January

Full chapter update to align with new format. New section added for Primary meningococcal conjunctivitis to provide information on the public health actions required.

Includes changes to the following sections.

• Epidemiology – new subsection for global epidemiology and update to the Aotearoa New Zealand epidemiology section.
• At risk and priority populations – new section.
• The disease – new section.
• Spread of infection – new subsections for reservoir and infection prevention and control.
• Routine prevention – new section.
• Case definition – new subsections for laboratory criteria and direct laboratory notification process. New laboratory definitive and suggestive evidence included. Confirmed case definition expanded to include those who meet the clinical criteria and have laboratory suggestive evidence.
• Laboratory testing guidelines – new section.
• Notification and reporting – new subsections for national escalation and international reporting.
• Case management – new subsections for public health priority and manaakitanga/manaaki in practice. New guidance for managing deceased cases.
• Contact management – new subsections public health priority for contacts, manaakitanga/manaaki in practice and advice to contacts. New contact definitions with detailed criteria for contact types (e.g. household-like, intimate, healthcare, travel, early childhood, other). Additional recommendation to check antibiotic sensitivity testing results if the index case travelled internationally in the 7 days prior to onset of symptoms.
• Exposure event management – new section.
• Outbreaks – new section.
• Primary meningococcal conjunctivitis – new section to provide information on the public health actions required.

For an overview of all updates made to the Communicable Disease Control Manual, refer to Updates to the Communicable Disease Control Manual – Health New Zealand | Te Whatu Ora (external link)

Invasive meningococcal disease, caused by the bacterium Neisseria meningitidis, remains a significant global health concern due to its rapid onset, high mortality and potential for long-term disability. Six serogroups (A, B, C, W, X, and Y) are responsible for most cases worldwide [1–3].

The global burden of invasive meningococcal disease is substantial, with approximately 1.2 million cases occurring each year, resulting in approximately 135,000 deaths worldwide, with a case fatality rate up to 50% in untreated cases [3].

The highest global burden of invasive meningococcal disease is concentrated in the ‘meningitis belt’ of sub-Saharan Africa, where outbreaks are frequent and severe, while moderate to low incidence is observed in regions such as Europe, the Americas and parts of Asia with serogroup distribution and disease patterns varying significantly across countries and over time [4,5].

Mass gatherings, such as the Hajj and Umrah pilgrimages, are well recognised as being associated with outbreaks of invasive meningococcal disease due to a combination of epidemiological, environmental and logistical factors [6–9].

For more detail on the number of reported invasive meningococcal disease cases globally, refer to the World Health Organization's data page for invasive meningococcal disease (external link).

For more information on global epidemiology, refer to the Immunisation Handbook.

Aotearoa New Zealand has a relatively high rate of invasive meningococcal disease compared to other high-income countries, particularly those with national immunisation programmes [10,11].

Between 2020 and 2024, there were between 33 and 69 cases of invasive meningococcal disease reported each year, resulting in between 1 and 5 deaths annually. Group B was the most common serogroup identified during this period [12]. In contrast, case numbers were higher in previous years. Between 2017 and 2019, annual cases ranged between 112 and 139 cases, with 9 to 10 deaths reported each year [13]. COVID-19-related restrictions are likely to have contributed to lower case numbers between 2020 and 2023 [14].

Isolated outbreaks of invasive meningococcal disease have previously been reported in Aotearoa New Zealand. In 2018, 2 separate outbreaks occurred: one in Northland, predominantly caused by Group W and another in the Southern region, caused by Group B [15,16]. In 2011 there was an outbreak in Northland, caused by Group C [17].

For further information on the epidemiology of invasive meningococcal disease in Aotearoa New Zealand, refer to the meningococcal surveillance reports (external link) – PHF Science, meningococcal disease dashboard (external link) – PHF Science and the Immunisation Handbook meningococcal chapter.

The following demographic groups experience higher rates of disease in Aotearoa New Zealand. This is likely due to both an increased likelihood of acquiring Neisseria meningitidis and increased susceptibility to invasive disease.

Age

Rates of invasive meningococcal disease are consistently highest among the following age groups [12,18–20].

• Children aged under 5 years, particularly infants aged under 1 year.
• Adolescents and young adults aged 13 to 25 years.
• Adults aged 65 years and over.

These disparities are likely due to a combination of factors including immature or weakened immune systems, increased exposure to the N. meningitidis, vague or non-specific symptoms that delay diagnosis, delays in seeking medical care, social behaviours that facilitate transmission, higher rates of N. meningitidis carriage, and the presence of other health conditions.

Ethnicity

Rates of invasive meningococcal disease are disproportionately higher among the following ethnic groups [12,18–20].

• Māori, particularly infants aged under 1 year.
• Pacific peoples, particularly young children aged under 5 years.

These disparities are driven by a combination of social, environmental and systemic factors. Key contributors may include population age structures, communal or crowded living environments, the presence of other health conditions and structural health and social inequities including limited access to healthcare and lower vaccination coverage rates.

Disability

Rates of invasive meningococcal disease for tāngata whaikaha | disabled people are not known due to limited disability data within the health system making it difficult to assess the true burden of disease. However, tāngata whaikaha | disabled people may be at increased risk due to systemic health inequities and poorer outcomes.

For further information on providing culturally safe and equitable care for a range of population groups, refer to the Equity chapter.

For further information on advancing hauora in the management of communicable diseases, refer to the Tū Kōkiritia chapter.

The following medical conditions increase an individual’s susceptibility to invasive disease [21].

• Splenectomy or splenic dysfunction.
• Complement deficiency or inhibition (including treatment with complement inhibitors).
• Human immunodeficiency virus infection.

The following occupations increase an individual’s likelihood of acquiring N. meningitidis.

• Laboratory workers with routine contact with N. meningitidis isolates [22,23].
• Healthcare workers with unprotected, close exposure to the airways of cases (i.e. during mouth-to-mouth resuscitation or airway management such as suctioning or intubation) [23].

The following risk factors increase an individual’s likelihood of acquiring N. meningitidis.

• Travel to or residence in areas with high rates of meningococcal disease (including during the Hajj and Umrah in Saudi Arabia).
• Living in close proximity to others (e.g. communal living, crowded living situations, boarding school, university hall of residence [24–26], military barrack, group accommodation, long-term institutional care or other settings with shared bedrooms).

The following risk factors may increase an individual’s likelihood of acquiring N. meningitidis and/or their susceptibility to invasive disease.

• Close contact of an invasive meningococcal disease case [27,28].
• Recent upper respiratory tract infection.
• Exposure to tobacco smoke (i.e. active or passive smoking).
• Frequent recreational drug use [29].

The goals of public health action for invasive meningococcal disease are to prevent secondary transmission and outbreaks. Vaccination and chemoprophylaxis (clearance antibiotics) are the key public health measures used to prevent secondary cases and limit further transmission.

Public health follow-up is especially important for individuals identified as a close contact of a confirmed case—such as household members, intimate partners, those exposed to respiratory secretions and individuals living in shared accommodation. These groups should be prioritised due to their higher risk of acquiring N. meningitidis and greater susceptibility to invasive disease. Refer to the Contact management section.

Meningococcal disease is caused by the gram-negative diplococcus bacterium Neisseria meningitidis, also known as meningococcus [30] and can present as a spectrum of clinical illness, including invasive infections. Invasive meningococcal disease refers to the spread of N. meningitidis into sterile sites in the body such as the bloodstream, and meninges. Almost all invasive meningococcal disease is associated with serogroups A, B, C, W, X and Y. Most cases of invasive meningococcal disease are sporadic, with transmission of N. meningitidis likely to have occurred from an asymptomatic carrier in the network of close contacts.

If invasive meningococcal disease occurs, this usually occurs within a few days of transmission of N. meningitidis and before antibodies can develop [31,32]. The events that cause invasive meningococcal disease are poorly understood but include a combination of organism, host and environmental factors (refer to the At risk and priority populations section for more information). Fewer than 1% of people colonised with N. meningitidis develop invasive meningococcal disease [33].

Invasive meningococcal disease typically presents as meningitis (inflammation of the meninges surrounding the brain or spinal cord), meningococcaemia (also known as meningococcal septicaemia, a blood infection caused by N. meningitidis), or both.

Meningitis

Meningitis (inflammation of the meninges surrounding the brain or spinal cord) is observed in approximately 50% of cases and is characterised by sudden onset of fever, headache and neck stiffness. It is often accompanied by meningococcaemia. Cases may also experience nausea, vomiting, photophobia and altered mental status (e.g. confusion, abnormal behaviour, altered level of consciousness) [33].

Infants and toddlers may have a slower onset of symptoms and may present with subtle and non-specific signs (such as poor appetite, lethargy and irritability) [34]. Neck stiffness may be absent and a bulging fontanelle may be seen [35,36].

Meningococcaemia

Meningococcaemia (a blood infection caused by N. meningitidis) without meningitis occurs in approximately 30 to 40% of cases and is a severe manifestation of invasive meningococcal disease [37].

