Prevention

Patsy and Jamie

As the mother of a meningitis survivor I can speak first hand as to the physical devastation meningitis can cause to a perfectly healthy child... don't let this happen to your child. Prevent what's preventable. 

- Patsy Schanbaum, The J.A.M.I.E Group, USA

Patsy and Jamie 

Preventing Meningitis

The best way to prevent meningitis is through vaccination. Second to clean drinking water and good hygiene, vaccines are the most effective way of preventing infectious diseases. Bacterial meningitis and septicaemia are examples of diseases where vaccination can be the difference between life and death or life-long disability. 

In its simplest sense, a vaccine helps to prevent an illness by increasing the body’s resistance to that illness. 

Vaccines prepare the immune system by exposing the body to a germ so that it is better able to fight an infection when it occurs. Vaccines contain either parts of a germ, live but weakened germs, or inactivated (dead) germs.

Keep reading to find additional information about vaccines and answers to commonly asked questions. 

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I believe Mary-Jo would still be here if she had been vaccinated. Mary-Jo died from a vaccine-preventable strain of meningitis – meningococcal meningitis type C.

- Rose, MAK  - Meningitis Awareness Key to Prevention , USA

Rose and her daughter Maryjo

Meningitis Vaccines Q&A

Vaccine Manufacture and Availability

1. What are vaccines made of?

Answer

Vaccines are made up of carefully chosen ingredients. These ingredients, both active and additional, make the vaccine work as effectively and safely as possible.

  • Active ingredients

Active ingredients make a person produce their own immunity before encountering the disease. They are made of live harmless germs, germs that have been killed, or carefully selected parts of the germ; sugar coat or purified germ proteins.  Gene technologies have been used more recently to make some of the newest meningitis vaccines.

  • Additional ingredients

Tiny amounts of special chemicals also need to be introduced in vaccines:

    ✓ Adjuvants to improve immune response

    ✓ Stabilizers to keep the contents of the vaccine vial constant

    ✓ Preservatives to prevent the growth of any unwanted germs in the vaccine

    ✓ Sterile water to dilute the vaccine for injection.

2. How do vaccines work?

Answer

Although we have millions of germs on and in our bodies, very few make us unwell, because our immune systems are designed to protect us from harm.

But some of these germs that enter our bodies can make us ill. Humans have adapted to fend off these infections by triggering the immune system into action to produce ‘antibodies’ to the germs. Our immune system recognises parts of the germs that are termed antigens, usually proteins and sugars. Once our immune systems have met a new germ they memorise it, and can produce the right antibodies that protect us if we meet the same germ again. For some diseases, the immune response is too slow and occurs too late to prevent the potential damage. This is particularly important for a disease like meningitis where the onset is typically very rapid. 

Vaccines work by introducing tiny amounts of the antigens to make our immune systems remember it, and produce antibodies that protect us against disease caused by a particular germ. It is rare for a person not to be able to receive vaccines, and it is especially important for people who have chronic illnesses to be vaccinated.

If enough people in the community are immunised, the germs become less common and are spread less easily from person-to-person so that everyone, even the most vulnerable, are protected. This is called Herd Protection.

Each of the bacteria and viruses (disease-causing germs) are unique and so our immune systems need to make a special antibody to each of these germs. As a result, there are several vaccines used to prevent disease caused by many of the meningitis germs. 

 3. Which vaccines can protect my child from bacterial meningitis?

Answer

Currently, there are vaccines available to protect against most strains of the three major causes of bacterial meningitis: meningococcal disease, pneumococcal disease and Haemophilus influenzae type b (Hib) disease.

 

Special notes about vaccines which protect against bacterial meningitis:

Meningococcal vaccines

Meningococcal disease is the leading cause of bacterial meningitis in many countries, but there are different types of meningococci (so called “types”).  There is a need for different vaccines to be effective against the main types of meningococcus germs: A, B, C, W, and Y.

 

There are 3 main versions of meningococcal vaccines: conjugate vaccines, polysaccharide vaccines, and serogroup B meningococcal vaccines. They are made quite differently.

Polysaccharide vaccines 

Plain polysaccharide vaccines are made from the purified sugary outside shell of the different germs. These vaccines are used less now as they are not effective in children under 2 years of age and because the immunity they induce is short lived.  However, polysaccharide vaccines are still used to control epidemics in the meningitis belt as they are less expensive than other vaccines and are effective at stopping outbreaks on the short term.

