Meningitis risks and plans to deal with them

By KATHERINE HOBY

Six South Otago students come down with meningitis.

A former Whangarei doctor is found guilty of professional misconduct after failing to diagnose the disease.

A South Auckland school is so concerned about meningitis that it gives students a week off lessons to focus their creative energies on learning about it.

New Zealand is in the grip of meningococcal disease epidemic. That epidemic has cost the country $630 million, of which direct costs to the health sector have been estimated at $300 million.

But how much do we really know about meningococcal disease? What is being done to combat it? What can you do to reduce the risks of contracting it? And when should you really worry?

A report prepared for the Ministry of Health by the Institute of Environmental Science and Research sheds some light on where we stand.

New Zealand is now in the eleventh year of a meningococcal disease epidemic. Last year there were 26 deaths and 650 cases of meningococcal disease recorded, the highest number since the start of the epidemic in 1991.

This year the number of confirmed cases stands at 349, with 11 deaths.

In 2001 no district in this country had a rate of less than 3.8 per 100,000 population. In most countries in the world, rates are less than 3 per 100,000. Australia has a rate of 1 to 2 per 100,000.

It is important to realise the difference between different strains of meningococcal disease. Some doctors report being asked why "little brown babies are dying in South Auckland and kids in the South Island are getting a vaccine".

This statement is incorrect and built on a foundation of misinformation, the Ministry of Health says.

The cases of meningitis in Balclutha were group C meningococcal disease. The students, and classmates and family members have been given antibiotics.

All South Otago High School pupils were offered an overseas vaccine for meningococcal disease last week after the six confirmed cases. The cost of the mass vaccination was about $15,000.

The vaccine gives about 95 per cent protection against group C meningococcal disease. Group C is a rarer form of the disease, having accounted for 10 per cent of all cases last year.

There is no vaccine for the group B strain, though it can be treated with antibiotics if caught early enough.

Dr Jane O'Hallahan is the director of meningococcal vaccine strategy.

"We are in the middle of a meningitis B epidemic," she said.

"This specific strain is causing up to 90 per cent of cases. This is at least four times the rate of other countries such as Australia."

Dr O'Hallahan said the group B strain really took off in 1995, the year a serious hunt for a vaccine also began. Auckland University was contracted by the Ministry of Health to run clinical trials, and a vaccine effectiveness evaluation.

"This wasn't something we could just take off the shelf, like for the A or C strains," she said.

"This was something different, and a little scary to deal with."

The Government has committed more than $100 million to the vaccine project. In the late 1980s Cuba introduced a vaccine to control a different strain of group B meningococcal disease and achieved a 95 per cent reduction in the disease within five years.

Hundreds of tiny bottles of a vaccine from Norway arrived in May for trials. Seventy-five New Zealand adults are involved in the first of three groups of trials. They have just had their third of three doses of the vaccine. Dr O'Hallahan said the vaccine was being tested for safety and the efficacy of antibodies.

"Even though the vaccine is a modification of the Norwegian vaccine, in our situation it is considered a new vaccine, so there is a definite need for trials."

In October a larger trial group, 600 children aged between 8 and 12 from South Auckland, will be involved in a second trial.

Toddlers and infants - the group most susceptible to meningococcal disease - will be involved in trials next year.

"Despite the fact that the little ones are the most in danger from meningitis, we have to start with the older, stronger people first."

Results from the adult trials should be known by the end of the year, and those results will be factored into decisions on further trials.

Dr O'Hallahan names April 30 next year as a possible date for launching into a programme to get everyone under 20 vaccinated.

"That is a very optimistic date though," she said.

"We are fast-tracking the trials because we know this is serious. But we have to take our time. No shortcuts can be taken."

The Meningococcal Vaccine Strategy aims to vaccinate at least 90 per cent of people under 20 by 2006.

The Immunisation Awareness Society says it is concerned about the cost and potential side-effects of the vaccine, but the Ministry of Health says immunisation is one of the most cost-effective ways of preventing disease.

Australia is planning to vaccinate children and teenagers against the meningococcal C strain.

In this country many of those testing the vaccine are from the South Auckland area. South Auckland has the dubious honour of being the highest rating area in terms of numbers who have contracted meningococcal disease over the decade since the epidemic started.

Overcrowding, poverty, and living in close quarters are all factors that contribute to an increased chance of meningococcal disease spreading.

One in every 100 Maori and Pacific Island children under the age of five can expect to catch the disease.

At least one school is seeking to educate families about meningococcal disease.

Karen Mose is the director of the junior and middle school, Southern Cross Campus: Middle School.

The year sevens, eights, and nines took a week out from their usual timetable two weeks ago to concentrate on a creative package aimed at educating them about meningitis.

Ms Mose said the school was conscious of the high numbers of South Auckland children contracting the disease.

The week was devoted to education, and the creation of entries for a stage challenge at the end of the week.

Each class put together posters, skits, songs or raps to show what they had learned about meningococcal disease.

"The kids got really engaged in learning because they were in control of it," she said.

"The aim was that they would be so involved that they would go out and spread the message to family and friends."

Ms Mose said a pamphlet did not get through to many students, or their families.

"We needed to think of some other way of getting that message through."

The winning song will also be recorded on to a CD.

"I am heartened to see how they really got behind it, and how they internalised the message," Ms Mose said.

"The kids know now. They won't share things because they know. We know we're winning now."

Anyone of any age can get meningitis. The median age of cases is markedly different within different ethnicities. It is 2.6 years for Maori, 3.8 years for Pacific Islanders, and 16.6 years for the European population.

Children are particularly susceptible because they have little or no previous experience with infections or diseases and have little immunity.

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