In Australia, the threat of invasive meningococcal disease (IMD) remains a pressing public health concern. Despite the availability of vaccines, a patchwork of policies across states and territories leaves many Australians at risk. Meningococcal serogroup B (MenB) has been particularly troublesome, accounting for at least 80% of cases from 2022 to 2024, according to the Australian Meningococcal Surveillance Programme. As of September 2025, 86 cases of IMD were reported nationwide, with MenB responsible for 83% of these cases.
Between 2003 and 2022, meningococcal infections led to 249 deaths in Australia. Although the incidence of meningococcal cases has decreased in the 2020s due to vaccination efforts, approximately 100 cases still occur annually, with a mortality rate ranging from 5-10%.
Understanding the Disease
Invasive meningococcal disease is an uncommon yet severe bacterial infection caused by Neisseria meningitidis. It can rapidly progress to life-threatening conditions such as meningitis and septicaemia, often within hours. The disease can result in serious disabilities, including brain damage, deafness, and limb loss, or even death within 24 hours.
Early symptoms, including high fever, headache, and lethargy, are often non-specific and can lead to misdiagnosis. As the disease progresses, more definitive symptoms such as nausea, vomiting, neck stiffness, joint pain, and a distinctive purple rash may appear, indicating sepsis. Infants may exhibit a high-pitched moaning cry, difficulty waking, and a bulging fontanelle.
While meningococcal disease can affect individuals of any age, infants and young children under two years old, as well as adolescents aged 15-19, are most at risk. Historically, the disease peaks during winter and spring, with asymptomatic carriage in the throat occurring in 5-25% of the population. Immediate treatment involves antibiotics like penicillin and ceftriaxone, with early intervention being crucial to prevent rapid deterioration.
Vaccine Landscape and Effectiveness
Thirteen serogroups of meningococcal bacteria are known, with serogroups A, B, C, W, and Y being the most common worldwide. Vaccines for these serogroups are available in Australia, yet MenB remains the predominant cause of cases. Notably, while vaccines for serogroups A, C, Y, and W are freely provided nationwide for infants and teenagers, the MenB vaccine is only freely available in South Australia (SA), Queensland (QLD), Northern Territory (NT), and Tasmania (TAS).
A study conducted in SA demonstrated that the MenB vaccine (4CMenB) reduced the risk of contracting MenB disease by 91% in children and 84% in adolescents. Additionally, the vaccine showed a 33% effectiveness against gonorrhoea in teenagers. A similar study in the UK reported 33-47% protection against gonorrhoea.
In follow-up studies, the MenB vaccine showed a vaccine effectiveness (VE) of 98.5-99.9% in children and 92.3% in adolescents, with a 39% VE against gonorrhoea infection.
Despite the proven efficacy of MenB vaccines, access remains a challenge, especially outside state-funded programs. The cost of the vaccine, approximately $122 per dose, poses a significant financial barrier for many families, prompting calls for broader inclusion in the National Immunisation Program (NIP).
Disparities in Vaccination Policies
The Australian Immunisation Handbook recommends meningococcal vaccines for infants, young children, adolescents, and special risk groups, including Aboriginal and Torres Strait Islander people and individuals with certain medical conditions. However, jurisdictional initiatives for MenB vaccines vary.
SA and NT have historically experienced higher per capita rates of IMD. SA was the first to implement a state-funded MenB vaccination program in 2018, leading to a notable reduction in cases. The NT launched a free routine MenB vaccination program in early 2025, targeting infants and students through the NT School Immunisation Program.
In March 2024, QLD introduced its MenB vaccination program, followed by a recent 2025 announcement from the TAS government for a free MenB vaccination program for infants and catch-up immunisation for young children.
Despite these efforts, MenB vaccines are not freely available in other Australian jurisdictions, except for Aboriginal and Torres Strait Islander children and individuals with specific medical conditions under the NIP. This inequity highlights the need for universal access to MenB vaccines to protect all at-risk populations.
Global Context and Future Directions
Globally, meningococcal disease remains a significant public health issue, particularly in the “meningitis belt” of sub-Saharan Africa. Mass vaccination campaigns have been crucial in controlling outbreaks, yet the global disease burden remains substantial. The World Health Organization (WHO) estimates over 250,000 deaths from all-cause meningitis in 2019 and aims to reduce meningitis deaths by 70% by 2030 through its “Defeating Meningitis by 2030” initiative.
In Australia, while vaccines have significantly reduced the risk of IMD, state-specific policies result in inequitable access. MenB disease continues to be a major public health concern due to its rapid progression and high mortality rates. Vaccination programs targeting high-risk groups have proven effective, but challenges such as vaccine accessibility, public education, and vaccine hesitancy persist.
Continued efforts at both national and global levels are essential to combat this life-threatening disease. Universal free access to MenB vaccines is crucial to effectively control the disease and protect vulnerable populations.
In conclusion, while Australia has made strides in mitigating the risk of IMD through vaccination, disparities in access to MenB vaccines highlight the need for a more cohesive national strategy. Ensuring equitable access to vaccines will be vital in safeguarding public health and preventing future outbreaks.
