Q&A: What are the first signs of meningitis? And who’s most at risk?

2026-03-24 - 16:35

Comment: Two cases of meningitis among tertiary students in Dunedin have hit the headlines at the same time as a devastating and perplexing outbreak of meningococcal meningitis in southeast England, where two young people have died from the disease. UK officials believe the English outbreak, which has so far resulted in 34 cases and has required a national public health response, started in a nightclub in Canterbury, where thousands of partying young people were sharing drinks and vapes. As the tertiary and school years get underway in New Zealand, the latest cases are a sobering reminder of the importance of vaccinations for at-risk age groups. What causes meningitis? A large number of different conditions can cause meningitis, which is inflammation of the meninges which line the brain and spinal cord. Severe, potentially life-threatening cases of meningitis are caused by bacteria and in New Zealand, meningococci and pneumococci are the most common causes in older children and adults. Symptoms are similar except a rash is more common with meningococcal disease. Who needs to get immunised? Meningococcal infection is life threatening and in New Zealand it is most commonly caused by two main types – Type B (prevented by one vaccine, Bexsero) or one of Types C, W or Z (prevented by another vaccine, MenQuadfi). The Bexsero vaccine provides some protection against type W as well as B, but to have the most complete protection, both types of vaccine are needed. The highest rates of meningococcal disease occur in children under two, and in adolescents, particularly in shared accommodation. Bexsero is available free of charge on the New Zealand schedule for infants with three doses starting at eight weeks of age, but as B causes most cases in infants, MenQuadfi is only funded for babies and children at higher risk of meningococcal disease. Both vaccines are free of charge for adolescents and young adults starting boarding school or college accommodation. For other age groups not funded in New Zealand, each of these vaccines is available for around $150 a dose – two doses for Bexsero and one for MenQuadfi. They have an excellent safety record and are suitable for use in all age groups if you wish to be protected. How is it transmitted? Through close contact such as kissing or sharing drinks or food, not just being in the same room. It is more common in crowded households and with large numbers of new people, for example a dormitory, military boot camp, or boarding school. How long are immunisations effective? To maintain full protection, a repeat dose is needed every five to 10 years although there is still probably greater protection than if not vaccinated for longer than this. What are the first symptoms to arise? Symptoms are variable but can come on very rapidly in some cases – too rapidly to get effective treatment, resulting in fatalities. So, prevention is definitely better than cure. Common symptoms include a pinpoint rash which can spread rapidly, feeling generally unwell, muscle pains and meningitis symptoms like headache and sore neck. How quickly do you need to act if you suspect meningitis – should you go to your GP, or the hospital emergency department? GPs are fully aware of the need for urgent attention with suspected meningococcal disease and can administer antibiotics immediately if needed. However, if a rash is spreading rapidly or the affected person is becoming drowsy or very unwell then head straight to hospital if this does not result in delay due to transport time. If the GP is significantly closer, then definitely head to the GP. How does NZ fare in terms of our immunisation rates? New Zealand is one of only a few countries where Bexsero is available for all newborns (not in Australia for instance) but like for other infant vaccines we could do better with uptake. For MedQuadfi and similar vaccines, other countries have these available for all adolescents, for example in the UK and Australia, but in neither country is Bexsero available as it is in New Zealand for students. Students are now well aware of this, but surprisingly not all of them take advantage of these being free while still eligible ie in the first year in residential colleges.