The changing epidemiology of invasive meningococcal disease in Australia: continuing rise in meningococcal W disease Julia Maguire Master of Philosophy in Applied Epidemiology (MAE) scholar Dr Helen Quinn Ms Cyra Patel Dr Clayton Chiu www.ncirs.usyd.edu.au

Invasive Meningococcal Disease (IMD) 1 3 2 1. Photo courtesy of Centers for Disease Control and Prevention 2 Photo courtesy of Centers for Disease Control and Preventio 3. httpwww.couriermail.com.au/news/queensland/meningococcal-brisbane-fivemonthold-archie-roberts-diagnosed-with-the-disease/news-story/72386003ab7c2f2511b5e27e7d7b5ea3:// 2

Objectives To identify and describe the changes in Invasive Meningococcal Disease (IMD) epidemiology in Australia Control the emergence of meningococcal serogroup W IMD by informing meningococcal vaccination policy in Australia 3

Data source National Notifiable Diseases Surveillance System (NNDSS) 1st January 1999 to 24th April 2017 Focusing on recent years to investigate the emergence of serogroups W and Y 4

Methods IMD notifications trends Serogroup dominance Age distribution trends Geographical variation Aboriginal and Torres Strait Islander variations Mortality 5

IMD secular trends Secular trends IMD notification rate by serogroup and year, 1999-2017* MenCCV added to the NIP The ‘not grouped/non-groupable’ notifications in 2017 may have been grouped since date of data extraction Trends are not shown for serogroups A (n=5) and X (n=2) *2017 Q1 only 6

IMD secular trends Secular trends IMD notification rate by serogroup and year, 1999-2017* MenCCV added to the NIP The ‘not grouped/non-groupable’ notifications in 2017 may have been grouped since date of data extraction Trends are not shown for serogroups A (n=5) and X (n=2) *2017 Q1 only 7

IMD secular trends Secular trends IMD notification rate by serogroup and year/quarter, 2012-2017 8

IMD age group trends IMD notification rate by 5-year age-group and serogroup, 2016-2017 9

IMD age group trends - MenB MenB notification rate by year and age groups, 1999-2017 10

IMD age group trends - MenW MenW notification rate by year and age groups, 1999-2017 11

IMD age group trends - MenW MenW notification rate by year and age groups, 2012-2017

Geographical variation 2012-2014 Dominant serogroup – B or W? 13

Geographical variation 2016-2017 Dominant serogroup – B or W? B&W W 14

IMD Rate among Aboriginal and/or Torres Strait Islander peoples - MenB MenB notification rate by age group with confidence intervals, 2012-2017 25 18 10 12 4 9 2 - - 80 59 21 16 13 204 83 40 37 Notification rate is displayed in the graphs Number of notifications is displayed in the tables 15

IMD Rate among Aboriginal and/or Torres Strait Islander peoples - MenW MenW notification rate by age group with confidence intervals, 2012-2017 2 6 5 2 - - 2 - - 13 9 1 1 2 46 30 28 57 Notification rate is displayed in the graphs Number of notifications is displayed in the tables 16

IMD mortality Number of mortalities and case-fatality ratio (CFR) by age group and serogroup (years) Serogroup C 1999-2017 Serogroup B 2004-2017 Serogroup W 2012-2017 n N CFR (%) CI <1 7 52 13.5 5.6-25.8 31 437 7.1 4.9-9.9 - 15 1-4 2 112 1.8 0.2-6.3 16 449 3.6 2.1-5.7 1 21 4.8 0.1-23.8 5-14 136 5.1 2.1-10.3 237 0.8 0.1-3.0 5 15-24 26 414 6.3 4.1-9.1 18 693 2.6 1.5-4.1 4 46 8.7 2.4-20.8 25-49 22 231 9.5 6.1-14.1 13 298 4.4 2.3-7.3 32 12.5 3.5-29.0 50-64 12 92 13.0 6.9-21.7 148 8.1 4.2-13.7 28 65+ 11 60 18.3 9.5-30.4 93 12.9 6.8-21.5 57 8.8 2.9-19.3 Total 88 1,099 8.0 6.5-9.8 104 2,356 3.6-5.3 14 204 6.9 3.8-11.2 17

Conclusions and public health implications MenW notification rates are higher among older populations MenW has increased in all state and territories since 2015 There is variation in rates and the dominant serogroup between different jurisdictions, with MenB remaining dominant in some IMD rates are generally higher among Aboriginal and Torres Strait Islander peoples particularly in the younger populations 18

