Outbreak in Central Australia
Since July 2017, there has been an outbreak of Meningococcal W (MenW) in Central Australia affecting parts of the Northern Territory (NT), South Australia (SA), Western Australia (WA) and Queensland (QLD). This follows an overall increase in MenW cases since 2013. More information on this outbreak can be found here.
The current outbreak is affecting Aboriginal and Torres Strait Islander communities in the Central Australia, Barkly and Katherine West regions of the Northern Territory, as well as areas in South Australia, Western Australia and Queensland. This current outbreak is mostly affecting young Aboriginal and Torres Strait Islander people.
National rise in MenW
IMD is caused by the bacterium Neisseria meningitidis. Approximately 10 per cent of the population are asymptomatic carriers of meningococcal bacteria in the upper respiratory tract, however IMD only occurs in a small number of people.
Six serogroups of meningococcal bacteria (A, B, C, W, X and Y) account for most cases of IMD. Serogroup C cases have declined significantly since 2003 when the meningococcal C vaccine was added to the National Immunisation Program. Until recently, serogroup B was the most common cause of IMD in Australia, with meningococcal serogroups A, W, Y and X less common in Australia, despite being more common overseas.
Since 2013, there has been an increase in the number of notifications of invasive meningococcal disease (IMD) due to Neisseria meningitidis serogroup W across Australia. Notifications of MenW have doubled between 2014 and 2015, more than tripled between 2015 and 2016 and have continued to rise in 2017. Rates of serogroup W have increased in all age groups.
Septicaemia (sepsis) and meningitis are common presentations in all age groups for MenW. However, there have also been a number of cases with atypical presentations for example pneumonia, septic arthritis or epiglottitis.
Be alert for presentations that could be due to IMD, including typical and atypical presentations.
Who is at risk?
Anyone is potentially susceptible to strains of meningococcal infection that they have not been vaccinated against.
People with certain pre-existing medical conditions, occupational exposures (some laboratory personnel) or overseas travel to endemic or high-risk areas (Hajj and African meningitis belt) are at higher risk of IMD.
Medical conditions associated with an increased risk of IMD in children and adults1 include:
- functional or anatomical asplenia
- HIV infection, regardless of stage of disease or CD4+ count
- haematopoietic stem cell transplant
- defects in or deficiency of complement components, including factor H, factor D or properdin deficiency
- current or future treatment with eculizumab (a monoclonal antibody directed against complement component C5)
Testing should ideally occur prior to administration of antibiotics where possible but should not delay administration of antibiotics. Empirical antibiotic options for different clinical presentations are described in the Therapeutic Guidelines.
When considering testing options, discussion with local infectious diseases or microbiology experts may be helpful. A blood (for serum) or CSF sample for PCR or culture is usually sufficient.
Notify all suspected and confirmed cases of IMD to the state or territory health authority in your jurisdiction; do not wait for laboratory confirmation before notifying. (Refer to the contact details at the end of this document).
Following notification of suspected cases, the state or territory health department will identify who should receive vaccines as part of contact management.
Following notification of suspected cases, the state or territory health department will identify who should receive clearance antibiotics (generally close household and/or intimate contacts). Staff providing care do not require clearance antibiotics unless exposed to the case’s nasopharyngeal secretions without personal protective equipment (e.g. involved in intubation without wearing masks).
Clearance antibiotics for the general population are not necessary. Testing for meningococcal carriage in asymptomatic individuals and treatment with clearance antibiotics is not required for the general population, and can be harmful by removing protective strains of bacteria and leading to antibiotic resistance.
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Quadrivalent meningococcal vaccines (4vMenCV and 4vMenPV) provide protection against meningococcal serogroup W and are available on private script. These are recommended for those at occupational risk (some laboratory personnel), certain overseas travel and certain medical conditions, and can be offered to those who wish to protect themselves or their family from the disease.
The Australian Immunisation Handbook 10th Edition, online version provides current guidance on meningococcal immunisation.
Vaccination for the Central Australia outbreak
In response to the outbreak in Central Australia, four jurisdictions are implementing a free, time limited, Meningococcal ACWY vaccination program in affected communities and in communities linked by culture or mobility.
Further information on what each state is doing can be found in the links below:
Other Men W Vaccination programs
In response to the increase in numbers since 2013, five jurisdictions have implemented a free meningococcal ACWY vaccination program for adolescents. The vaccination programs will be run by each state and are time limited. The programs target children aged 15-19 years, with NSW targeting 17-18 year olds.
More information on what each state is doing, and who is eligible for a free vaccination, can be found in the links below:
Contact details to notify suspected and confirmed IMD in Australia
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||Public health unit contact details
||02 6205 2155
||1300 066 055
Contact details for the public health offices in NSW Local Health Districts (www.health.nsw.gov.au/Infectious/Pages/phus.aspx)
||08 8922 8044 Monday-to Friday daytime and 08 8922 8888 ask for CDC doctor on call – for after hours
||13 432 584
Contact details for the public health offices in QLD Area
||1300 232 272
||1800 671 738 (from within Tasmania), 03 6166 0712 (from mainland states)
After hours, follow the prompt “to report an infectious disease”
||1300 651 160
||08 9388 4801 After hours 08 9328 0553
Contact details for the public health offices in WA
- Australian Immunisation Handbook