 ✓  Group A- C vaccine

 ✓  Group A-C-W vaccine

 ✓  Group A-C-Y-W vaccine

 

Conjugate vaccines

Conjugate vaccines exist for routine immunisation of infants, children and adolescents and protect against multiple strains of meningitis. These vaccines link a specific meningococcal sugar coat to a protein known for its strong immune response and selected from another germ. Conjugate vaccines are highly effective in young infants and produce much higher and sustainable levels of protection than the pure polysaccharide vaccines. They are also able to prevent acquisition of colonization of the germ, reducing the transmission of the germ in the community and thus preventing disease even in unvaccinated persons. 

 ✓  Conjugate group C vaccine (e.g. MenC)

 ✓  Conjugate groups A-C-Y-W vaccine (eg. MenACYW)

 ✓ A conjugate Group A vaccine for use in Africa has been developed by the Meningitis Vaccine Project. MenAfriVac® is being used to reduce and control epidemics of meningococcal meningitis in the meningitis belt of Sub-Saharan Africa.

Recombinant Protein Vaccines

Recently meningococcal serogroup B protein (MenB) vaccines to protect against MenB meningitis have become available in several countries across the world. These vaccines consist of antigens found in meningococcal bacteria that are known to efficiently stimulate the immune response.

 

One of these vaccines is now part of the infant immunization programme in some European countries.

Pneumococcal vaccines

Pneumococcal vaccines exist to protect against the bacterium Streptococcus pneumoniae that can lead to meningitis, as well as blood poisoning (septicaemia), pneumonia and ear infection. A large number of different S.pneumoniae types exist (over 90 in fact!); however, only some of these are known to commonly cause disease.

The vaccines available can be conjugated (PCV) or polysaccharide (PPV) and can offer specific protection against many different types of S.pneumoniae (currently 10-23).

Conjugate Vaccines

Conjugate vaccines are effective from 6 weeks of age at preventing meningitis and other severe pneumococcal infections and are recommended for infants and children up to the age of 5 years, and in some countries for adults aged over 65 years, as well as individuals from certain risk groups. 

There are two different conjugate pneumococcal vaccines, the number tells us how many types are included in the vaccine:

 ✓  PCV10 conjugate vaccine protects against the 10 most common types

 ✓ PCV13 conjugated vaccine protects against the 13 most common types.

 

New conjugate vaccines designed to protect against 15-20 pneumococcal types are in late stage clinical development. 

Polysaccharide Vaccines

PPV23 is a combined polysaccharide vaccine against the 23 most common strains causing pneumococcal disease, and is used mostly in those aged over 65 years, as well as individuals from certain risk groups. It is not used in children under 2 years of age. In adults at risk and/or elderly a combined approach with both PCV13 and PPV23 is now recommended in several countries.

As for other polysaccharide vaccines (e.g. meningococcal) this type of vaccine is considered less effective than conjugate vaccines.   

Haemophilus influenzae type b (Hib) vaccines

Hib conjugate vaccines protect specifically against Haemophilus influenzae type b. They are highly effective in preventing Hib disease and are largely recommended for routine use in infants. They are included in the so-called penta- or hexavalent vaccines recommended in vaccine schedule.

*Access to all these vaccines varies by country depending upon the national licensing and immunisation programme.*

4. Which vaccines can protect my child from viral meningitis?

Answer

Although there are no vaccines for most causes of viral meningitis, there are effective vaccines against a few dangerous viruses which can sometimes cause viral meningitis and encephalitis (inflammation of the brain). 

These viruses are:

  • Measles

  • Mumps and rubella (MMR vaccine)

  • Chicken pox (also called varicella)

  • influenza (‘flu).

 

Special notes about these vaccines:

MMR and MMRV

The viruses included in the vaccines are ‘live attenuated’. This means that they are made from live germs which have been treated so they are weakened. They either cause no disease or only a very mild form of disease (this sometimes happens with measles and chicken pox vaccines). 

They are supplied in freeze-dried form and mixed with sterile water to make them injectable.

*Please note that following extensive international and independent research, strong evidence has been found that measles vaccine and MMR vaccine are NOT associated with the development of autism.*

 

Varicella

Currently available as a single vaccine, some countries have already introduced this vaccine into their routine immunisation programme. Soon this vaccine will be added to MMR as MMRV. 

