1. 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

2. 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/ ab7c2f2511b5e27e7d7b5ea3:// 2

3. 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

4. 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

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

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 6

7. 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

8. IMD secular trends Secular trends IMD notification rate by serogroup and year/quarter, 2012-20178

9. IMD age group trends IMD notification rate by 5-year age-group and serogroup, 2016-20179

10. IMD age group trends - MenB MenB notification rate by year and age groups, 1999-201710

11. IMD age group trends - MenW MenW notification rate by year and age groups, 1999-201711

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

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

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

15. IMD Rate among Aboriginal and/or Torres Strait Islander peoples - MenB MenB notification rate by age group with confidence intervals,
Notification rate is displayed in the graphs
Number of notifications is displayed in the tables 15

16. IMD Rate among Aboriginal and/or Torres Strait Islander peoples - MenW MenW notification rate by age group with confidence intervals,
Notification rate is displayed in the graphs
Number of notifications is displayed in the tables 16

17. IMD mortality Number of mortalities and case-fatality ratio (CFR) by age group and serogroup
(years)
Serogroup C
Serogroup B
Serogroup W n N
CFR (%) CI
<1 7 52
13.5 31
437
7.1 - 15
1-4 2
112
1.8 16
449
3.6 1 21
4.8
5-14
136
5.1
237
0.8 5
15-24 26
414
6.3 18
693
2.6 4 46
8.7
25-49 22
231
9.5 13
298
4.4 32
12.5
50-64 12 92
13.0
148
8.1 28
65+ 11 60
18.3 93
12.9 57
8.8
Total 88
1,099
8.0
104
2,356 14
204
6.9 17

18. 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

19. 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
2017/18: MenACWY
4vMenCV in five states
State/territory funded (not on NIP) targeting years old
This vaccine is also available in the private market at a cost of approx. $ 19

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

22. Additional slides

23. 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 (Aged years)
Aged years in 2017
High school years in 2017
Aged years in 2017
High school year 10 in
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

24. 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

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

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

27. Notification rate, hospitalisation rate and CFR

28. IMD Rate among Aboriginal and/or Torres Strait Islander peoples, 2012-201716

29. Hospitalisations, length of stay and death
Age Group (years)
Hospitalisations
( )
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

30. Mortality and CFR by serogroup
Age Group
(years)
Serogroup B
Serogroup C
Serogroup W n N
CFR (%) CI
<1 31
437
7.1 3 26
11.5 - 15
1-4 16
449
3.6 90 1 21
4.8
5-14 2
237
0.8 4 93
4.3 5
15-24 18
693
2.6
277
5.8 46
8.7
25-49 13
298
4.4
133
12.0 32
12.5
50-64 12
148
8.1 38
13.2 28
65+
12.9 34
14.7 57
8.8
Total
104
2,355 49
691 14
204
6.9

31. Diagnostic testing methods