One core aspect of parenthood that I was particularly daunted by, before becoming a mother myself, was the enormous weight of responsibility that comes with it. Those two pink lines staring back at me came with the stark realisation that after nearly three decades of only having myself to look after, I was now being entrusted with nurturing this tiny, growing little person. I took on the simpler recommendations easily – healthy eating, cutting out alcohol – but when it comes to other decisions, such as whether to take anti-emetic medication for severe morning sickness, or whether to have the whooping cough vaccination in the third trimester, without a clear idea of how that may affect our baby, the weight of responsibility for making that choice can feel overwhelming. As a parent, it’s natural to feel fiercely protective over our babies, and as such I think it’s really important to have all the information, reliable information, that you need to make these decisions comfortably. Today I’ll be talking about meningococcal meningitis and the MenB vaccine, the latest addition to the UK national childhood immunisation programme, with the aim of giving you the knowledge to make this particular choice on behalf of your child with more confidence.
Meningococcal disease comprises meningitis (infection of the membrane covering the brain and spinal cord) and septicaemia (infection in the bloodstream), and are caused by a bacteria called Neisseria Meningitidis, of which there are several types. The most common types in the UK are B (around 90% of cases), C, W and Y. The bacteria can be found in the throats of around 10% of adults, where they are usually harmless, due the the body’s natural defences. They are spread from one person to another through saliva – coughing, sneezing, kissing and sharing food or drink; but in susceptible individuals, particularly babies, once spread the bacteria may rapidly develop into meningococcal disease. Meningitis or septicaemia caused by this bacteria requires emergency treatment in hospital with antibiotics as early as possible, however even so the disease is fatal in 5-10% of cases, and those who survive can be left with lifelong disabilities.
The Meningococcal B (MenB) vaccine was introduced on the 1st September 2015 as part of the national immunisation programme. The vaccine, which also goes by the brand name Bexsero, is given in three doses, at 2, 4 and 12 months of age, and provides protection against the type B bacteria which most commonly cause meningococcal disease. Babies born on or after May 2015 were offered a catch-up vaccination, but there is currently no MenB immunisation offered for older children on the NHS, unless they suffer from a health condition which puts them at high risk of meningococcal disease. Back in 1999, a vaccine was introduced against type C meningococcal meningitis, MenC, which successfully vastly reduced the rates of disease from this strain of bacteria and saved hundreds of lives as a result – this is still offered on the UK national immunisation programme at 12 months of age. Due to the nature of the type B bacteria, it has been very difficult to develop a vaccine to protect against it, hence it not being previously available, and only very recently introduced, despite being the leading cause of meningococcal meningitis in the UK.
An understandable concern of many parents regarding any vaccination, but particularly a new one, is whether there are any risks or side effects to having it. Prior to being rolled out on the immunisation programme, the MenB vaccine was tested in clinical trials on 8000 people, including 5000 children, and was not found to have any serious adverse events; to date over 1 million MenB vaccinations have been administered, showing that the vaccine has a good safety profile. It has however, drawn attention to itself due to the fact that when given at 2 and 4 months of age, it carries a higher risk of causing a high temperature than the other vaccinations given at that time. for this reason, the NHS recommends that three doses of paracetamol are given after the first two MenB vaccinations at 2 and 4 months: one at the time of, or soon after immunisation, a second 4-6 hours later, and a third 4-6 hours later. Without paracetamol, over half of infants will develop a high temperature, which peaks at around 6 hours after the vaccination. By one year of age, a baby’s immune system is more developed and paracetamol not routinely recommended after the MenB booster dose, unless they develop fever and discomfort. The other common side effects of the MenB vaccination, are:
Redness, swelling or tenderness around the injection site
Being miserable or unsettled
Loss of appetite
These side effects are expected to last for a total of 1-2 days. Always speak to your doctor before getting the MenB vaccine if your child has ever had a serious reaction to a vaccination, has had a fever on the day of the jab, or has a bleeding disorder.
Should I Get The Vaccine Privately?
I know that many of you have an older child that had their first immunisations before the MenB vaccine was rolled out, and as it is not available to over twos on the NHS, it has left you wondering whether you should pay to have your child immunised privately. I can only imagine that this situation feels particularly uncomfortable if you have one child who has had the vaccination, and a second who has not, as we always strive to give each of our children equal opportunities.
The reason that the MenB vaccination was rolled out to all babies from September 2015, but not older children, is multifactorial. Firstly, cases of meningococcal meningitis and septicaemia are most common in babies aged under 1, with peak incidence at 5 months old. In the UK, there are 12 cases per 100,000 children aged 1-4; but this drops to only 2 cases per 100,000 children aged 5-9 years old. Due to practical, logistical and cost reasons the government had to choose to focus the immunisation programme for MenB on the group at highest risk of meningococcal disease, rather than attempting to treat all children. Following the MenB vaccine being rolled out, older children who have not had the vaccine themselves, in time, will have some protection due to herd immunity. The idea behind this is that as younger children will be immunised against the type B bacteria, there will be less cases of the disease, and therefore less to potentially spread to others — and so cases of the disease in older children will also fall.
The MenB vaccine is available privately for older children, and those aged over two will require just 2 doses, rather than 3, for full immunity. The cost price per vaccine is around £75, and it is worth shopping around for the best price from your own GP surgery, to other practices and local travel clinics. Whether you should get your older children immunised is ultimately your choice, and you may find it a difficult one to make – but I do hope that this information has made this decision a little more clear for you.
For those of you that have older children, I wanted to add that there is a second peak in cases of meningococcal disease between the ages of 15-19 years, in particular amongst university freshers. In response to this, another vaccination was rolled out in 2015; this one is called MenW: it protects against meningococcal disease caused by type A, C, W and Y bacteria and is available to all 14-18 year olds on the NHS.
If you are still with me, thank you! I really do hope that you have found this to be useful, and if you have any questions about anything, pop them in the comments and I’ll do my best to answer them. To finish, I’ll leave you with a table of signs that may represent meningococcal disease in children aged under five; we all knew about the key symptoms in adults (headache, neck stiffness, non-blanching rash) but it’s important to remember that in young children the signs can be more subtle, and non-specific, which can make them harder to pick up early on. Keep this table handy, and if your child is unwell, and you suspect meningococcal disease, be sure to seek medical help without delay.