Northland meningococcal vaccination programme: questions and answers

In December 2018, Northland DHB established a targeted vaccination programme in response to a local outbreak of meningococcal W.

Why is Northland DHB doing a free vaccination programme for Meningococcal W?

There is currently a community outbreak of meningococcal W disease in Northland. 

Who are they vaccinating?

They are vaccinating children aged from 9 months to under 5 years and those aged 13 to under 20 years who are Northland residents.

Why are you only targeting under 5s (9 months to 4 years of age more exactly) and 13 to under 20-year-olds?

We are targeting children under 5 because this is the population that is generally most affected by meningococcal disease. As a result, vaccinating this age group will protect them from getting meningococcal disease. The vaccine cannot be given to babies under 9 months. We’re targeting 13 to under 20 year olds because this is the age group that generally carries the bacterium that causes the disease. Even if they have no symptoms, carriers can infect those around them. Vaccinating this age group will lower the number of carriers in Northland and stop the spread of meningococcal disease across the entire community. In other words, vaccinating this age group will help protect all the people in Northland.

How will you contact those who are eligible to notify them about this?

Northland have a regional communications campaign via newspaper and radio media to ensure that those who are eligible for vaccination, and their caregivers, are aware of the programme, and where they can get vaccinated.

Why aren’t you vaccinating other age groups in Northland?

Vaccine stocks are limited, both nationally and internationally. Therefore we are vaccinating those most at risk from the disease and also those most likely to carry the disease and infect others.

Why did you only get 25,000 doses?

Vaccine stock is in short supply globally. New Zealand has purchased the 25,000 doses that were available immediately.

Why are you only targeting Northland and not the rest of New Zealand?

There is currently a community outbreak in Northland with a higher number of cases for the population than elsewhere in the country. It is important that we act quickly in this region to limit the spread of disease within this community. Although there have been meningococcal W disease cases in other parts of the country, at this stage the rates are small and we do not have other community outbreaks. The Ministry is monitoring the situation closely and will work with other district health boards if there are increases in cases in their regions.

What will you do if there are other outbreaks in other communities in New Zealand?

The Ministry is monitoring the situation closely and will work with other district health boards if there are increases in cases in their regions.

When did you start the vaccination programme? Was that fast enough?

The vaccine programme began on 5 December 2018. The focus of the campaign is to stop the spread throughout the Northland region and is timely in this regard.

Why has it taken so long to take action?

The Ministry and the Northland DHB have been working closely together once the community outbreak was identified in mid-November to determine the best response. Action was taken immediately once a decision to undertake an outbreak vaccination response was made. Before now, cases have been sporadic and have been dealt with on an individual case-by-case basis with antibiotics given to the affected individual and their close contacts. This is the standard response and it will continue.

Have there been delays in accessing the vaccine?

No, as soon as a decision to vaccinate was made, PHARMAC contacted vaccine manufacturers to source the vaccine. Some of the vaccine came from Australia, which is why it only took a week to reach New Zealand, but other stock came from further afield and arrived later in December.

Is the time of year this close to Christmas and the end of the school year expected to impact on the roll out?

The timing this close to Christmas and school holidays made the logistics challenging but the Ministry and Northland DHB did not want to wait until the New Year to commence the vaccination campaign.

Where do they vaccinate those targeted by this campaign?

Between 5 and 21 December 2018, Northland DHB held large clinics open seven days a week in Whangarei, Kaitaia and Kerikeri, and smaller clinics at various times in other places throughout the region. Since then, the vaccine has been available for those aged 13 to under 20 in certain community pharmacies, and additional clinics will be established in early 2019. See the Northland DHB website or Facebook page for updates on locations.

What is your advice to people who aren’t covered by the free vaccination campaign?

Meningococcal disease bacteria can be spread from person-to-person through secretions and respiratory droplets. Therefore, we recommend covering your nose or mouth when you sneeze or cough, and wash and dry your hands afterwards. Also, avoid sharing eating or drinking utensils, toothbrushes and pacifiers.

People need to be aware of the symptoms of meningococcal disease. The vaccine that will be given in Northland provides protection against four strains of meningococcal disease (A, C, W and Y) but not for the B strain, which is also common in New Zealand. Anyone who has symptoms of meningococcal disease should talk to their doctor or call Healthline as soon as possible irrespective of whether they have been vaccinated or not.

People can also pay privately for the vaccination, although stocks are limited and may not be available in the short term.