Signs of meningococcaemia include sudden onset of fever and a characteristic petechial or purpuric rash. Other non-specific symptoms may be reported, including myalgia, arthralgia, nausea, vomiting and diarrhoea [38]. Cold extremities and abnormal skin colour (pale or mottled) are often observed in children and adolescents.

More severe infection leads to shock, disseminated intravascular coagulation (a life-threatening problem with blood clotting and bleeding) and multi-organ failure. Cases with severe meningococcaemia often respond poorly to treatment, with death common within 24 hours of onset.

In infants and young children, meningococcaemia may present with non-specific symptoms, including irritability, reduced feeding, high-pitched crying, grunting or moaning, drowsiness, difficulty waking and convulsions [39].

Other forms of invasive meningococcal disease

Less common manifestations of invasive meningococcal disease include myocarditis (inflammation of heart muscle), pericarditis (inflammation of heart lining) and septic arthritis (joint infection) [40,41]. These often precede or occur concurrently with meningitis and meningococcaemia.

Prognosis

Even with treatment, the case-fatality rate for invasive meningococcal disease is around 5 to 15% internationally [42–44]. Up to 20% of those who survive the infection experience long term sequelae such as hearing loss, vision impairment, seizures, learning disabilities, skin loss/scarring and limb or digit amputation [10,30].

Other infections caused by Neisseria meningitidis

• Primary meningococcal conjunctivitis

For more information and required actions on primary meningococcal conjunctivitis refer to the Primary meningococcal conjunctivitis section.

• Urogenital and anorectal infections

N. meningitidis can also cause infection of urogenital and anorectal sites, primarily via sexual transmission, which may be asymptomatic or present with symptoms and signs indistinguishable from Neisseria gonorrhoeae infection.

The risk of progression to invasive meningococcal disease in someone with urogenital or anorectal infection or in their sexual contacts is currently not known. Between 2023 and 2024, an outbreak of urogenital N. meningitidis serogroup Y was reported in Australia with a common sequence type (ST-1466), with no known associated cases of invasive meningococcal disease [45]. In 2023 an increase in N. meningitidis serogroup Y of the same sequence type was observed in the USA, disproportionately affecting people living with human immunodeficiency virus (HIV), however whether cases or contacts had preceding urogenital or anorectal infection is unknown [46].

Urogenital and anorectal infection with N. meningitidis is not notifiable in Aotearoa New Zealand and no public health action is required in response to a person with this infection.

Since 2024, PHF Science has conducted passive laboratory surveillance for urogenital infection with N. meningitidis; these infections are infrequently detected in Aotearoa New Zealand. Isolates are sent to PHF Science for characterisation, and a variety of groups and sequence types have been detected to date. The evidence regarding urogenital and anorectal infection with N. meningitidis and risk of progression to invasive disease is under regular review.

• Non-bacteraemic pneumonia

Isolation of N. meningitidis from sputum, nasopharynx, or bronchoalveolar lavage is not by itself an indication for public health action as asymptomatic carriage is common. Non-bacteraemic meningococcal pneumonia is not an indication for public health action but may carry a small risk of transmission in healthcare settings, especially to individuals who are immunocompromised [47]. In this situation, a risk assessment should be undertaken.

Humans are the only reservoir of Neisseria meningitidis which normally colonises the mucosa of the upper respiratory tract without causing disease. However, in a small number of people N. meningitidis enters the bloodstream, resulting in systemic (‘invasive’) disease.

Carriage rates have been estimated at between 3 and 25% of the population [48], with the highest rates observed among teenagers and young adults [49,50]. Refer to Occupational risk factors and Other risk factors. Carriage episodes may last for many months and usually result in protective immunity against the specific serogroup, however the extent and duration of that protection can vary substantially.

The incubation period for invasive meningococcal disease is usually 3 to 4 days, ranging from 2 to 10 days.

Transmission is from person-to-person through contact with droplets or secretions from the upper respiratory tract of a case or carrier. This can occur through close, prolonged or intimate contact (e.g. kissing, coughing, or sneezing).

Low-level salivary contact (e.g. sharing food, drinks or cigarettes/vapes) is not considered a significant means of transmission [39,51].

Transmission from a symptomatic case is uncommon. In most cases, transmission occurs as a result of prolonged contact with an asymptomatic carrier.

For more information on primary meningococcal conjunctivitis refer to the Primary meningococcal conjunctivitis section.

Cases are considered infectious while N. meningitidis is present in secretions from the nose and throat. Completing 24 hours of appropriate antibiotic therapy (e.g. ciprofloxacin, rifampicin, or ceftriaxone) is usually sufficient to eradicate N. meningitidis from the nasopharynx of the case.

For the purposes of contact tracing, cases are considered infectious from 7 days prior to the onset of symptoms until they have received 24 hours of appropriate antibiotic treatment.

Community

It is unlikely that whānau or other individuals will be involved in providing care for a case in the community because almost all cases would require treatment in hospital. However, if required the whānau/caregivers should wear a medical mask when providing care until 24 hours after the case started appropriate antibiotic treatment. Any attending healthcare workers including first responders should follow the infection prevention and control precautions as described for healthcare settings below.

Hand hygiene and standard cleaning practices should also occur.

For more information, refer to Appendix 6: Infection, prevention and control guidance and Infection prevention and control – Health New Zealand | Te Whatu Ora.

Healthcare settings

Suspected, probable and confirmed cases of invasive meningococcal disease should be promptly isolated and placed in a single room. Staff should follow standard and droplet precautions due to the risk of transmission via respiratory secretions. Until 24 hours after the start of appropriate antibiotic treatment:

• droplet precautions should be used
• ensure all staff who enter the room wear a medical mask
• eye protection should be worn for close care, especially if a case is coughing, or when undertaking airway management or resuscitation
• if aerosol-generating procedures are required (such as intubation or airway management) respiratory precautions are recommended with the use of a N95/P2 mask.

For contact management in healthcare settings refer to Healthcare setting contacts.

Hand hygiene and standard cleaning practices should also occur.

For more information refer to Infection prevention and control – Health New Zealand | Te Whatu Ora

Post-mortem settings

Anyone handling the body should follow standard precautions with additional droplet and contact precautions if the case was not treated with effective antibiotics for 24 hours prior to death.

Direct contact with the body is not generally considered a risk; however, contact with bodily secretions and mucous membranes should be avoided. Body bags are not necessary, and transport to other countries for burial or cremation does not pose a risk. There is no restriction on embalming or whānau taking the body home in an open casket.

Vaccination is the most effective method for preventing invasive meningococcal disease. Routine prevention primarily aims to protect individuals at higher risk through funded vaccination programmes. For detailed information on meningococcal vaccination, including information on eligibility, efficacy and contraindications to vaccination, refer to the Immunisation Handbook – Meningococcal disease and National Immunisation Schedule.

In Aotearoa New Zealand there are 2 funded vaccines, the MenACWY and MenB vaccine.

The MenB vaccine (Bexsero), is funded for the following groups.

• Infants and children aged under 5 years as a part of the National Immunisation Schedule and Immunisation Handbook - recommended immunisation schedule (since 1 March 2023).
• Young people aged 13 to 25 years in their first year in a communal living situation or who are entering a communal living situation within 3 months. 
• Children and adults at high risk of disease due to medical conditions.
• Close contacts of someone with invasive meningococcal disease.
• Individuals who have had previous invasive meningococcal disease of any group, regardless of time since infection provided the person is no longer acutely unwell.

The quadrivalent MenACWY vaccines (MenQuadfi or Nimenrix) are funded for the following groups.

• Young people aged 13 to 25 years in their first year in a communal living situation or who are entering a communal living situation within 3 months.
• Children and adults at high risk of disease due to medical conditions.
• Close contacts of someone with invasive meningococcal disease.
• Individuals who have had previous invasive meningococcal disease of any group, regardless of time since infection provided the person is no longer acutely unwell.

Vaccination is also recommended but not funded for the following groups.

• Laboratory workers who handle high concentrations or large quantities of organisms or are routinely exposed to isolates should be protected with the quadrivalent vaccine.
• Adolescents and young adults living in communal or crowded accommodation not covered by funded vaccine.
• Individuals travelling to high-risk countries.
• All infants, young children, adolescents and young adults not covered by funded vaccine.

For information on infection, prevention and control refer to the Infection prevention and control subsection and Appendix 6: Infection, prevention and control guidance.

Confirmed: A person who has laboratory definitive evidence; OR who meets the clinical criteria AND has laboratory suggestive evidence.

Probable: A person who has a clinically compatible illness that meets the clinical criteria.

Under investigation: A person who has been notified to the medical officer of health, but information is not yet available to classify further.

Not a case: A person who has been investigated and subsequently found not to meet the case definition.

Clinical evidence of meningitis, sepsis, petechial or purpuric rash or other invasive disease (refer to The disease section), AND meningococcal disease is considered the most likely diagnosis by the treating clinician.

There are no epidemiological criteria for invasive meningococcal disease.

