 1st September 1999 to 31st August 2002) should be getting the vaccine via their school nursing system or other local arrangements. Depending on the school these pupils will have either already been vaccinated in the 2015/16 academic year or will be vaccinated during 2016/17. If you are unsure about whether your child has been vaccinated, speak to the school or your child’s GP.
  • Young people born between 1st September 1997 and 31st August 1998) are currently being offered the vaccine from their GP. 
  • Young people born between 1st September 1998 and 31st August 1999) will be offered the vaccine from their GP after April 2017. 
  • From the academic year 2016/17, year 9 students will be routinely immunised in school.
Wales
  • Those born between 1st September 1996 and 31st August 1997 should have already been contacted by their GP to get the vaccine. If you have not had your invitation, go to your GP and ask for the vaccine.
  • Pupils in school years 9 and 11 during 2015/16 academic year should have received the vaccine via their school nursing system or other local arrangements. If you are unsure about whether your child has been vaccinated, speak to the school nurse or your child’s GP surgery.
  • Pupils in school years 9 and 11 during 2016/17 academic year should get the vaccine via their school nursing system or other local arrangements in the 2016/17 academic year.
  • Young people born between 1st September 1997 and 31st August 1999) are currently being offered the vaccine from their GP. 
  • From the academic year 2016/17, year 9 students will be routinely immunised in school.
Northern Ireland
  • Those born between 2nd July 1996 and 1st July 1997 are eligible for vaccination. If you have not had your vaccination yet, go to your GP and ask for it.
  • Students currently in years 11 and 12 (born between 2nd July 1999 and 1st July 2001) should have received the vaccine at school this academic year.
  • Older children (those born between 2nd July 1997 and 1st July 1999) will be called in for vaccination by their GP
  • Vaccination of everyone born between 2nd July 1997 and 1st July 2001 should be completed by late summer 2016. 
  • From the academic year 2016/17 onwards, year 11 students will be routinely immunised in school.
Scotland
  • Vaccination of those born between 2nd August 1996 and 28th February 2002 was completed by the end of March 2016. 
  • From the academic year 2016/17 onwards, S3 students will be routinely immunised in school.

Box 2: Problems accessing MenACWY vaccine?

Meningitis Research Foundation has received calls to its helpline from students experiencing difficulties accessing the MenACWY vaccine from their GP.

The NHS has sent information to GP’s about the vaccine and so most GPs should be issuing it to those who are eligible.

If you experience difficulties please:

  • Check your eligibility using our fact sheet: www.meningitis.org/uk-menacwy 
  • Ask to speak to the GP practice nurse rather than the receptionist
  • Point your GP towards the official documents (either Enhanced Service Specification Meningococcal ACWY (MenACWY) 18 years on 31 August vaccination programme 2016/17 OR Enhanced Service Specification for the Meningococcal Freshers vaccination programme which were sent to all GP practices in April 2016. These documents outline which patients are eligible for vaccination and provide full details of reimbursement after vaccination. 
  • A minority of GPS may not have signed up to this scheme, but should direct you to the local NHS England team who will be able to help you find an alternative provider.
  • If you are eligible for MenACWY vaccine but you have not been specifically called in by your GP, it is a good idea to ring in advance so that your surgery can order the vaccine for you. GPs can order vaccine for eligible patients through ImmForm (www.ImmForm.dh.gov.uk) or by emailing helpdesk@immform.org.uk

Is anyone other than teenagers eligible to get the vaccine free on the NHS?

People with asplenia or splenic dysfunction, those with complement disorders, or those on Eculizumab therapy are at increased risk of meningococcal disease. They are entitled to receive the MenACWY and other meningitis vaccines free of charge on the NHS whatever their age4 and anyone with any of these medical conditions should contact their GP to ask about vaccination.

What vaccine will be provided?

There are two MenACWY vaccines currently available in the UK, Menveo® and Nimenrix®. Both vaccines have been licensed in Europe and widely used for several years: Menveo® since 2010 and Nimenrix® since 2012. Both of these vaccines are being used to immunise teenagers.

Are the vaccines safe?

Both vaccines have a good safety profile. As with all drugs, vaccines can cause side effects. Side effects of MenACWY vaccines are similar to other routine vaccines and may include soreness/redness/swelling or hardness of skin at the injection site, fever, headache, nausea, muscle aches, tiredness/fatigue, loss of appetite, generally feeling unwell.

