• Meningococcal disease is the result of systemic infection with Neisseria meningitidis. It is transmitted by droplet or by direct contact from carriers or individuals in the early stages of the disease. It has an incubation period of 2–7 days.
• There are 13 serotypes of Neisseria meningitidis of which groups B and C are the most common in the UK. In some areas of the world, the risk of acquiring meningococcal infection, particularly group A, is much higher than in the UK. The biggest risk is in the so-called meningitis belt from sub-Saharan West Africa to East Africa.
• Meningococcal disease most commonly presents as either meningitis or septicaemia, or a combination of both.

• The quadrivalent, inactivated, meningitis vaccine is recommended for travellers. A single dose provides cover against strains A, C, Y, and W135 of the disease. Two types are available:
• ACWY Vax^® (polysaccharide vaccine)
• Menveo^® (conjugate vaccine)
• Several other inactivated meningitis C vaccines are licensed for use in the UK.
• Meningitec^®
• Mengugate^®
• NeisVac-C^®
• Meningitis C with Haemophilus Influenza type B
• These vaccines are used as part of the routine childhood immunization programme. See the CKS topic on Immunizations - childhood for more information.
• Currently there is no vaccine available for meningitis B.

In depth

• Vaccination with meningitis ACWY^® is recommended prior to travel to areas with a high risk for Group A meningococcal meningitis for:
• People staying for extended time periods, such as 1 month or more.
• People engaging in high-risk holidays or work, such as backpacking or living in rural communities.
• People attending the Hajj (Mecca) and Umrah pilgrimages in Saudi Arabia (since there have been epidemics in recent years in these areas).
• People undertaking seasonal work in the Hajj area.
• Saudi Arabia requires proof of vaccination with ACWY Vax^® for visitors arriving for the Hajj and Umrah pilgrimages, or for seasonal working in the Hajj areas.
• Meningococcal C conjugate vaccine is part of the childhood immunization programme (see Immunizations - childhood for more information). This vaccine protects against group C disease only. Travellers should be immunised with the quadrivalent polysaccharide vaccine (ACWY^®), even if they have previously received the Meningococcal conjugate vaccine.

In depth

• For adults and children aged 1 year and older — vaccinate with quadrivalent meningococcal vaccine 2–3 weeks before travel.
• For children under 1 year of age — vaccinate with quadrivalent meningococcal vaccine 2 months before travel (two doses needed).
• Menveo^® (conjugate vaccine) is preferred to ACWY Vax^® (polysaccharide vaccine) for all age groups (off-label use in children under 11 years of age) because of better and longer lasting protection.
• Menveo^®
• Primary immunization:
• For adults and children aged 1 year and older, give a single dose of vaccine.
• For children under 1 year of age, give two doses of vaccine, one month apart.
• Booster doses:
• Children who received their primary immunization as infants should be given an additional dose of Menveo^® (with an interval of at least 12 months between completion of the primary course and the booster dose) if they remain at high risk.
• The need for booster doses in other age groups has yet to be determined, however it is likely to provide longer protection than ACWY Vax^®.
• ACWY Vax^®
• Primary immunization:
• For adults and children over 5 years old, give a single dose of vaccine.
• ACWY Vax^® is no longer recommended for children under the age of 5 years.
• Booster doses:
• For adults and children over 5 years old, give a booster dose every 5 years to those at continued risk.
• Children who were under 5 years when first vaccinated should be given a booster dose (preferably with Menveo^®) after 2–3 years if they remain at high risk.

In depth

• Menveo^®
• Commonly reported reactions include injection site reactions (such as pain, erythema, induration, pruritus), headache, nausea, rash, and malaise.
• ACWY Vax^®
• Generalized reactions to the quadrivalent vaccine are rare although pyrexia occurs more frequently in young children than in adults.
• Injection site reactions occur in approximately 10% of recipients and last for approximately 24–48 hours.
• Confirmed anaphylaxis after immunization is extremely rare, with anaphylactoid reactions reported for approximately 1 in every 500,000 doses.

In depth