Laboratory definitive evidence

Isolation of Neisseria meningitidis from blood, cerebrospinal fluid or other normally sterile sites (refer to the NZMN Position Statement on Microbiological Specimen Sterility (external link)).

OR

Detection of Neisseria meningitidis nucleic acid by polymerase chain reaction from blood, cerebrospinal fluid or other normally sterile sites (refer to the NZMN Position Statement on Microbiological Specimen Sterility (external link)).

Laboratory suggestive evidence

Detection of gram-negative intracellular diplococci by microscopy in blood or cerebrospinal fluid or skin lesions (petechial, purpuric or necrotic).

Refer to Appendix 4: Direct laboratory notification of communicable diseases flowcharts for the direct laboratory notification process for Meningococcal (Neisseria meningitidis) invasive disease.

At the time of clinical presentation, Neisseria meningitidis infections can be difficult to differentiate from other severe bacterial infections. The purpose of testing people with suspected invasive meningococcal disease is to:

• confirm or exclude a diagnosis of invasive meningococcal disease in a suspected case
• provide direction for appropriate antimicrobial treatment.

Public health service staff do not have a role in initiating diagnostic testing for suspected meningococcal infections. People with severe bacterial infections such as invasive meningococcal disease, should be managed in a hospital setting. Diagnostic investigations are the responsibility of the clinical team, with guidance from the clinical microbiologist and/or infectious disease physician as required.

Interpretation of laboratory results is required to determine whether a microbiologically confirmed N. meningitidis infection meets the case definition for invasive meningococcal disease. Refer to Laboratory criteria.

Microscopy

Gram staining by microscopy can be used for the presumptive identification of N. meningitidis when intracellular gram-negative diplococci are observed in cerebrospinal fluid samples, positive blood cultures, or skin lesions.

Polymerase chain reaction (PCR) testing should always be performed if the gram stain morphology is suggestive of N. meningitidis, and bacterial culture fails to grow the organism.

Culture

Bacterial culture has a high specificity for the identification of N. meningitidis. It is also required to conduct:

• N. meningitidis serogrouping
• N. meningitidis antimicrobial susceptibility
• whole genome sequencing.

N. meningitidis grows in culture after 18 to 24 hours of incubation, with final bacterial identification results (+/- antimicrobial susceptibility results) generally available within 48 to 72 hours following sample receipt at the laboratory. Antimicrobial susceptibility testing is performed and reported for N. meningitidis isolates from sterile site samples.

Although antibiotic treatment administration is often clinically necessary and should not be delayed, it can reduce the sensitivity of N. meningitidis detection by culture and preclude antibiotic sensitivity testing.

Neisseria meningitidis polymerase chain reaction (PCR)

PCR testing is useful for the diagnosis of infections caused by N. meningitidis. It involves nucleic acid extraction, PCR amplification and detection of N. meningitidis targets in a clinical sample. The sensitivity of PCR in detecting N. meningitidis is less impacted by prior antibiotic administration.

For samples that test positive for N. meningitidis via PCR testing, the laboratory should attempt to culture for antimicrobial susceptibility testing and refer the culture to the reference laboratory for further genomic characterisation.

N. meningitidis detected by PCR testing, but which fail to grow in culture should be referred to PHF Science for further molecular characterisation.

Genomic or molecular characterisation

Characterisation of N. meningitidis is crucial for surveillance purposes, outbreak investigations and epidemiological studies. Six meningococcal capsular groups (A, B, C, W, X and Y) cause almost all invasive meningococcal infections in humans. The pattern of disease caused by each group varies by time and geographical location.

Attending health practitioners must immediately notify the local medical officer of health as soon as a case of invasive meningococcal disease is suspected. Notification should not await microbiological confirmation. Notifying health practitioners should include any information on accessibility needs that may need to be considered during follow up by public health services (e.g. if the case is Deaf and/or requires a New Zealand Sign Language interpreter).

Laboratories are required to notify the local medical officer of health of any positive Neisseria meningitidis test results via the direct laboratory notification process, refer to Direct laboratory notification process and Appendix 4: Direct laboratory notification of communicable diseases flowcharts.

Public health services should ensure complete case information is entered into the appropriate surveillance database for notifiable diseases (i.e. EpiSurv).

For information on primary meningococcal conjunctivitis refer to the Primary meningococcal conjunctivitis section.

National escalation or informing can be considered in the event of an outbreak of invasive meningococcal disease or a death. The local medical officer of health should first discuss with their regional clinical director (if available) and/or the on-call National Protection Clinical medical officer of health to decide about national escalation.

Refer to Appendix 5: Escalation pathways for more information.

There are no routine international reporting requirements.

If a case was overseas during the incubation period or infectious on a flight, this should be reported through the Ministry of Health’s International Health Regulations National Focal Point using standard International Health Regulation processes (refer to Appendix 5: Escalation pathways for more information).

Immediate recognition and treatment of invasive meningococcal disease is critical. Suspected cases of invasive meningococcal disease are a medical emergency and should be treated promptly without waiting for laboratory confirmation.

Invasive meningococcal disease requires an urgent public health response to prevent transmission and further cases. Public health follow-up should be initiated as soon as possible, ideally within 24 hours of notification, as the risk of secondary cases is highest immediately following the onset of symptoms [52]. Public health follow-up should be undertaken for all confirmed and probable cases, and for suspected cases where the clinical picture is consistent with invasive meningococcal disease.

For information on primary meningococcal conjunctivitis refer to the Primary meningococcal conjunctivitis section.

It is critical that a manaaki-centred approach underpins all response and engagement mechanisms. By embedding best practice and culturally appropriate manaaki approaches that respond to the needs of Māori and Pacific peoples, public health service staff can build and strengthen relationships and trust with cases, their whānau and wider contacts. For more information on this approach refer to the Equity (external link) and Tū Kōkiritia (external link) chapters.

Due to the severity of invasive meningococcal disease, cases are likely to be in hospital being supported by their treating team. When cases who are Māori and Pacific peoples are in hospitals that have Māori and/or Pacific health teams, it is recommended public health service staff suggest to the hospital staff that they make a referral for cultural support to those teams.

This can be a highly distressing time for whānau. When engaging with cases, caregivers and whānau, it is essential to prioritise the following approaches that are both supportive and culturally responsive.

• Balance public health actions with empathy and respect, ensuring that whānau are given space during this challenging time.
• Align engagement of clinical priorities with whānau values and priorities to ensure it is meaningful and appropriate. This may include identifying a trusted whānau member/members or Māori or Pacific healthcare kaimahi to act as a single point of contact with their whānau.
• Acknowledge barriers to immunisation. While meningococcal disease can be vaccine-preventable, the vaccine is not funded universally across age groups. Use this opportunity to explore reasons for non-vaccination, if eligible previously, and address any concerns or barriers to access.
• Ensure access to clear, understandable, culturally appropriate information about meningococcal disease through the use of interpreters and translated information as needed.

For further information on accessing support that is available refer to Appendix 7: Manaaki and Welfare (external link).

Case investigation should focus on the following key steps and interview considerations.

• Confirm the diagnosis (or suspected diagnosis) and that the individual meets the Case definition.
• Obtain a history of illness.
• Identify risk factors for acquiring invasive meningococcal disease.
• Calculate the infectious period.
• Identify close contacts.

A case investigation checklist template (external link) of generic process steps is available for public health service staff to adapt and use as needed.

Once the diagnosis is agreed upon, discuss with the treating team the need to interview the case (or their whānau/caregivers) to obtain a history of illness and to identify close contacts.

Case interviews should occur in person where possible and in line with local processes, ensuring relevant infection prevention and control processes are followed.

The interviewer should confirm the case’s ethnicity (to ensure appropriate cultural support is provided) and discuss any accessibility needs (e.g. translation or interpretation services). If the case ethnicity is Māori and/or Pacific peoples, it is advisable for the case interview to undertaken by Māori or Pacific public health service staff where possible.

Ensure the case (or their whānau/caregivers) is aware of the diagnosis before commencing the interview. Ensure details of your visit and actions taken are documented in the clinical notes for the hospital clinical team to view.

In the event a case is too unwell to provide a history directly or is deceased, the interview should be carried out with their next of kin/whānau/caregivers. If a case is deceased, ensure appropriate cultural support is provided on funeral practices and appropriate timing for the interview (refer to the Deceased cases section).

Confirm the diagnosis and that the individual meets the case definition

Confirm the results of laboratory tests, recommend to the treating clinician that further testing be carried out or ensure appropriate tests have been carried out with results pending. Confirm the case has a clinically compatible illness. If there is any uncertainty around the diagnosis, discuss this with the treating clinician. Refer to the Case definition section for definitions of clinically compatible illness.

Obtain a history of illness

Obtain a history of illness including the date of symptom onset, signs and symptoms of illness, antibiotic treatment to date (including type of antibiotic and date/time administered).

Identify risk factors for acquiring invasive meningococcal disease

Identify any risk factors for acquiring the disease including vaccination status and medical history (including underlying risk factors such as asplenia, complement deficiencies and HIV). Refer to the At risk and priority populations section.