Varicella vaccines are made from live germs that have been made inactive that have been weakened ('live attenuated'). 

 

Influenza

The most common method for producing ‘flu vaccines is by growing ‘flu germs in eggs, but other methods include growing them in mammal cells, or by using parts of a wild ‘flu variety combined with another common and non-disease-causing virus. 

Once the ‘flu germs have grown they are collected and either killed and purified (for the inactivated ‘flu jab) or weakened (‘live attenuated’) for the newer nasal spray vaccine.

5. Which causes/forms of meningitis have no vaccine?

Answer

There are no vaccines to prevent the most common causes of meningitis in newborn babies:

  • Group B Streptococcal disease

  • Group B Streptococcal disease

  • Klebsiella

  • E. coli

  • Listeria

There are no vaccines available for some types of viral or any types of fungal meningitis.

There are other things you can do to minimise the risks of contracting meningitis.

6. Why does it take so long to develop a vaccine and why are they so expensive?

Answer

Knowing how important vaccines are, it’s not surprising that if for some reason one suddenly becomes unavailable, people can become concerned. Surely it can’t take that long to produce a vaccine?

Vaccines can take up to 10 years or more from first research to being available to protect people. This is because there are many stages to the development process, including strict safety and quality assessments at every stage. In brief this is each step: 

  1. The need for the vaccine has to be proved through health department information about the numbers of cases and how severe the disease is. 

  2. Once the need for a vaccine is proven, research is carried out to identify the best antigens, or bits of the germ, responsible for triggering protective immune responses.

  3. Next, there are numerous trials, first in animals and then in humans, to ensure that the vaccines are safe, effective, and respond to official guidelines. The results of the trials are also published in scientific journals so that the whole research community knows about it, and can comment on this work. 

  4. Large-scale efficacy or effectiveness and safety studies to prove the vaccine works with a big positive benefit (called efficacy) compared with any risk.

  5. Before being licensed, each vaccine must gain approval of drug regulatory agencies. 

  6. For the vaccine to be manufactured on a large scale, government health agencies need to be convinced of the benefits to fund the vaccine and introduce it in a recommended schedule. 

  7. A panel of national and international infectious disease experts and doctors decide on the immunisation schedules for each country. They balance the need to provide protection to infants, children and adults with the age when the risk of the disease is the highest and the body’s immune system will respond best, and thus recommend the earliest possible age to be given each vaccine.

 

Almost all the vaccines we use are produced by private pharmaceutical companies. CoMO works with the relevant companies to understand their priorities and processes, and to lobby for the widest possible access to meningitis vaccines everywhere in the world.

7.If unable to access a vaccine, what should you do? 

Answer

In the case of bacterial meningitis and septicaemia, the best thing you can do is learn the symptoms. Meningitis and septicaemia can become serious very quickly so it’s important to be aware of what to look out for and act immediately if you suspect an infection so that treatment can be started as soon as possible.

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Meningitis acts quickly and can seriously injure or kill a previously healthy child or teenager within hours.
 

Greg, The Nico Williams Foundation, USA

Greg's son Nicolis

Vaccine Protection

 1. Who should get meningitis vaccines?

Answer

Infants and young children

  • Hib and Pneumococcal Conjugate Vaccines are largely recommended within routine programmes for infants and young children

  • Recommendations for routine use of conjugate meningococcal vaccines vary in different continents: in many countries, routine infant vaccination is recommended (e.g. England, European Member States, Canada, Australia, and many countries in South America and Africa); in others, routine immunisation includes only teenagers (USA).

 

Adults over 65

  • Pneumococcal polysaccharide vaccines are also recommended for adults over 65 years of age (and in some risk groups in a combined schedule with pneumococcal conjugate vaccines).

Other groups at increased risk 

  • Increased risk of exposure: the vaccines may also be recommended for travellers to areas where meningitis outbreaks are occurring, at risk of occurring, military recruits, and other people at increased risk of exposure.

  • Vaccination is also recommended for persons of all ages who have medical conditions that increase their risk of severe disease with one or more of the meningitis germs

Everyone while controlling outbreaks 

  • Vaccination may also be used to control outbreaks of meningitis.

Speak to a local health care professional or meningitis organisation to obtain recommendations for your area.

2. Does having meningitis and surviving mean that I am immune?

Answer

Not necessarily. 

Having the disease may protect you only against the specific type of germ that caused your case of meningitis. Although it is rare, it is possible to contract meningitis more than once. 