Who should consider purchasing the vaccine privately?

Meningococcal disease is rare, but vaccination is recommended for private purchase by some groups who are at greater risk of the disease. This includes teenagers and young adults living in communal accommodation such as hostels or boarding school. 

Is there enough vaccine for people wanting to purchase the vaccine privately?

There is limited supply of the vaccine available privately, and there have been intermittent local vaccine shortages. Stocks of the vaccine are likely to be limited for the foreseeable future due to global demand but suppliers are doing what they can to secure more vaccines for the private market in New Zealand.

How much does the vaccine cost if you pay privately?

People need to contact their GP to find this out, but we understand it is approximately $150 per immunisation.

What was your advice to people going to the Scout Jamboree in Northland this summer?

We advised the organisers of the Jamboree that there is a community outbreak in Northland and advised that extra vigilance is required. We also suggested that attendees from overseas should check their vaccination status.

How many people have contracted meningococcal disease in New Zealand this year and how many have had MenW? How does this compare to last year?

Up to date detailed information about meningococcal cases and deaths in recent years is available from the ESR website.

As of 30 November 2018 there were 109 cases of meningococcal disease in New Zealand in 2018 – 29 of these cases were meningococcal W strain, including 7 in Northland. The MenW strain is the cause of 29 per cent of meningococcal cases. Overall, 10 people died. Six deaths were due to meningococcal W – three of those people were in Northland. In 2017, there were 12 cases of meningococcal W in New Zealand, including only 1 in Northland, and three deaths. In total, there were 94 cases of meningococcal disease in 2017. Meningococcal W accounted for 11 per cent of cases.

Why is meningococcal W disease on the rise in New Zealand?

This strain of meningococcal disease is increasing around the world. We don’t really know why at this stage.

Why is meningococcal W disease so deadly?

Meningococcal W is a particularly aggressive strain of the bacteria and can quickly lead to severe illness and, in some cases, death. Also, the symptoms can be similar to those of other common illnesses, such as nausea, headaches and gastroenteritis, which means that an early diagnosis of this disease is difficult. That is why the Ministry issued an advisory to GPs and emergency departments to be vigilant for people presenting with symptoms of meningococcal disease, and encouraged them to treat people with antibiotics before sending them to hospital because early treatment is vital.

What if my child has already been vaccinated against other strains of meningococcal disease such as B or C? Can they still get this vaccine?

Yes.

What are the symptoms of meningococcal disease?

The symptoms and signs of meningococcal disease include a fever, nausea, vomiting, headache, stiff neck, rash, sleepiness and irritability. Meningococcal W can also cause gastroenteritis and pneumonia.

What should the public do to prevent getting meningococcal disease?

Meningococcal disease bacteria can be spread from person-to-person through secretions and respiratory droplets. Therefore, we recommend covering your nose or mouth when you sneeze or cough, and wash and dry your hands afterwards. Also, avoid sharing eating or drinking utensils, toothbrushes and pacifiers.

Vaccination is the best protection.

What should they do if they suspect they have meningococcal disease?

If you suspect you have meningococcal disease or have any of the symptoms – a fever, nausea, vomiting, headache, stiff neck, rash, sleepiness, irritability, gastroenteritis or pneumonia – it is important to seek medical help immediately by contacting your GP or Healthline. 

How much will this campaign cost?

The costs have yet to be calculated.

Who will pay for it?

The campaign costs will be covered by baseline Health funding.

What is the long-term strategy?

Longer term, PHARMAC and the Ministry are considering the best approach to protect people from meningococcal disease.

What are you telling GPs and emergency departments regarding treatment and diagnosis?

Advice has been sent out to GPs and emergency departments about treatment and diagnosis, including asking them to be vigilant in monitoring for potential meningococcal cases.

Have previous targeted immunisation campaigns worked in New Zealand?

In 2011 Northland DHB experienced a community outbreak of Meningococcal C disease and rolled out a vaccination programme for all children and youth aged between 1–20 years between September and December 2011. This stopped the outbreak and Northland has only had two cases of Meningococcal C disease since.

A nationwide MeNZB vaccination programme was implemented between 2004–2006 across the whole of New Zealand for anyone aged under 20 years as a response to high rates of Meningococcal B disease. Babies and preschoolers continued to be offered MeNZB vaccine until June 2008. The disease rate dropped from around 300 cases per year to 2001 to less than 30 cases across the country in 2010.

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