Calculate the infectious period

Cases are considered infectious from 7 days prior to the onset of symptoms until they have received 24 hours of appropriate antibiotic treatment.

Identify close contacts

When identifying close contacts, consider the following.

• Incubation period.
• Mode of transmission.
• Exposure to a confirmed case, including length and type.
• Occupation or workplace.
• Living situation, particularly communal living environments.
• Healthcare setting interactions.
• Attendance at university, school or early childhood education centres.
• Attendance at cultural settings like marae or Pacific churches
• Local and international travel during the incubation period (particularly to endemic countries, refer to Global epidemiology).
• Attendance at festivals, parties, concerts, school camps, etc.

Refer to the Contact management section for close contact definitions.

Most cases of invasive meningococcal disease will require treatment in hospital where they should be promptly isolated and placed in a single room. Standard and droplet precautions are maintained until 24 hours of appropriate antibiotic treatment has been received. Refer to the Infection prevention and control section for more information on precautions required.

Parenteral antibiotics (given by intramuscular or intravenous administration) should be administered as soon as meningococcal disease is suspected, ideally before admission to hospital. Antibiotics given prior to transfer should be clearly noted on information accompanying the suspected case to hospital. For treatment guidance refer to relevant clinical guidelines.

Clearance antibiotics

It is important that the case receives an antibiotic that will eliminate their nasopharyngeal carriage of Neisseria meningitidis. The aim of providing clearance antibiotics is to prevent transmission among the case’s network and to protect close contacts against invasive disease. Some antibiotics, including penicillin, do not reliably clear nasopharyngeal carriage, so appropriate clearance antibiotics should be given to prevent onward transmission.

The recommended antibiotics for clearance are ciprofloxacin, rifampicin and ceftriaxone. Unless one of these has been used during the case’s treatment, it should be given to the case by their treating team, before discharge from hospital. Refer to Table 2 in the Contact management section for dosing and administration for cases (if required) and contacts.

Public health service staff are responsible for confirming, with the case’s treating team, that clearance antibiotics have been given before the case is discharged from hospital.

Vaccination

It is important to note that MenB vaccines do not provide protection against all meningococcal B strains.

All cases (including those who are not New Zealand residents) will be offered funded vaccinations for Group B and Group A, C, W and Y) when they are well enough. The vaccine offered will depend on the age of the case.

• 3 doses of Nimenrix vaccine (covers A, C, W and Y) (aged under 1 year).
• 1 to 3 doses of quadrivalent MenACWY vaccine.
• Up to 3 doses of recombinant MenB vaccine.

Public health service staff are responsible for coordinating the provision of the vaccine. This may be administered directly by public health service staff or by requesting a primary care provider to administer. A letter template for public health service staff to notify primary care of vaccination given or request vaccine administration is available here (external link). 

For advice about cases who have been previously vaccinated and/or may require additional doses contact the Immunisation Advisory Centre (IMAC) (external link).

For information on others eligible for funded vaccination refer to Routine prevention. 

The role of public health service staff involves following up with cases (or their whānau/caregivers) during and/or following hospital treatment to provide further information and commence public health action. Provide all cases (or their whānau/caregivers) with the appropriate case information letter (external link) and meningococcal disease information sheet (external link). These provide information about meningococcal disease, the nature of infection and advice on what actions to take and where to go to get further advice and support.

Public health services should ensure communication is provided in an accessible format and is culturally and language appropriate.

An information sheet and case letters are available here Meningococcal (Neisseria meningitidis) invasive disease (external link) and public facing information is available here Meningococcal disease (external link). The information sheet and case letters will be available in translated and accessible formats in the future. Additional translated resources are available on HealthEd (external link).

Refer to Appendix 7: Manaaki and Welfare for a list of the welfare support (including weblinks) to consider for all cases.

Due to the rapidly progressive nature of invasive meningococcal disease, deaths may occur in hospital or in the community. When managing a deceased case, public health service staff should refer to their local death and bereavement policy (if applicable).

Culturally safe and respectful engagement with the whānau is essential. Public health service staff should be aware of and responsive to cultural expectations and customs around death and mourning and should work in partnership with cultural advisors and advocates where needed.

Public health service staff should do the following.

• Engage Hauora Māori Tūmatanui, Pacific Public Health and/or other cultural advisors as appropriate as soon as practicable using their local protocols.
• Consider taking a koha when visiting the whānau/significant others.
• Maintain a sensitive and empathetic manner when undertaking contact tracing and administration of clearance antibiotics and/or vaccination. Be mindful of tangi processes or other cultural practices that may be in progress.
• Make contact with the whānau to arrange a suitable time to visit (this may be by telephone or face-to-face). Where possible, the visit should be made by 2 staff members, including at least 1 senior staff member and with the involvement of a relevant cultural advisor when appropriate based on a decision made in partnership with whānau. Be aware that in some situations, death may occur shortly before arrival or during a visit. In these situations, maintain a sensitive and empathetic manner, and request support of another staff member or senior colleague.
• Identify what support the whānau has available to them (e.g. relatives, whānau, friends, ministers of religion, church members, professional counsellors, general practitioner, undertaker, kaumātua/kuia, kaitautoko).
• Facilitate referral to the appropriate support services if no support is available and the whānau consents.
• Inform the whānau/significant others that the media may approach them and offer to act as a liaison person for them.
• Engage with the case’s primary care practice and the coroner when appropriate.
• Access the appropriate debriefing and psychological support services available for public health service staff following such events.

The aim of public health action for invasive meningococcal disease is to prevent transmission of an invasive strain, and reduce the risk of further cases, particularly among those at higher risk of disease (refer to At risk and priority populations). This is achieved by eliminating Neisseria meningitidis carriage from the case’s close contacts and providing longer-term protection through vaccination. 

Clearance antibiotics are a key measure for protecting close contacts. They reduce transmission by eliminating asymptomatic nasopharyngeal carriage of N. meningitidis and provide short-term protection to those recently exposed and at risk of developing invasive meningococcal disease. These antibiotics help prevent secondary cases by targeting asymptomatic individuals who may unknowingly spread the infection, and by protecting contacts who have newly acquired the invasive strain from the same source.

Public health follow-up of contacts should be initiated as soon as possible, ideally within 24 hours of notification, as the risk of secondary cases is highest immediately following the onset of symptoms [52].

For information on primary meningococcal conjunctivitis refer to the Primary meningococcal conjunctivitis section.

Manaaki considerations are the same for cases and close contacts. Refer to the Manaakitanga/Manaaki in practice section under case management section for guidance.

For the purposes of contact tracing, a contact is defined as anyone who has had unprotected contact with upper respiratory tract or respiratory droplets from the case during the 7 days before onset of symptoms to 24 hours after onset of effective clearance antibiotics.

Contacts are classified as either ‘close’ or ‘casual (low-risk)’ based on their duration, frequency and degree of contact with the case. Table 1 provides an overview of the contact categories, with further information on each category provided below.

Close contacts are those who have had close, prolonged and/or intimate contact with the case. This group should be offered clearance antibiotics and vaccination, ideally within 24 hours of the case’s diagnosis, to prevent further cases (refer to Clearance antibiotics and Vaccination). They should be advised to watch for symptoms, seek urgent medical attention if they become unwell and inform staff, they are a contact of a case (refer to Advice to contacts).

Casual (low-risk) contacts who do not meet the definition of a close contact (e.g. friends, work colleagues) should, where possible, be provided with information and advised to watch for symptoms and seek medical attention if they become unwell (refer to Advice to contacts). This could be done by providing setting management with the information sheet to share. There is no evidence to support the use of clearance antibiotics in this group [37].

Public health service staff should assess each contact to determine the length and nature of their exposure to the case during the case’s infectious period. This assessment will inform whether the contact is classified as a close or casual (low-risk) contact, which determines the appropriate public health actions. Investigating staff should also identify whether the contact is immunocompromised or has other factors that may place them at higher risk for invasive meningococcal disease, refer to the At risk and priority populations section.

Routine throat or nasopharyngeal swabbing of contacts is not recommended because asymptomatic carriage is common.

If a local cluster or outbreak is identified during the contact investigation, refer to the Outbreaks section.

No quarantine or restrictions are required for contacts.

Clearance antibiotics

Clearance antibiotics are given to close contacts to provide short-term protection against invasive strains. They help to prevent secondary cases by eliminating carriage among asymptomatic contacts who may be the source of infection, thus preventing further transmission. They also provide protection to contacts who have newly acquired the invasive strain (from the same asymptomatic source) and may be at risk of invasive meningococaal disease. This strategy is estimated to reduce the risk of secondary cases among household contacts by up to 84% [64].

Wider use of clearance antibiotics is not recommended as potential harms such as medication side effects, antimicrobial resistance and elimination of protective flora outweigh the potential benefits.

Clearance antibiotics should be given as soon as possible, ideally within 24 hours of the case’s diagnosis, and no later than 14 days.