In most cases, the body’s immune system ‘remembers’ the disease-causing organism so that it is already prepared with antibodies before harm can be caused. However, as there are various causes of meningitis it is possible to contract meningitis from one of the other causes. 

 

Children who have had pneumococcal meningitis and septicaemia still need pneumococcal vaccination- any immunity they have acquired from the infection will be primarily specific to the strain causing their disease, and there are over 90 different strains of pneumococcal bacteria. 

 

In addition, children who recover from Hib and all who recover from meningococcal C disease also need to be vaccinated.

Some viruses (including herpes simplex virus 2) can trigger a recurring rare non-infectious meningitis, known as Mollaret’s meningitis. Read more about CoMO member Recurrent Meningitis Association.

3. How quickly does a meningitis vaccine work?

Answer

Although all vaccines start working to protect you from the time they are given, it takes a week or more for full immunity to develop.

Some vaccines need boosters (one or several doses at intervals) to build long-lasting protection. 

4. How long does protection from a meningitis vaccine last?

Answer

The protection that a vaccine provides depends on the type of vaccine.

For most meningitis vaccines, more than one dose is needed for best protection.

 

The bacterial meningitis vaccines that are made from polysaccharides and other proteins need two or three doses for maximum immunity.

 

Immunity always begins to wear off after a certain time as the levels of protective antibodies in the blood decrease, so ‘boosters’ may be needed to ‘reboot’ the immune system and restore high levels of antibodies.

5. Do meningitis vaccines offer complete protection?

Answer

Nearly no vaccine provides 100% protection.

 

The different meningitis vaccines protect against only the germs that cause the type of meningitis that they are designed for, but not against all other strains. 

Not all cases of meningitis can be prevented by vaccines but the vaccines that exist do protect many people who might become unwell if they didn't get vaccinated. Therefore, it is essential to be familiar with the symptoms of meningitis and trust your instincts; seek medical attention if you’re at all worried.

6. How effective are the meningitis vaccines currently in use?

Answer

After clean water, vaccines are the most effective way of preventing infectious diseases in a country. Bacterial meningitis and septicaemia are examples of diseases where vaccination can truly be the difference between life and death or life-long disability.

How effective a vaccine is for an individual depends on many things:

  • how strong the immune system of the recipient is;

  • how strong an immune response it produces;

  • how widely it covers disease-causing strains circulating in the region;

  • whether it prevents germs from being carried and passed on;

  • how long protection lasts; and

  • whether it works sufficiently well in all age groups.

In addition, the overall number of cases prevented in a community depends on other things, including how widely the vaccine is offered and how many people choose to have it.

Overall, meningitis vaccines are extremely effective. In countries that include Hib, meningococcal, and pneumococcal vaccines in routine immunisation programs, meningitis and other severe infections caused by the meningitis bacteria have decreased to all-time lows. Now, there’s only one twentieth of the cases seen before vaccines were available.

7. How important is it to follow the recommended schedule?

Answer

Babies, children and adults who are not vaccinated on time are at risk of serious diseases.

Recommended immunisation schedules are carefully worked out by experts, who clearly define the need to protect children and babies at the best possible age, often the earliest, and the best and safest way to do it. 

Experts identify key at risk groups in the population (children and adults) and so following the schedules at any age is important to avoid unnecessary illness.

Vaccine Safety

1. Are meningitis vaccines safe?

Answer

The safety of meningitis vaccines is carefully verified in clinical trials before they are used in the general population. 

After release for general use, major national and international monitoring systems continually keep a close eye on side effects and after effects of vaccines to monitor vaccine safety, so that every event occurring after any vaccination is carefully documented. 

Millions of doses of vaccines are used every year worldwide, so this ‘pharmaco-vigilance’ database is very extensive and rigorous. This process goes on as long as the vaccines are licensed and administered.

To vaccinate against serious childhood diseases is hundreds of times safer than not to vaccinate! 

2. What are the side effects of meningitis vaccines?

Answer

All medicines, including vaccines, occasionally cause side effects. The side-effects from any vaccines are usually mild and include soreness, swelling, or redness at the site of injection, within the next 1 to 3 days after receiving the vaccine. 

Severe side effects are very rare but can occur. Occasionally, most of these vaccines have been linked to convulsions due to a raised temperature (this demonstrates the successful immune response of the vaccine).