The vaccines have been used extensively in the UK and around the world amongst pilgrims attending Hajj to combat meningitis outbreaks that have occurred among Hajj pilgrims in the past. MenACWY vaccine is compulsory for people attending Hajj, and since 2010, there have been 2-3 million Hajj pilgrims each year worldwide. The vaccines have also been used amongst people at higher risk of the infections as a result of medical conditions and Menveo® has been used as part of the routine immunisation programme in Chile and some parts of the US to routinely immunise teenagers.

Is it a risk to other people once someone has had the vaccine

No, quite the contrary. Vaccinating adolescents not only protects them, but reduces their risk of acquiring the bacteria, which commonly live in the nose and throat, particularly in adolescents. By getting vaccinated, adolescents are also protecting younger and older people who are vulnerable to the infections.

What are the ingredients in the vaccine?

Each different group (A,C,W and Y) of meningococcal bacteria has a different type of sugar capsule surrounding the bug. The MenACWY vaccines contain fragments of the sugar capsules of all four groups. The sugar fragments are linked to a protein which makes the vaccine stronger and longer lasting. 

All of the vaccine components have been processed and inactivated and are not part of any living bacteria, but can still stimulate the immune system.

Once you are vaccinated with MenACWY, your immune system can recognise and kill bacteria with the same sugar capsule that is contained in the vaccine, so if you are exposed to these types of bacteria you do not become ill.

Other ingredients in the vaccines are used to ensure it is has the same level of acidity and salt concentration as your body.

In Menveo® the other ingredients include5:
  • Sucrose
  • Potassium dihydrogen phosphate
  • Sodium dihydrogen phosphate monohydrate
  • Disodium phosphate dihydrate
  • Sodium chloride
  • Water for injections
In Nimenrix® the other ingredients include6:
  • Sucrose
  • Trometamol
  • Sodium chloride
  • Water for injections

Are the vaccines Halal?

Menveo® has been certified as Halal by the Indonesian Council of Ulama and the Islamic Services of America. Nimenrix® has been certified as Halal by the Halal Food Council of Europe. 

See more 

Are there any safety reasons not to have the vaccine? What about allergies?

People who have previously had an anaphylactic reaction to any of the vaccine components listed above should not get the vaccine. 

Anaphylaxis to current vaccines is very rare and is estimated to occur in one in a million doses given, although a recent study7 found no reports of anaphylaxis following more than 5 million preschool and infant immunisations over an entire year in the UK and Ireland.

People with severe immune system problems cannot have live vaccines, but the MenACWY vaccines are not live. Food allergies are not a reason to avoid vaccination. People often worry that eczema, asthma, epilepsy and a family history of reactions to vaccinations are a reason to avoid vaccinations, but this is not true8.

The packaging on both vaccines may contain natural rubber latex. The risk of developing an allergic reaction is very small, but in case of known severe latex allergy, you should speak to your doctor or nurse before being vaccinated.

My child has already been vaccinated with MenC in her first year at secondary school. Why is she being vaccinated again?

A MenC vaccine for 14 year olds was added to the routine schedule in June 2013 to ensure that levels of MenC disease remain low, but this vaccine did not give protection against MenW disease. The MenACWY catch up programme was recommended for 14 to 18 year olds in response to rise in a harmful strain of MenW disease. Vaccinating with MenACWY will give vital protection against MenW whilst boosting protection against MenC.

Is it safe for those who have recently had MenC vaccination?

Yes. The MenACWY vaccine can be administered safely at any interval after MenC vaccine.

Is there a separate MenW vaccine like MenC?

No. There is currently no licensed vaccine that just protects against MenW .

Is it safe (or necessary) for people who have had meningococcal disease?

Yes. The vaccine is safe for people who have previously had meningococcal disease, and the vaccine cannot give them the disease. There are very few safety reasons for not vaccinating and these are outlined above.

There are many different types of meningococcal disease. Although someone who has been ill in the past may have some immunity against the strain that caused disease, they would not be protected against other types. Vaccination is necessary for broader protection and to boost any existing immunity generated from a previous infection.  
 

Is it safe if you are pregnant?

Yes. Meningococcal vaccines may be given to pregnant women. There is no evidence of risk from vaccinating pregnant women or those who are breast-feeding.

My child is attending university but is not a fresher. Will s/he be eligible?