Antibiotics recommended for Neiserria meningitidis clearance in Aotearoa New Zealand include ciprofloxacin, rifampicin and ceftriaxone (Table 2).

Ciprofloxacin and rifampicin resistant strains are rare in Aotearoa New Zealand but have been reported overseas. Therefore it is recommended that antibiotic sensitivities are checked if the index case was overseas in the 7 days prior to disease.

Public health service staff are responsible for coordinating the provision of clearance antibiotics. The process for this may vary by region, and may be done directly via standing orders or by requesting a primary care provider to administer clearance antibiotics. A letter template for public health service staff to notify primary care of treatment given or request clearance antibiotics provision is available here (external link). 

Provide all close contacts (or their whānau/caregivers) with the appropriate contact information letter (external link) and meningococcal disease information sheet (external link). These provide information about meningococcal disease, the nature of infection, signs and symptoms and advice on what actions to take and where to go to get further advice and support.

The meningococcal disease information sheet (external link) can also be provided to casual (low-risk) contacts and shared with setting management (e.g. school principal) for distribution.

Public health services should ensure communication is provided in an accessible format and is culturally and language appropriate.

An information sheet and contact letters are available here Meningococcal (Neisseria meningitidis) invasive disease (external link) and public facing information is available here Meningococcal disease (external link). The information sheet and case letters will be available in translated and accessible formats in the future. Additional translated resources are available on HealthEd (external link).

It is important the close contact understand they:

• should take the antibiotic medication, as prescribed
• should watch out for symptoms even if they have taken clearance antibiotics and have previously been vaccinated and seek urgent medical advice if they do develop symptoms
• do not need to isolate (stay at home)
• should get vaccinated if not vaccinated, or revaccinated, according to the National Immunisation Schedule.

Refer to Appendix 7: Manaaki and Welfare for a list of the welfare support (including weblinks) to consider for all contacts.

An exposure event refers to settings attended by the case where transmission of Neisseria meningitidis may have occurred. In the case of invasive meningococcal disease, settings may include the household or household-like setting, healthcare settings, and early childhood education settings. Refer to Contact management for guidance on identification of close contacts in these settings.

As the risk of secondary cases is highest immediately following the onset of symptoms [52], contact identification in these settings should commence immediately following notification of a confirmed or probable case, and suspected cases where the clinical picture is consistent with invasive meningococcal disease.

In some settings there may be large numbers of casual (low-risk) contacts who may or may not be individually identified. Depending on the situation and community needs, further information may need to be disseminated or communicated. The meningococcal disease information sheet (external link) can be shared with setting management (e.g. school principal) for distribution, refer to Advice to contacts.

If the exposure setting is a healthcare facility such as a hospital, infection prevention and control and occupational health teams will often undertake the risk assessment and management of healthcare close contacts, though this can vary by region. In these situations, the public health service should liaise with these teams to review progress of contact tracing and management or if close contacts have been discharged to the community. Refer to the Infection prevention and control section for further information.

When large groups of people have been exposed to a case, it is likely that contacts will have returned to different parts of Aotearoa New Zealand. In this instance, handover of any contacts to the contact’s local public health service may be required. Any close contact follow-up needs to be coordinated by the appropriate public health service to ensure consistent advice and treatment are provided.

An outbreak of invasive meningococcal disease is classified as 2 or more cases that are epidemiologically linked. These would be reported as an outbreak in the appropriate surveillance database for notifiable diseases (i.e. EpiSurv) for surveillance purposes.

For an organisational or community outbreak, the following definitions and thresholds should be considered as guidance to determine possible control measures, with each outbreak assessed on its specific circumstances. Public health service staff can contact PHF Science or the NPHS Protection Clinical team if further guidance is needed to classify an outbreak.

Organisational outbreak

Where 2 or more cases of the same strain (group and PorA type) occur within a 4-week period among people who have a common organisation-based affiliation (such as attending the same high school, extended families and/or social groups) but no close contact with each other.

Community outbreak

Where 3 or more confirmed cases of the same strain (group and PorA type) occur within a 3-month period and an age-specific incidence or specific community population incidence of approximately 10 per 100,000 (this is not an absolute threshold), where there is no other obvious link between the cases. The numerator is defined by the number of unlinked cases (that is, they are not close contacts of each other and do not share a common affiliation). The denominator is defined as the population at risk that makes best sense in terms of population residence and movement, and therefore transmission of Neisseria meningitidis. Consideration should be given to restricting the definition of population at risk to the specific age groups where the age-specific incidence is high.

Suggested approaches for defining the population at risk are described in the Outbreak control section.

Identification of local clusters and outbreaks of invasive meningococcal disease is the responsibility of the public health service. Any suspected outbreak must be entered into the appropriate surveillance database for notifiable disease (i.e. EpiSurv).

PHF Science review meningococcal group and PorA typing results every week. If there are 3 or more cases of the same group and PorA type reported within 13 weeks from one district, PHF Science liaise with the relevant public health service and the NPHS Protection Clinical team to assess if the population incidence threshold is met for a community outbreak.

Escalation to a national level should occur as described in the Notification and reporting section.

Management of local outbreaks

Individual cases and outbreaks will be managed by the local public health service with support from regional and/or national teams as required.

The aim of public health action in an invasive meningococcal disease outbreak is to prevent transmission by eradicating nasopharyngeal carriage of the strain from a population at high risk.

Suggested approaches for defining the population at risk are as follows.

• If the outbreak has occurred in an early childhood setting, the population at risk should include all children and staff in the centre unless there are clearly separated subgroups within the centre and children in each subgroup do not mix.
• In larger organisations, limit the definition of the population at risk to the smallest subgroup that includes the cases. Cases are linked by a common affiliation; therefore, the population at risk is usually the group of persons who best represent that affiliation (e.g. if 2 cases attend the same university but have a common affiliation to a particular hall of residence, it would be appropriate to define the population at risk as the hall of residence).
• In early childhood settings and primary schools, the population at risk should normally include staff (e.g. teachers and teacher aides). In educational institutions other than early childhood settings and primary schools, the population at risk should not normally include staff unless one or more cases were staff members.

• Identification of source

Check for other notified cases in the district. Screening by throat and nasopharyngeal swabbing of individuals should not be performed as asymptomatic carriage is common.

• Clearance antibiotics

The purpose of clearance antibiotics is to provide short-term clearance of N. meningitidis carriage. While clearance antibiotics are effective at eliminating N. meningitidis from the nasopharynx, recolonisation is likely to occur in the following weeks or months.

Organisational outbreak: clearance antibiotics should be provided following the same approach used for the management of close contacts of sporadic cases, with the following additional requirements.

• Given on the same day where possible.
• Given to children aged under 16 years only with written parental/caregiver consent, unless parent present.

Community outbreak: clearance antibiotics are not indicated in the management of community outbreaks other than for close contacts.

For organisational and community outbreak definitions refer to Outbreak definition.

• Vaccination

The purpose of vaccination is to provide longer-term protection against invasive meningococcal disease. Conjugate vaccines (MenACWY) also provide protection against N. meningitidis carriage whereas MenB vaccines are protein-based or recombinant vaccines and do not provide protection against N. meningitidis nasopharyngeal carriage.

Organisational outbreak: provide mass vaccination to the population at risk following the same approach used for close contacts of sporadic cases.

Community outbreak: in some situations (e.g. a high number of cases in an at risk and priority population, high mortality rate) mass vaccination of the population at risk (which may be restricted to specific age groups) may be indicated. Vaccination should be provided following the same approach used for close contacts of sporadic cases, with an additional requirement being the decision to implement mass vaccination to control a community outbreak should only be taken after careful consultation with relevant stakeholders.

For organisational and community outbreak definitions refer to Outbreak definition.

• National support and coordination

Support from national teams is always available. Requests for support with response activities should occur early in a response, before local and regional capacity is exceeded. Refer to Appendix 5: Escalation Pathways.

An invasive meningococcal disease response must be nationally coordinated when cases, contacts, exposure events or outbreaks cross regional boundaries. National coordination will be activated following a discussion (usually an Initial Assessment Team meeting) between local and national teams (refer to Nationally Coordinated Response Plan for Outbreaks of Communicable Disease (external link)).

Determining when an outbreak is over

Outbreak status can be reassessed in the following circumstances.

• Organisational outbreak: may be considered over if no further outbreak-associated cases have occurred for 12 months.
• Community outbreak: may be considered over if incidence has returned to expected levels 12 months after the last outbreak-associated case.

These timeframes provide a reference point but should not restrict the ability to reassess more frequently or to continue public health interventions if warranted.

The final decision to determine an outbreak is over should be made by local and national medical officers of health, based on epidemiological evidence, ongoing risks and the broader public health context.

Meningococcal transmission can occur through asymptomatic carriers, with outbreak-associated cases sometimes reported months after the last known case. Therefore, unlike other pathogens, invasive meningococcal disease outbreaks cannot be declared over once 2 incubation periods have passed without a case [66].

For more information

Refer to the following documents for more information.

