more_vert
Why is it that different states and territories have different policies on meningococcal B vaccination?
In Australia, invasive meningococcal disease (IMD) continues to pose a consistent and serious public health risk, with meningococcal serogroup B (MenB) responsible for at least 80% of cases in 2022, 2023 and 2024, according to data from the Australian Meningococcal Surveillance Programme. As of September 2025, 86 cases of IMD were reported throughout Australia with MenB accounting for 83%.
Between 2003 and 2022, meningococcal infections were responsible for 249 deaths in Australia. While the number of meningococcal cases has fallen in the 2020s in Australia, following the earlier introduction of vaccines, there are still approximately 100 cases per year, with a death rate of 5-10%.
The disease
IMD is an uncommon bacterial infection caused by Neisseria meningitidis, which can lead to life-threatening illnesses such as meningitis and septicaemia, often within in only a few hours, and can cause serious disability and complications, eg brain damage, deafness, loss of limbs, or even death within 24 hours.
Early non-specific symptoms of meningococcal disease, such as high fever, headache and lethargy can be misdiagnosed, but a clearer diagnosis emerges as symptoms/signs accrue including nausea, vomiting, neck stiffness, joint pain, sensitivity to light, pale blotchy skin, cold hands and feet, and a distinctive purple rash, which can be an indication of sepsis.Babies may have a high-pitched moaning cry, difficulty waking and/or a bulging fontanelle.
While meningococcal disease can occur at any age, infants and young children (< 2 years of age), followed by adolescents between 15–19 years of age, are the most at risk. Historically, winter and spring have been the peak seasons for meningococcal disease, and there is asymptomatic carriage in the throat among 5–25% of people.
Immediate treatment for IMD includes antibiotics, such as penicillin and ceftriaxone, and supportive care. Early intervention is critical, as rapid deterioration can occur.
Available vaccines
There are 13 known serogroups, the most common causing disease around the world being serogroups A, B, C, W, and Y. For all of these, safe and effective vaccines are available in Australia. Critically in Australia, serogroup B causes the great majority of cases with each of A, C, Y and W only causing a handful of cases each year. And yet, while vaccines for A, C, Y and W are freely provided for infants and teenagers, country-wide, serogroup B is only freely available in four of our eight states and territories (SA, QLD, NT and TAS).
Vaccine effectiveness
A study in SA reported 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 (Neisseria gonorrhoeae) in teenagers. A study in the UK with MenB vaccine also showed 33–47% protection against gonorrhoea.
In a follow-up study to the SA study, reductions of 72.7% and 76.2% the incidence of MenB disease were observed in infants less than one year and adolescents aged 15–18 years respectively, with a vaccine effectiveness (VE) of 98.5–99.9% in children (3 dose schedule) and 92.3% in adolescents (2 dose schedule). There was also some protection against gonorrhoea infection with a VE of 39%.
Despite the proven efficacy of MenB vaccines, accessibility remains a challenge, particularly outside of state-funded programs. The cost of the vaccine can be a barrier for many families, leading to calls for broader inclusion in the National Immunisation Program (NIP).
Who should be vaccinated?
Quadrivalent meningococcal vaccines against serogroups A, C, W, and Y (MenACWY) are available under the NIP for all infants (two doses) and for all adolescents aged 14 to 16 years. The MenB vaccine, which targets only serogroup B, is also part of the NIP but only for infants in specific high-risk groups, including Aboriginal and Torres Strait Islander infants, and individuals with certain medical conditions.
The Australian Immunisation Handbook states that Meningococcal vaccines are recommended for:
- infants and young children, adolescents and young adults;
As well as special risk groups, which include:
- Aboriginal and Torres Strait Islander people;
- individuals with certain medical conditions, including defects in, or deficiency of, complement components, including factor H, factor D or properdin deficiency; functional or anatomical asplenia including sickle cell disease or other haemoglobinopathies; HIV; and haematopoietic stem cell transplant recipients;
- laboratory workers handling Neisseria meningitidis;
- travellers, especially those travelling to sub-Saharan Africa; and
- young adults who live in close quarters with or who are smokers.
