Meningitis is a disease which strikes fear into parents. The high mortality rate and the sudden onset of the illness mark it out from other diseases. Added to this is a feeling of helplessness because of the lack of preventative measures they can take.
The launch here tomorrow of a vaccination campaign against one of the strains of meningitis is therefore most welcome. The meningitis C vaccine will initially be targeted at the under-twos and at 15 to 17-yearolds. Public health doctors are hoping to see an immediate reduction in the number of cases of meningitis C following mass vaccination.
The under-twos have the highest incidence of the meningococcal C infection, and the Republic has the highest incidence in Europe of meningitis. Between July 1999 and June 2000, there were 165 cases of meningococcal group C disease in the State.
Experience in the UK suggests that we should see a 75 per cent reduction in meningitis C cases after the first year's immunisation. Given that one in 10 people who contract meningitis C dies from the infection, we can look forward to the vaccine saving lives here.
Bacterial meningitis is caused by a number of organisms, of which the meningococcus is the most virulent. There are several subgroups of meningococci. Group A is the cause of regular large epidemics in sub-Saharan Africa. Group B accounts for approximately 60 per cent of cases in the Republic, with group C meningococcus causing about 40 per cent.
There is no vaccine currently available for meningococcus B, so that the new vaccine should eventually help eradicate about half of the meningococcal disease in the State.
The vaccine will be given to babies at two, four and six months at the same time they receive their primary vaccinations (DPT, oral polio and Hib). There will be no charge for the service by family doctors.
Recent press reports in the UK have raised concerns about the safety of the meningitis C vaccine and parents here may have some concerns as a result. The UK Committee on Safety of Medicines (CSM) and our own Irish Medicines Board (IMB) have refuted any links between childhood deaths and the new vaccine.
Twelve deaths have been reported to the CSM. Seven of these were from Sudden Infant Death Syndrome (SIDS). The CSM has stated that SIDS deaths occur most commonly at exactly the ages when meningitis C vaccine is given to infants: in its view, it is inevitable that some SIDS cases will occur shortly after the vaccine was given.
The most commonly reported reactions to the vaccine include dizziness, headache, nausea, vomiting and fainting. These would be regarded as non-vaccine specific, as would sorenes and redness at the injection site.
Seizures associated with meningococcal immunisation would be a cause for concern, but there have been no reports of convulsions from the vaccine trials conducted on over 25,000 children. However, as the vaccine does not contain live bacteria, it would be surprising if it caused any serious side effects.
Meningitis is predominantly a disease of children and young adults, with most cases occurring in the winter months. The microbes are transmitted by close contact.
Meningococci, however, do not cause meningitis alone. In about 10 per cent of cases, a condition called septicaemia is the result of infection. Septicaemia causes the rash which many associate with meningitis itself. The rash usually first appears pink and pinprick-like, but as the infection increases, a purple rash begins to spread across the skin.
The presence of the rash represents a medical emergency and immediate help should be sought. A useful way to decide whether a child's skin rash is serious or not is to carry out the tumbler test. Take a clear glass and press the base of it on the rash. If the rash blanches and disappears, then it is almost certainly not meningococcal.
The treatment of meningitis involves intravenous penicillin given in high dosage. Doctors are now trained to administer this treatment in all suspected cases of meningococcal disease. Patients who receive the drug before hospital admission have a much better prognosis.
Household contacts of the infected child will be offered oral antibiotics to minimise the risk of meningcoccal spread.
Contact Dr Houston at mhouston@irish-times.ie or leave messages on tel 01- 6707711, ext 8511.