People who are not university freshers are not eligible for the vaccine. The immunisation campaign has been arranged as an emergency programme at very short notice in response to the recent rapid rise in MenW infection. For this reason the focus is on immunising those at highest risk as quickly as possible, and so people at lower risk of infection are not eligible.

Will this vaccine be offered to babies free of charge within the health service?

There is no current recommendation for babies to be vaccinated against MenACWY.

The MenB vaccine Bexsero, which is given to children at 2, 4 and 12 months in the UK, should provide some protection against this particular ST-11 MenW strain that is causing severe disease9.

Adolescents are more likely to carry meningococcal bacteria than any other age group and offering MenACWY vaccine to all of them should stop the bacteria from being passed on. This means that even unvaccinated people including babies should eventually also be indirectly protected from catching the disease – an effect known as population protection (or herd protection).

What about those who are too young/old to qualify for the MenACWY vaccine on the NHS. Should they get the vaccine privately?

Babies are at the highest risk of contracting meningococcal disease with peak incidence at around 5 months of age. All babies are now immunised with the MenB vaccine Bexsero which should provide some protection against this virulent ST-11 MenW strain9
 
Children older than 5 months of age are still at risk of disease, but their risk is substantially lower than that of younger babies. Current incidence of disease amongst the under 1s is around 20 per 100,000 per year (or 1 baby in 5000 per year), reducing to 6 per 100,000 per year for children aged 1-4 (1 child in about 16,667 per year). The incidence of disease amongst people older than age 5 is substantially less.

Vaccinating adolescents should stop the bacteria from being passed on which means that even unvaccinated people should be indirectly protected from catching the disease.

However, meningococcal disease is such a deadly and disabling disease that some may wish to be protected however small the risk of them contracting disease. The vaccine is available privately for those who wish purchase it. 

How can I get the vaccine for my child if s/he is not eligible for it free of charge within the health service?

Separate stocks of the vaccine are available privately for travellers, and it is usually possible to pay for MenACWY vaccination at pharmacies and travel clinics.

How much will the vaccine cost if I want to get it privately?

As a guideline, the NHS list price of both vaccines is £30 per dose excluding VAT. The price that you will be charged will vary according to where it is being purchased. The provider of the vaccine is likely to charge a fee for administering the vaccine.

Once my teenager has had their MenACWY vaccine, can they still get meningitis?

Unfortunately yes, although it is much less likely. Meningitis vaccines are excellent, but they do not protect against all strains. For example MenB has been the most common kind of meningitis for decades. A new MenB vaccine has recently been recommended for routine use in babies the UK which should prevent many more cases of meningitis (see www.meningitis.org/MenB). However, there is currently no recommendation for this vaccine to be offered to teenagers and there are still some kinds of meningitis that cannot be prevented, so it is important to know the symptoms. 

  1. Snape, M.D. and A.J. Pollard, Meningococcal polysaccharide-protein conjugate vaccines. Lancet Infect Dis, 2005. 5(1): p. 21-30.
  2. 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.
  3. 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.
  4. Department of Health. Meningococcal: the green book, chapter 22. [cited 2016 February]; Available from: https://www.gov.uk/government/publications/meningococcal-the-green-book-chapter-22 
  5. GSK. Menveo. Summary of product Characteristics. Cited February 2016. Available https://www.medicines.org.uk/emc/medicine/27347
  6. Pfizer. Nimenrix. Summary of Product Characteristics. Cited February 2016. Available from https://www.medicines.org.uk/emc/medicine/26514 
  7. Erlewyn-Lajeunesse M, Hunt L.P, Heath P.T, Finn A, Anaphylaxis as an adverse event following immunisation in the UK and Ireland. Arch Dis Child, 2012. 97:487-90.
  8. Department of Health. Contraindications and special considerations:the green book, chapter 6. 2013 [cited 2013 November ]; Available from: https://www.gov.uk/government/publications/contraindications-and-special-considerations-the-green-book-chapter-6.
  9. Ladhani S.N, Giuliana M.M, Biolchi A, Pizza M, Beebeejaun K, Lucidarme J, Findlow J, Ramsay M.E, Borrow, R, Effectiveness of meningococcal B vaccine against endemic hypervirulent Neisseria meningitides W strain, England. Emerg infect Dis. 2016 Feb;22(2):309-11. doi: 10.3201/eid2202.150369.

Page last updated 22.08.16