• The Nationally Coordinated Response Plan for Outbreaks of Communicable Disease (external link) for guidance on a nationally coordinated response.
• The Guidelines for the investigation and control of disease outbreaks (external link) for a comprehensive guide on outbreak investigation and management.

Primary meningococcal conjunctivitis is a rare cause of bacterial conjunctivitis. International evidence indicates that between 10 to 29% of primary meningococcal conjunctivitis cases may develop invasive disease [67].

Cases typically experience acute or hyperacute conjunctivitis that is painful, purulent, and often only affecting one eye. Clinical presentation is similar to gonococcal conjunctivitis. They may also develop complications such as keratitis (corneal inflammation), corneal ulcers, and anterior uveitis (inflammation of the inner eye) [67].

For more general information on meningococcal disease refer to The disease section in the main chapter.

Primary meningococcal conjunctivitis occurs after inoculation of Neisseria meningitidis into the conjunctival sac either through direct contact or airborne exposure [67]. Neonatal meningococcal conjunctivitis is thought to be due to contact with the N. meningitidis in the mother’s genitourinary tract [68].

For more general information on meningococcal disease refer to Spread of infection section in the main chapter.

Although not meeting the definition of a case of invasive meningococcal disease, primary meningococcal conjunctivitis is considered an indication for public health action because of the high immediate risk of developing invasive disease [67].

For further information on case definitions, refer to the Case definition section in the main chapter.

Isolation of N. meningitidis from the eye or conjunctival sac triggers a direct laboratory notification to the medical officer of health. Refer to Direct laboratory notification process and Appendix 4: Direct laboratory notification of communicable diseases flowcharts

Although primary meningococcal conjunctivitis is not notifiable, public health services will be notified through the Direct laboratory notification process. Public health service staff should enter information into the appropriate surveillance database for notifiable diseases (i.e. EpiSurv).

Case information should be entered as a case event with the status under investigation while public health actions are undertaken and recorded. When the case event is closed that status should be not a case.

For further information on notification and reporting, refer to the Notification and reporting section in the main chapter.

Primary meningococcal conjunctivitis cases should be discussed with secondary care (e.g. Infectious Diseases or General Medicine) by the responsible clinician. Each case should be reviewed to:

• investigate potential invasive meningococcal disease (e.g. blood culture)
• initiate prompt treatment with systemic antibiotics (refer to Clearance antibiotics section)
• arrange vaccination to reduce the risk of invasive disease [69,70].

Primary meningococcal conjunctivitis cases (including suspected cases awaiting test results) should be excluded from early childhood education centres, school, work, or other community gatherings, until they have completed 24 hours of antibiotics as indicated for meningococcal clearance (Table 2). 

Given primary meningococcal conjunctivitis is not notifiable, the short timing required for exclusion, and safeguards in place (such as infectious disease guidelines for early childhood education centres), there is unlikely to be a requirement to use the Health Act 1956 to issue any directions in this situation.

The treating clinician and/or public health service staff should discuss with the case any potential reasons which may impact their ability to follow the recommended restrictions and provide information on support available (refer to Appendix 7: Manaaki and Welfare for nationally available support).

For further infection, prevention and control guidance, refer to the Infection prevention and control section in the main chapter.

It is possible for cases of primary meningococcal conjunctivitis to transmit the disease to close contacts. Although the risk of transmission has not been quantified, a small number of occurrences have been reported in the literature and therefore a precautionary approach is warranted [69,70].

Close contacts of cases of primary meningococcal conjunctivitis should therefore be managed the same as close contacts of invasive meningococcal disease and offered clearance antibiotics and vaccination. Refer to the guidance in the Contact management section.

