There are distressful problems for which there are now 100 per cent effective solutions. Bacterial meningitis is one such problem, although significant medical progress has rendered the problem much less severe than it once was. Before the advent of antibiotics, the death rate from meningococcal infections was in excess of 75 per cent of all cases. Now that rate is somewhere between five and 15 per cent, depending on where and how the statistics are collected. In Ireland, the rate is at the lower end of that range, but that will be little consolation to those families who have lost relatives to what can still prove a very rapidly fatal disease.
This year, as ever at this time, deaths are occurring as they have throughout history. But there is no reason to believe that there will be any more, or even as many, as there were last year or in any earlier period. On the contrary, given the more widespread alertness among both the general public and the medical profession about the seasonal prevalence of the condition, there is reason to hope that the death toll may decline. But the disease will remain with us until some effective means of prevention is discovered, and no such discovery has yet been made. There is still no vaccine against what is the most prevalent bacterium causing those cases most likely to lead to fatal illness in this part of the world.
The war against the B strain of meningococcus must, therefore, continue to be waged in terms of treatment rather than prevention and the battle, in individual cases, must be fought on the ground of early diagnosis and the administration of the most effective treatment as soon as is humanly possible. This is not always as easy as it may sound, since the earliest symptoms of infection are often indistinguishable from those of influenza or many other less lethal conditions, and those cases which seem to lead to death are often those which develop most rapidly, sometimes causing death from septicaemia (an overwhelming release of bacterial toxins in the blood stream) within 24 hours.
Some slight encouragement may be taken from a communication to The Lancet this week from doctors working with children in Glasgow. This suggests that, in addition to the most vigorous administration of antibiotics, the use of a relatively simple process known as haemo diafiltration which may remove toxins from the blood, can aid recovery. But only four cases have been reported and, even though all survived, three had to undergo amputations of a leg or some toes as a result of the damaging effects of the bacterial toxins. Four such cases do not make much of a scientific point and, clearly, there is still much research to be done to establish whether this filtering of blood has a part to play in the battle.
Meanwhile, small groups at real risk of contracting the illness (those, for instance, in closest proximity to other cases) can be given some protection by the administration of prophylactic antibiotics during the period of greatest risk. For the rest, alertness to the possibility of meningococcal infection by both doctors and patients, particularly if influenza like symptoms are accompanied by severe headache, neck stiffness or increased sensitivity to bright light, may lead to earlier diagnosis and treatment of the disease. And it may be that the expert panel to be appointed by the Minister for Health hopefully with all possible speed will be able to make further recommendations to deal more effectively with this annual and distressful problem.