Jurisdictional (state and territory) initiatives vary for MenB vaccines
Historically, SA and the NT have experienced higher per capita rates of IMD, and SA was the first to implement a state-funded MenB vaccination program in 2018, which soon led to a notable reduction in cases, especially in children under four years and adolescents aged 17–20 years.
The NT launched a free routine MenB vaccination program in early 2025 for infants aged six weeks to 12 months and students in Year 9, administered with other scheduled childhood vaccines, through the NT School Immunisation Program. Furthermore, young children aged 12 months to two years and adolescents aged 15-19 can also receive the free vaccine until the end of 2026, as part of a two-year catch-up program.
Just prior to the NT launch, in March 2024, the QLD MenB vaccination program was launched, while the recent 2025 election campaign in Tasmania has resulted in a state government announcement of a free MenB vaccination program for all infants from six weeks to 12 months old and free catch-up immunisation for children over 12 months and under two years.
The Table summarises Vaccine recommendations for IMD under current national and jurisdictional immunisation programs.
Equitable access
Although serious IMD infections are uncommon, it is clear that MenB is the serogroup most likely to cause serious disease in Australia. While the vaccine is free for children and adolescents in SA, QLD, NT and recently TAS, it is not free in other Australian jurisdictions except for Aboriginal and Torres Strait Islander children, and people with specified medical high-risk factors (under the NIP). It can however be purchased with a prescription for around $122 per dose, which provides a significant financial barrier to vaccination for low-income populations and those under financial stress. Universal free access to MenB vaccines would allow all children, adolescents and people at risk to be protected against severe meningococcal disease.
The global burden
Globally, meningococcal disease remains a significant public health issue, particularly in the “meningitis belt” of sub-Saharan Africa, comprising 26 countries from Senegal to Ethiopia, where epidemics can occur. Different serogroups, such as A, B, C, W, and Y, exhibit varying epidemiological patterns. In regions with high incidence, mass vaccination campaigns play a pivotal role in controlling outbreaks; however, the global disease burden is still significant, with the World Health Organization (WHO) estimating over 250,000 deaths from all-cause meningitis in 2019. The WHO’s “Defeating Meningitis by 2030” initiative aims to reduce meningitis deaths by 70% and halve the number of cases globally.
Last word
Invasive meningococcal disease poses a serious threat to individuals and healthcare systems. In Australia, vaccines have been instrumental in mitigating IMD risk, but state-specific policies lead to inequity of access. MenB disease remains a significant public health concern due to its rapid progression and high mortality and morbidity rates. Vaccination programs, especially those targeting high-risk groups, have demonstrated effectiveness in reducing disease incidence. There are also persistent challenges such as vaccine accessibility, public education and awareness, and vaccine hesitancy due to disinformation. Continued efforts at both national and global levels are essential to combat this life-threatening disease. Put simply, the vaccine should be free in order to effectively control MenB, the way that serogroups A, C, W, and Y have already been well controlled.
Acknowledgements:
Gratitude to Dr John McEwen for reviewing the manuscript.
(Boxed table)
Vaccine recommendations for IMD
MenACWY vaccine
The National Immunisation program (NIP) covers:
- children 12 months of age;
- adolescents in year 10 (~14 to 16 years), with a catch up for those aged 15 to 19 years (interestingly, individual states and territories introduced teen-based campaigns between 2016 and 2019, which were ceased due to the NIP taking over in 2019);
- people of all ages with specified medical risk conditions that increase their risk of IMD.
MenB vaccine
The National Immunisation program (NIP) covers:
- Aboriginal and Torres Strait Islander infants ≥2 months;
- catch-up: for all Aboriginal and Torres Strait Islander children under 2 years (ongoing program);
- people of all ages with specified medical risk conditions that increase their risk of IMD.
Jurisdictional Immunisation programs (JIP) cover:
- South Australia: for infants up to 12 months and adolescents in Year 10;
- Queensland: for infants up to 12 months and adolescents aged 15-19 years. Catch up for children aged over 12 months to <2 years;
- Northern Territory: for infants up to 12 months and Year 9 students. Catch up for children aged over 12 months to <2 years and adolescents aged 15-1;
- Tasmania: infants from six weeks to 12 months and free catch-up immunisation for children over 12 months and under two years.