Meningococcal outbreak in Tasmania – a regional headache

Crystal Gao, Editorials and Publications Team PMSA

Meningococcal meningitis, or invasive meningococcal disease (IMD), is a serious disease that causes inflammation of the membrane that surrounds the brain and spinal cord. It is most commonly caused by the bacteria Neisseria meningitidis, but can also be viral or aseptic (i.e. no infectious cause) in origin. Because it is associated with a high risk of severe sequelae (>10%), it is important to commence treatment with antibiotics as soon as possible in order to prevent complications and death (1). Currently, 12 types of meningitis have been identified; the most common of these are the strains A, B, C, W and Y, for which there are vaccines available (2,3).

Overall Australia has a low incidence of IMD, with a decrease in the number of reported cases over 2003 – 2013 following the introduction of the meningococcal C vaccine into the national immunisation schedule. However, the numbers have been climbing recently, with 2017 having the highest incidence of IMD since 2006. Just recently in the past month, 5 new cases of meningococcal were reported in Tasmania, with health services stating that none of these 5 cases were linked in any way. This follows a similar incidence earlier in the year, when Fiji reported an outbreak of meningococcal C on the 20th of March 2018 (4). In light of the recent outbreak and the rising incidence particularly of meningococcal W, the Australian government have implemented a state-based vaccination program for meningococcal ACWY strains in the adolescent/teenage population (15 – 19)(5).

Although meningococcal is a relatively uncommon disease in Australia, and indeed in most of the Pacific regions, it is nonetheless an important disease to watch out for and to recognise. This can often be difficult, as the symptoms of meningitis can be unspecific e.g. fever, headache, nausea etc and difficult to distinguish from other milder infections. However, the presence of certain “red flags” should increase suspicion for IMD – these include (1):

Neck stiffness

Photophobia (aversion to bright light beyond what is normal)

Petechiae (a rash that doesn’t go white or “blanch” when you press down on it)

1. WHO. Meningococcal meningitis. In: WHO, ed2018.

2. Borrow R, Alarcón P, Carlos J, et al. The Global Meningococcal Initiative: global epidemiology, the impact of vaccines on meningococcal disease and the importance of herd protection. Expert Review of Vaccines. 2017;16(4):313-328.

3. James E. More meningococcal cases in Tasmania. 2018.

4. Fiji Go. Fiji Meningococcal C Outbreak Situation Report: Volume 04, 2018. In: (MoHMS) MoHaMS, ed2018.

5. Department of Health A. Meningococcal Disease. In: Health Do, ed. www.health.gov.au: Australian Government; 2018.