Editor’s note: Last week, we took a more in-depth look at meningitis and local cases in the Philadelphia region. Here’s a look at how the disease affects those in the United Kingdom. Our regular contributor Gary Emmett, MD, recently traveled to London.
The world is too small. That was my first thought last week when an undergraduate at Drexel University died of meningococcal meningitis B. People are always surprised when this happens since many know that all children are supposed to get a meningococcal immunization at age 11 and then again before college.
However, the "B" strain of this germ is still very rare in the United States and the U.S. shot (or "jab" as they say in Britain) contains four other strains: A, C, W-135 and Y. These strains accounted for over 90 percent of the approximately 1500 cases of meningococcal meningitis and meningococcal septicemia (blood infection) seen in the U.S. yearly and the most widely strain seen in Sub-Saharan Africa.
Meningococcal disease is rare, but quite horrible. In the U.S. about 12 percent of victims die. Another 20 percent are permanently crippled with deafness, brain damage or the loss of body parts, especially arms and legs (the last case I saw lost both legs), It happens most commonly when people who come from very different communities come together for the first time. College freshman, army recruits, and sleep over summer camps are high risk venues.
Strain B is common other places in the world. Last month, I was flying the overnight plane to London to visit one of my daughters at graduate school in Coventry. I went to get a drink of water in the galley and saw a banner headline on The Independent, a major British tabloid, "New Meningitis Vaccine for Every Child." It turns out that meningococcal strain B is not rare in England with well over a 1,000 cases per year in a country with one quarter the population of the U.S. and that it is primarily in children under 10. More than 50 children die of this disease in England every year and another 200 or 300 hundred are crippled. Meningococcal disease is the number one cause of infectious death for children under 5 years old in the U.K.
There is a separate vaccine for meningococcal B and its use is a major political controversy in the U.K. The British Joint Committee on Vaccination and Immunization (JCVI) had decided last year not to recommend routine vaccination with this "jab," because it would cost at current prices about 1 billion American dollars per year. But wealthy Britons were going to private doctors and getting the series for their children between 6 and 24 months at costs up to $1,200 U.S. dollars per child.
This led to a controversy about the difference in care between poor and rich children. The decision of the JCVI was heavily criticized on both political and medical grounds and last week the JCVI rethought its decision and reversed it. Sources close to Jeremy Hunt, the Health Cabinet Secretary in the British government, told The Independent that the National Health Service would universally introduce the meningococcal B vaccine next year.
Doctors do not really know why meningococcal B is common in schoolchildren in the U.K., but not in the U.S., or why seven Princeton University students became very ill with this germ last year and the Drexel student took to bed with what she thought was a "virus" and was dead of overwhelming meningococcal B bacterial infection two days later.
The fact that I worked all day on a Friday, went to the gym, had a nice dinner and could still be in London early Saturday morning, just shows how easy it is to take oneself and one germs from one part of the world to another. I see malaria and tuberculosis regularly as an university pediatrician even though these diseases are relatively rare in the U.S., and, in fact, malaria can almost never be caught in the U.S. (two cases in the last decade).
We travel, germs travel on us, and no one is isolated anymore. The world is too small.