Meningococcal Immunisation Programmes in Australia 2003 onwards: MenC vaccination MenCCV has been on the National Immunisation Program (NIP) since 2003 Administered to infants at 12 months of age Broad catch-up program administered to those ≤19 years of age from 2003-2008 2017/18: MenACWY 4vMenCV in five states State/territory funded (not on NIP) targeting 15-19 years old This vaccine is also available in the private market at a cost of approx. $100-150 19

Acknowledgements Dr Aditi Dey Dr Katie Glass Dr Frank Beard National Notifiable Diseases Surveillance System (NNDSS) Australian Technical Advisory Group on Immunisation (ATAGI)

Additional slides

Nationally and state funded meningococcal vaccination programs in Australia Year Funding body Program Target age groups / year level 2003 National   MenCCV universal - one dose MenCCV universal - one dose (catch-up program until 2008) Aged 12 months All children aged 1-19 years 2013 Hib-MenCCV universal - one dose 2017 State 4vMenCV vaccination in school children in NSW - one dose 4vMenCV vaccination in school children in Vic, Tas & QLD - one dose 4vMenCV vaccination in school children in WA - one dose High school years 11 & 12 in 2017 (Aged 17-18 years) Aged 15-19 years in 2017 High school years 10-12 in 2017 Aged 18-19 years in 2017 High school year 10 in 2018-19 MenCCV Hib-MenCCV 4vMenCV Meningococcal conjugate C vaccine Meningococcal conjugate C vaccine in combination with Haemophilus influenzae type b (Hib) Meningococcal quadrivalent conjugate A, C, W and Y vaccine

IMD secular trends Secular trends IMD notification rate by serogroup and year, 1999-2017* MenCCV added to the NIP The ‘not grouped/non-groupable’ notifications in 2017 may have been grouped since date of data extraction Trends are not shown for serogroups A (n=5) and X (n=2) *2017 Q1 only

Geographical variation 2012-2014 Dominant serogroup – B or W? http://www.clker.com/clipart-2073.html

Geographical variation 2016-2017 Dominant serogroup – B or W? B&W W http://www.clker.com/clipart-2073.html

Notification rate, hospitalisation rate and CFR

IMD Rate among Aboriginal and/or Torres Strait Islander peoples, 2012-2017 16

Hospitalisations, length of stay and death Age Group (years) Hospitalisations (1999-2013) LOS per admission (average, days) Deaths# n (^) Rate* Median (^) % <1 1,194 (1,122) 29.1 (27.4) 6.7 (6.0) 48 4.0 1.17 1-4 1,646 (1,570) 10.2 (9.7) 5.4 (4.0) 32 1.9 0.20 5-14 1,219 (1,156) 3.0 (2.8) 5.1 (4.0) 18 1.5 0.04 15-24 2,177 (1,925) 5.1 (4.5) 7.8 (6.0) 43 2.0 25-49 1,215 (1,007) 1.1 (0.9) 8.4 (6.0) 55 4.5 0.05 50-64 575 (429) (0.8) 13.0 (8.0) 28 4.9 65+ 434 (261) (0.6) 13.3 (10.0) 54 12.4 0.13 Total 8,460 (7,470) 2.7 (2.4) 7.5 (5.0) 278 3.3 0.09

Mortality and CFR by serogroup Age Group (years) Serogroup B 2004-2017 Serogroup C 1999-2002 Serogroup W 2012-2017 n N CFR (%) CI <1 31 437 7.1 4.9-9.9 3 26 11.5 2.4-30.2 - 15 1-4 16 449 3.6 2.1-5.7 90 1 21 4.8 0.1-23.8 5-14 2 237 0.8 0.1-3.0 4 93 4.3 1.2-10.6 5 15-24 18 693 2.6 1.5-4.1 277 5.8 3.3-9.2 46 8.7 2.4-20.8 25-49 13 298 4.4 2.3-7.3 133 12.0 7.0-18.8 32 12.5 3.5-29.0 50-64 12 148 8.1 4.3-13.7 38 13.2 4.4-28.1 28 65+ 12.9 6.8-21.5 34 14.7 5.0-31.1 57 8.8 2.9-19.3 Total 104 2,355 3.6-5.3 49 691 5.3-9.3 14 204 6.9 3.8-11.2

Diagnostic testing methods