Any health risk from the vaccines are far lower than the risks of severe complications, hospitalisation or death from meningitis or septicaemia.

3. Can vaccines overload the immune system of my child?

Answer

No. The immune system can cope with a very large number of vaccines at a time. 

Babies, from birth, are actually exposed to far more immune challenges from the surrounding environment than from all the vaccines contained in the routine immunisation schedule combined.

 

Even babies who are a little unwell (for example with a cold or teething) can produce excellent protective immune responses to vaccines.

 

By providing protection against potentially fatal infections, vaccines stimulate and strengthen the immune system before encountering the germ responsible for severe diseases.

4. What are the risks of not vaccinating?

Answer

Not taking up recommended vaccines, exposes you and your child to potentially life-threatening diseases. Not using recommended vaccines at the recommended dose and schedule can also threaten the health of those around you, including family members and the local community.

If too many people – adults and children - are not vaccinated, they contribute to a collective risk in their community or household and open up opportunities for meningitis germs to spread.

Very few people cannot receive vaccines but they are especially vulnerable. These people include those having treatment for certain cancers (or other forms of immunosuppression).

5.    Who should not receive vaccines? 

Answer

Certain individuals are not advised to receive vaccines. This group includes:

  • anyone who is currently unwell with a high fever (until better).

  • anyone with a history of allergic reactions to certain components of the vaccine.

 

Tell your doctor if you have any severe allergies.

  • anyone with a weakened immune system should seek medical advice before receiving live vaccines

  •  pregnant women may have inactivated vaccines, but not live vaccines

(For example, CDC recommends that pregnant women should wait until they have given birth before getting the MMR vaccine).

 

See these links for more information:

Other points on prevention

 

Risk factors and behaviours 

  • Seasonal factors can affect the incidence of bacterial meningitis. In temperate regions, the disease is more common in the winter and early spring. In Sub-Saharan Africa, outbreaks occur in the dry season.

  • Cases are more frequent in low income countries due to poverty, overcrowding, and lack of access to vaccines.

 

With meningococcal and Hib infections, anyone who has been in close contact with someone who has contracted the disease within seven days before the onset is at increased risk of contracting it themselves. Preventative antibiotics are usually offered to close contacts. These reduce, but cannot eliminate, the risk of family members or other close contacts becoming ill.

Protective behaviours

Some behaviours can help protect individuals and communities. For instance: 

  • Washing hands thoroughly

  • Keeping surfaces clean 

  • Avoid sharing anything that has been in someone else’s mouth e.g. drink, cigarette etc.

  • Stopping smoking may lower the risk of spreading meningitis germs and is good for your health. Smoking increases the risk of being a carrier of meningitis bacteria.

Group B strep

Group B Streptococcus (GBS) is a major cause of sepsis and meningitis in babies under 3 months.

Women commonly carry GBS without any harm to themselves but they may pass the bacteria to their babies around birth. Most GBS infections in newborn babies can be prevented through providing intravenous antibiotics – ideally penicillin – to women whose babies are at raised risk during labour. Women whose babies are at raised risk of the infection are typically identified by testing them for GBS carriage late in pregnancy or using key risk factors.

There is currently no vaccine to prevent GBS infection, although different vaccine trials are at various stages of development. A vaccine against GBS could have huge benefits, preventing many more GBS infections than antibiotics in labour can, as well as reducing the use of antibiotics.

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We know that this dramatic story would not necessarily have happened if we had known of the existence of a vaccination against pneumococcal infections and had vaccinated our little Ondra. But we did not know about it until it was too late.
 

Rudolf and Katherine, NAHLAS, Czech Republic

Katherine and her son Ondra

 
 

General

1. Where can I get more information on vaccines?

Answer

For the most up-to-date information specific to your area, speak to your doctor or local healthcare professional.

Most governments have websites with information about recommendations. Some excellent Government websites include the UK Immunisation website, the USA CDC website, the Australian Immunisation website; all of these have excellent and comprehensive local advice.

Lastly, our CoMO members have a wealth of knowledge and experience on vaccinations and the immunisation schedules.

 

Safe, effective vaccines are now available for many common types of meningitis and new vaccines are in development all the time.  

Contact a CoMO Member in your country to find out what vaccines are available to you. 

The Meningitis Vaccines Q&A Resource was made for members by The Confederation of Meningitis Organisations (CoMO). All information has been verified by The CoMO Scientific Advisory Group and is accurate as of April 2020.