1. Shen S, Findlow J, Peyrani P. Global Epidemiology of Meningococcal Disease-Causing Serogroups Before and After the COVID-19 Pandemic: A Narrative Review. Infect Dis Ther [Internet]. 2024 Dec 1 [cited 2025 Oct 10];13(12):2489–507. Available from: https://link.springer.com/article/10.1007/s40121-024-01063-5 (external link)
2. Jafri RZ, Ali A, Messonnier NE, Tevi-Benissan C, Durrheim D, Eskola J, et al. Global epidemiology of invasive meningococcal disease. Popul Health Metr [Internet]. 2013 Sep 10 [cited 2025 Oct 10];11(1). Available from: https://pubmed.ncbi.nlm.nih.gov/24016339/ (external link)
3. Tin Tin Htar M, Findlow J, Balmer P, Swerdlow D. Global epidemiology of serogroup Y invasive meningococcal disease: a literature review. Epidemiol Infect [Internet]. 2024 Dec 5 [cited 2025 Oct 10];152:e157. Available from: https://www.cambridge.org/core/journals/epidemiology-and-infection/article/global-epidemiology-of-serogroup-y-invasive-meningococcal-disease-a-literature-review/E60E706731557F0B557DA80999A68018 (external link)
4. Centers for Disease Control and Prevention (CDC). Meningococcal Disease in Other Countries [Internet]. 2024 [cited 2025 Oct 10]. Available from: https://www.cdc.gov/meningococcal/php/global/index.html (external link)
5. Pardo De Santayana C, Tin Tin Htar M, Findlow J, Balmer P. Epidemiology of invasive meningococcal disease worldwide from 2010–2019: a literature review. Epidemiol Infect [Internet]. 2023 Mar 6 [cited 2025 Oct 10];151:e57. Available from: https://www.cambridge.org/core/journals/epidemiology-and-infection/article/epidemiology-of-invasive-meningococcal-disease-worldwide-from-20102019-a-literature-review/4E7075C191423B51678ACFBC92049939 (external link)
6. Vachon MS, Barret AS, Lucidarme J, Neatherlin J, Rubis AB, Howie RL, et al. Cases of Meningococcal Disease Associated with Travel to Saudi Arabia for Umrah Pilgrimage — United States, United Kingdom, and France, 2024. MMWR Morb Mortal Wkly Rep [Internet]. 2024 Jun 6 [cited 2025 Oct 10];73(22):514–6. Available from: https://www.cdc.gov/mmwr/volumes/73/wr/mm7322e1.htm (external link)
7. Badur S, Khalaf M, Öztürk S, Al-Raddadi R, Amir A, Farahat F, et al. Meningococcal Disease and Immunization Activities in Hajj and Umrah Pilgrimage: a review. Infect Dis Ther [Internet]. 2022 Aug 1 [cited 2025 Oct 10];11(4):1343–69. Available from: https://link.springer.com/article/10.1007/s40121-022-00620-0 (external link)
8. World Health Organization. Invasive meningococcal disease - Kingdom of Saudi Arabia [Internet]. 2025 [cited 2025 Oct 10]. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON563 (external link)
9. Coudeville L, Amiche A, Rahman A, Arino J, Tang B, Jollivet O, et al. Disease transmission and mass gatherings: a case study on meningococcal infection during Hajj. BMC Infect Dis [Internet]. 2022 Dec 1 [cited 2025 Oct 10];22(1):1–10. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07234-4 (external link)
10. Burton C, Best E, Broom M, Heffernan H, Briggs S, Webb R, et al. Pediatric Invasive Meningococcal Disease, Auckland, New Zealand (Aotearoa), 2004–2020. Emerg Infect Dis [Internet]. 2023 Apr 1 [cited 2025 Oct 10];29(4):686–95. Available from: https://wwwnc.cdc.gov/eid/article/29/4/22-1397_article (external link)
11. Kvalsvig A, Wilson N, Jackson C, Timu-Parata C, Rentta N (Nelly), Baker M. Are we ready to eliminate invasive meningococcal disease in Aotearoa New Zealand? [Internet]. 2023 Aug [cited 2025 Oct 10]. Available from: https://www.phcc.org.nz/briefing/are-we-ready-eliminate-invasive-meningococcal-disease-aotearoa-new-zealand (external link)
12. New Zealand Institute for Public Health and Forensic Science (PHF Science). Meningococcal disease dashboard [Internet]. 2025 [cited 2025 Oct 10]. Available from: https://www.phfscience.nz/digital-library/meningococcal-disease-dashboard/ (external link)
13. Institute of Environmental Science and Research (ESR). Meningococcal disease quarterly report 2019 Q4 [Internet]. 2019 Dec [cited 2025 Oct 10]. Available from: https://www.phfscience.nz/digital-library/meningococcal-disease-quarterly-report-2019-q4/ (external link)
14. George CR, Booy R, Nissen MD, Lahra MM. The decline of invasive meningococcal disease and influenza in the time of COVID-19: the silver linings of the pandemic playbook. Med J Aust [Internet]. 2022 Jun 6 [cited 2025 Oct 10];216(10):504–7. Available from: https://pubmed.ncbi.nlm.nih.gov/35340025/ (external link)
15. Immunisation Advisory Centre. Meningococcal disease [Internet]. 2024 [cited 2025 Oct 10]. Available from: https://www.immune.org.nz/diseases/meningococcal-disease (external link)
16. O’Brien M. Carriage of Neisseria meningitidis and meningococcal vaccine hesitancy among students residing in residential colleges in Dunedin, New Zealand [Internet]. University of Otago; 2022 [cited 2025 Oct 10]. Available from: https://digitalnz.org/records/49828225 (external link)
17. Mills C. Invasive meningococcal disease in Northland, New Zealand - The New Zealand Medical Journal. New Zealand Medical Journal [Internet]. 2011 Dec 16 [cited 2025 Oct 10];124(1347):95–7. Available from: https://nzmj.org.nz/journal/vol-124-no-1347/invasive-meningococcal-disease-in-northland-new-zealand (external link)
18. Institute of Environmental Science and Research (ESR). Meningococcal disease report Jan-Dec 2023 [Internet]. 2023 Dec [cited 2025 Oct 10]. Available from: https://www.phfscience.nz/digital-library/meningococcal-disease-report-jan-dec-2023/ (external link)
19. Institute of Environmental Science and Research (ESR). Meningococcal disease monthly report December 2024 [Internet]. 2025 Feb [cited 2025 Oct 10]. Available from: https://www.phfscience.nz/digital-library/meningococcal-disease-monthly-report-december-2024/ (external link)
20. Institute of Environmental Science and Research (ESR). Meningococcal disease monthly report November 2024 [Internet]. 2024 Dec [cited 2025 Oct 10]. Available from: https://www.phfscience.nz/digital-library/meningococcal-disease-monthly-report-november-2024/ (external link)
21. National Institute for Health and Care Excellence (NICE). Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. 2024 Mar;
22. Sejvar JJ, Johnson D, Popovic T, Miller JM, Downes F, Somsel P, et al. Assessing the risk of laboratory-acquired meningococcal disease. J Clin Microbiol [Internet]. 2005 Sep [cited 2025 Oct 10];43(9):4811–4. Available from: https://pubmed.ncbi.nlm.nih.gov/16145146/ (external link)
23. Riccò M, Vezzosi L, Odone A, Signorelli C. Invasive Meningococcal Disease on the Workplaces: a systematic review. Acta Biomed [Internet]. 2017 [cited 2025 Oct 10];88(3):337–51. Available from: https://pubmed.ncbi.nlm.nih.gov/29083344/ (external link)
24. Bruce MG, Rosenstein NE, Capparella JM, Shutt KA, Perkins BA, Collins MJ. Risk factors for meningococcal disease in college students. JAMA [Internet]. 2001 Aug 8 [cited 2025 Oct 10];286(6):688–93. Available from: https://pubmed.ncbi.nlm.nih.gov/11495618/ (external link)
25. Weil LM, Crowe SJ, Rubis AB, Soeters HM, Meyer SA, Hariri S, et al. Risk Factors for Serogroup B Meningococcal Disease Among College Students. Open Forum Infect Dis [Internet]. 2023 Dec 1 [cited 2025 Oct 10];10(12). Available from: https://pubmed.ncbi.nlm.nih.gov/38149105/ (external link)
26. Harrison LH, Dwyer DM, Maples CT, Billmann L. Risk of meningococcal infection in college students. JAMA [Internet]. 1999 May 26 [cited 2025 Oct 10];281(20):1906–10. Available from: https://pubmed.ncbi.nlm.nih.gov/10349894/ (external link)
27. Cartwright KAV, Stuart JM, Robinson PM. Meningococcal carriage in close contacts of cases. Epidemiol Infect [Internet]. 1991 [cited 2025 Oct 10];106(1):133–41. Available from: https://www.cambridge.org/core/journals/epidemiology-and-infection/article/meningococcal-carriage-in-close-contacts-of-cases/97146406AA91AB401CA1F8A03B53749D (external link)
28. Kristiansen BE, Tveten Y, Jenkins A. Which contacts of patients with meningococcal disease carry the pathogenic strain of Neisseria meningitidis? A population based study. BMJ [Internet]. 1998 Sep 5 [cited 2025 Oct 10];317(7159):621–5. Available from: https://pubmed.ncbi.nlm.nih.gov/9727987/ (external link)
29. Tully J, Viner RM, Coen PG, Stuart JM, Zambon M, Peckham C, et al. Risk and protective factors for meningococcal disease in adolescents: matched cohort study. BMJ [Internet]. 2006 Feb 23 [cited 2025 Oct 17];332(7539):445–50. Available from: https://www.bmj.com/content/332/7539/445 (external link)
30. Heymann DL. Control of Communicable Diseases Manual. 19th ed. Heymann DL, editor. Washington: American Public Health Association; 2008.
31. Trotter CL, Gay NJ, Edmunds WJ. The natural history of meningococcal carriage and disease. Epidemiol Infect [Internet]. 2006 Jun [cited 2025 Oct 10];134(3):556–66. Available from: https://pubmed.ncbi.nlm.nih.gov/16238823/ (external link)
32. Goldschneider I, Gotschlich EC, Artenstein MS. Human immunity to the meningococcus. II. Development of natural immunity. J Exp Med [Internet]. 1969 [cited 2025 Oct 10];129(6):1327–48. Available from: https://pubmed.ncbi.nlm.nih.gov/4977281/ (external link)
33. Centers for Disease Control and Prevention. Meningococcal Disease. In: Hall E, Wodi A, Hamborsky J, Morelli V, Schillie S, editors. Pink Book: Epidemiology and Prevention of Vaccine-Preventable Diseases [Internet]. 14th ed. Washington: Public Health Foundation; 2024 [cited 2025 Oct 10]. Available from: https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-14-meningococcal-disease.html (external link)
34. Le Saux N. Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age. Paediatr Child Health [Internet]. 2014 [cited 2025 Oct 10];19(3):141–6. Available from: https://pubmed.ncbi.nlm.nih.gov/24665226/ (external link)
35. Martinón-Torres F. Deciphering the Burden of Meningococcal Disease: Conventional and Under-recognized Elements. Journal of Adolescent Health [Internet]. 2016 Aug 1 [cited 2025 Oct 10];59(2):S12–20. Available from: https://pubmed.ncbi.nlm.nih.gov/27449145/ (external link)
36. Rubis A, Schillie S. Meningococcal Disease. In: Manual for the Surveillance of Vaccine-Preventable Diseases [Internet]. 2024 [cited 2025 Oct 10]. Available from: https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-8-meningococcal-disease.html (external link)
37. Kimberlin DW. Meningococcal Infections. In: Kimberlin DW, Brady M, Jackson M, Long S, editors. Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases. 31st ed. Elk Grove Village: American Academy of Pediatrics; 2021. p. 519–32.
38. Isaacs D. Controversies in SIGN guidance on management of invasive meningococcal disease in children and young people. BMJ [Internet]. 2008 Jun 14 [cited 2025 Oct 10];336(7657):1370–1. Available from: https://pubmed.ncbi.nlm.nih.gov/18556319/ (external link)
39. Department of Health Victoria. Meningococcal disease [Internet]. 2025 [cited 2025 Oct 10]. Available from: https://www.health.vic.gov.au/infectious-diseases/meningococcal-disease (external link)
40. Taha S, Deghmane AE, Taha MK. Recent increase in atypical presentations of invasive meningococcal disease in France. BMC Infect Dis [Internet]. 2024 Dec 1 [cited 2025 Oct 10];24(1). Available from: https://pubmed.ncbi.nlm.nih.gov/38926823/ (external link)
41. Campbell H, Parikh SR, Borrow R, Kaczmarski E, Ramsay ME, Ladhani SN. Presentation with gastrointestinal symptoms and high case fatality associated with group W meningococcal disease (MenW) in teenagers, England, July 2015 to January 2016. Eurosurveillance [Internet]. 2016 Mar 24 [cited 2025 Oct 10];21(12):30175. Available from: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2016.21.12.30175 (external link)
42. Heckenberg SGB, De Gans J, Brouwer MC, Weisfelt M, Piet JR, Spanjaard L, et al. Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: A prospective cohort study. Medicine [Internet]. 2008 Jul [cited 2026 Jan 16];87(4):185–92. Available from: https://journals.lww.com/md-journal/fulltext/2008/07000/clinical_features,_outcome,_and_meningococcal.1.aspx (external link)
43. Centers for Disease Control and Prevention (CDC). Yellow Book. 2025 [cited 2026 Jan 16]. Meningococcal Disease. Available from: https://www.cdc.gov/yellow-book/hcp/travel-associated-infections-diseases/meningococcal-disease.html (external link)
44. World Health Organization. Vaccine-preventable diseases and vaccines. In: International Travel and Health (Updates 2019) [Internet]. Poumerol G, Wilder-Smith A, editors. Geneva: World Health Organization; 2012 [cited 2026 Jan 16]. p. 80–143. Available from: https://www.who.int/publications/m/item/international-travel-and-health-chapter-6---vaccine-preventable-diseases-and-vaccines (external link)
45. Lahra MM, Latham NH, Templeton DJ, Read P, Carmody C, Ryder N, et al. Investigation and response to an outbreak of Neisseria meningitidis serogroup Y ST-1466 urogenital infections, Australia. Commun Dis Intell (2018) [Internet]. 2024 Apr 10 [cited 2025 Oct 10];48. Available from: https://pubmed.ncbi.nlm.nih.gov/38594793/ (external link)
46. Centers for Disease Control and Prevention (CDC). CDC Health Alert Network. 2024 [cited 2025 Oct 10]. Increase in Invasive Serogroup Y Meningococcal Disease in the United States. Available from: https://www.cdc.gov/han/2024/han00505.html (external link)
47. UK Health Security Agency. Guidance for public health management of meningococcal disease in the UK [Internet]. 2025 [cited 2026 Jan 16]. Available from: https://assets.publishing.service.gov.uk/media/694a83a9033693d5d50eb8f7/Meningo-disease-guidelines-2025.pdf (external link)
48. Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: A systematic review and meta-analysis. Lancet Infect Dis [Internet]. 2010 Dec [cited 2025 Oct 10];10(12):853–61. Available from: https://pubmed.ncbi.nlm.nih.gov/21075057/ (external link)
49. Caugant DA, Maiden MCJ. Meningococcal carriage and disease-Population biology and evolution. Vaccine [Internet]. 2009 Jun 24 [cited 2025 Oct 10];27(SUPPL. 2). Available from: https://pubmed.ncbi.nlm.nih.gov/19464092/ (external link)
50. Baker M, McNicholas A, Garrett N, Jones N, Stewart J, Koberstein V, et al. Household crowding a major risk factor for epidemic meningococcal disease in Auckland children. Pediatr Infect Dis J [Internet]. 2000 [cited 2025 Oct 10];19(10):983–90. Available from: https://pubmed.ncbi.nlm.nih.gov/11055601/ (external link)
51. Orr HJ, Gray SJ, Macdonald M, Stuart JM. Saliva and Meningococcal Transmission. Emerg Infect Dis [Internet]. 2003 Oct [cited 2025 Oct 10];9(10):1314. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3033078/ (external link)
52. De Wals P, Hertoghe L, Borlée-Grimée I, De Maeyer-Cleempoel S, Reginster-Haneuse G, Dachy A, et al. Meningococcal disease in Belgium: Secondary attack rate among household, day-care nursery and pre-elementary school contacts. Journal of Infection [Internet]. 1981 [cited 2025 Oct 10];3(1 Suppl):53–61. Available from: https://pubmed.ncbi.nlm.nih.gov/7185953/ (external link)
53. Centers for Disease Control and Prevention (CDC). Occupational Transmission of Neisseria meningitidis-California, 2009. MMWR Morb Mortal Wkly Rep [Internet]. 2010 Nov 19 [cited 2025 Oct 10];59(45):1480–3. Available from: https://www.researchgate.net/publication/278282212_Occupational_Transmission_of_Neisseria_meningitidis-California_2009_Reprinted_from_MMWR_vol_59_pg_1480-1483_2010 (external link)
54. Gilmore A, Stuart J, Andrews N. Risk of secondary meningococcal disease in health-care workers. Lancet [Internet]. 2000 Nov 11 [cited 2025 Oct 10];356(9242):1654–5. Available from: https://pubmed.ncbi.nlm.nih.gov/11089828/ (external link)
55. European Center for Disease Prevention and Control (ECDC). Public health management of sporadic cases of invasive meningococcal disease and their contacts. 2010 Oct [cited 2025 Oct 10]; Available from: www.ecdc.europa.eu (external link)
56. Davison KL, Andrews N, White JM, Ramsay ME, Crowcroft NS, Rushdy AA, et al. Clusters of meningococcal disease in school and preschool settings in England and Wales: what is the risk? Arch Dis Child [Internet]. 2004 Mar [cited 2025 Oct 10];89(3):256–60. Available from: https://pubmed.ncbi.nlm.nih.gov/14977705/ (external link)
57. Murray RL, Britton J, Leonardi-Bee J. Second-hand smoke exposure and the risk of invasive meningococcal disease in children: systematic review and meta-analysis. BMC Public Health [Internet]. 2012 [cited 2025 Oct 10];12(1). Available from: https://pubmed.ncbi.nlm.nih.gov/23228219/ (external link)
58. Lee CC, Middaugh NA, Howie SRC, Ezzati M. Association of secondhand smoke exposure with pediatric invasive bacterial disease and bacterial carriage: a systematic review and meta-analysis. PLoS Med [Internet]. 2010 Dec [cited 2025 Oct 10];7(12). Available from: https://pubmed.ncbi.nlm.nih.gov/21151890/ (external link)
59. Read RC. Neisseria meningitidis and meningococcal disease: recent discoveries and innovations. Curr Opin Infect Dis [Internet]. 2019 Dec 1 [cited 2025 Oct 10];32(6):601–8. Available from: https://pubmed.ncbi.nlm.nih.gov/31567569/ (external link)
60. Menichetti F, Fortunato S, Ricci A, Salani F, Ripoli A, Tascini C, et al. Invasive Meningococcal Disease due to group C N. meningitidis ST11 (cc11): The Tuscany cluster 2015–2016. Vaccine [Internet]. 2018 Sep 25 [cited 2025 Oct 10];36(40):5962–6. Available from: https://pubmed.ncbi.nlm.nih.gov/30172636/ (external link)
61. Finn R, Groves C, Coe M, Pass M, Harrison L. Cluster of serogroup C meningococcal disease associated with attendance at a party - PubMed. South Med J [Internet]. 2001 Dec [cited 2025 Oct 10];94(12):1192–4. Available from: https://pubmed.ncbi.nlm.nih.gov/11811858/ (external link)
62. Weiss D, Stern EJ, Zimmerman C, Bregman B, Yeung A, Das D, et al. Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in Brooklyn, New York. Clinical Infectious Diseases. 2009 Apr 1;48(7):894–901.
63. Krause G, Blackmore C, Wiersma S, Lesneski C, Woods C, Rosenstein N, et al. Marijuana use and social networks in a community outbreak of meningococcal disease - PubMed. South Med J [Internet]. 2001 May [cited 2025 Oct 10];94(5):482–5. Available from: https://pubmed.ncbi.nlm.nih.gov/11372796/ (external link)
64. Telisinghe L. Systematic review of the effect of antibiotics and/or vaccination in preventing subsequent disease among household contacts of cases of meningococcal disease. 2014 May.
65. Hoek MR, Christensen H, Hellenbrand W, Stefanoff P, Howitz M, Stuart JM. Effectiveness of vaccinating household contacts in addition to chemoprophylaxis after a case of meningococcal disease: a systematic review. Epidemiol Infect [Internet]. 2008 [cited 2025 Oct 10];136(11):1441–7. Available from: https://pubmed.ncbi.nlm.nih.gov/18559124/ (external link)
66. Centers for Disease Control and Prevention (CDC). Guidance for the Evaluation and Public Health Management of Suspected Outbreaks of Meningococcal Disease. 2019 Sep 28 [cited 2025 Oct 10]; Available from: https://www.cdc.gov/meningococcal/downloads/meningococcal-outbreak-guidance.pdf (external link)
67. Parikh SR, Campbell H, Mandal S, Ramsay ME, Ladhani SN. Primary meningococcal conjunctivitis: Summary of evidence for the clinical and public health management of cases and close contacts. Journal of Infection [Internet]. 2019 Dec 1 [cited 2025 Oct 10];79(6):490–4. Available from: https://researchportal.ukhsa.gov.uk/en/publications/primary-meningococcal-conjunctivitis-summary-of-evidence-for-the (external link)-
68. Fiorito SM, Galarza PG, Sparo M, Pagano EI, Oviedo CI. An unusual transmission of Neisseria meningitidis: neonatal conjunctivitis acquired at delivery from the mother’s endocervical infection. Sex Transm Dis [Internet]. 2001 [cited 2025 Oct 10];28(1):29–32. Available from: https://pubmed.ncbi.nlm.nih.gov/11196042/ (external link)
69. Bigham J, Hutcheon M, Patrick D, Pollard A. Death from invasive meningococcal disease following close contact with a case of primary meningococcal conjunctivitis--Langley, British Columbia, 1999. Can Commun Dis Rep [Internet]. 2001 Jan 15 [cited 2025 Oct 10];27(2):13–8. Available from: https://pubmed.ncbi.nlm.nih.gov/11227821/ (external link)
70. Stansfield RE, Masterton RG, Dale BAS, Fallon RJ. Primary meningococcal conjunctivitis and the need for prophylaxis in close contacts. J Infect [Internet]. 1994 [cited 2025 Oct 10];29(2):211–4. Available from: https://pubmed.ncbi.nlm.nih.gov/7806886/ (external link)

Health New Zealand: Infection prevention and control – Infection prevention and control information (external link)

Health New Zealand: Immunisation Handbook – Meningococcal disease chapter (external link)

Case and contact management resources (external link) (including letters and information sheet)

We would like to acknowledge the effort, contribution and commitment of all members of the Meningococcal Disease Clinical and Technical Advisory Group who have supported this work. For a list of members refer to Meningococcal CTAG membership (external link).