Health: There's a killer on the run...

Meningitis is the disease that every parent dreads. But the fightback has begun.
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The Independent Culture
Good news is not what we have come to expect from meningitis. It is a fearsome disease, dreaded equally by parents and doctors, trailing tales of tragedy, not triumph. Parents worry for their children about a disease that attacks with unnerving speed and ferocity, and doctors worry for their reputations, for it is notoriously easy to miss. Lucy Prescott's symptoms were diagnosed as tonsillitis, after which she was prescribed antibiotics and painkillers. Two days later, she was critically ill in hospital, although she went on to make a full recovery.

Yet, there is encouraging progress in the battle against meningitis. The war is far from over but advances are being made against one of the most devastating illnesses of modern times. Today, Tessa Jowell, the health minister, will climb aboard a London bus full of children who have survived meningitis to mark the launch of this year's Meningitis Awareness Campaign.

The children, who are testimony to the advances made against the disease, will seek to remind doctors and parents that because meningitis can kill in hours, minutes cannot be wasted. Early diagnosis and urgent treatment provide the best hope of recovery.

The message is getting through. Despite the huge rise in cases in recent years, the death rate is sharply down. There are even signs that the disease may have peaked. Last winter saw the first fall in total cases of meningococcal disease, the commonest and severest form of meningitis, for six years.

Since the winter of 1991-92, the annual toll has doubled from 1,200 cases to over 2,500 in 1996-97, the highest for 50 years. The increase is thought to be due to greater awareness and better recording, but no one really knows why it should have risen so far and so fast. (It is still well below the epidemic of the early 1940s when cases rose to a peak of 13,000 a year.) It is too soon to tell whether last winter's dip is a blip or the beginning of a downward trend but it is the first encouraging sign this decade.

The chances of any individual diagnosed with meningitis surviving to tell the tale have dramatically improved during the 1990s, in spite of the rise in cases. The reason is greater recognition of the need for immediate treatment with antibiotics and improved care. The death rate from meningococcal septicaemia - blood poisoning, and the most serious complication of meningitis - fell from almost 60 per cent in 1989 to under 20 per cent in 1997. Overall, for every 100 people who developed meningococcal meningitis last year, more than 90 survived.

Too many still die. In 1997, there were 243 deaths. The only sure defence against this fatal illness would be a vaccine given in infancy and providing lifelong protection.

Last week scientists revealed a real hope of developing a vaccine against the Group C strain of the disease, the fastest growing one, which accounts for 40 to 50 per cent of all cases. Trials have shown promising results that it could provide lifelong protection from infancy.

Dr David Salisbury, principal medical officer at the health department, which is backing the trials by the Government's Public Health Laboratory Service, said: "The studies will take one to two years to complete. The results so far are very exciting. The vaccine is given at two months of age and produces a fantastic level of antibodies and appears remarkably safe."

Dr Salisbury said progress was also being made towards the development of a Group B vaccine, which caused over half of all cases of meningitis, but that would take longer. Once the studies were complete, there would be a further delay before manufacturers could apply for a licence and produce the vaccine in commercial quantities. Details of research on the vaccines were given at a press conference chaired by the Government's chief medical officer, Sir Kenneth Calman, making one of his last appearances in the post - he retires this week to take up a post as vice-chancellor of Durham University. He said the public and GPs should be vigilant for signs of the disease and act quickly where it was suspected.

"The diagnosis is difficult and the symptoms are often like flu. Any flu-like illness that occurs outside the flu season should be treated with great care," he said.

Sir Kenneth disclosed that students in Southampton, Leicester and Cardiff were being offered vaccination against meningitis because of the history of outbreaks among students in those cities, but it would not be offered to students elsewhere. The existing vaccine against the Group C strain is only partially effective, lasts for one to two years and does not provide protection in infants under 18 months of age.

The worry about offering a partially effective vaccine, which is anyway active against only one strain of the disease, is that it may induce a false sense of security and lull individuals who fall ill into believing they cannot have meningitis so that they delay seeking medical help. Sir Kenneth said that the decision to vaccinate had been taken by the three universities concerned and was not appropriate for all students.

There has been great concern about meningitis outbreaks among students, although the peak age is in infants under one. Cases are high in children up to the age of five and the disease kills more children between one and four than any other single factor. A second, smaller peak occurs around the age of 15 onwards and drops off by the age of 18 or 19.

Sir Kenneth said every minute counted in the management of meningitis and parents of babies who were floppy, unresponsive and unwell with a rash should apply the glass test. Under a glass tumbler, a normal rash disappears but a meningococcal rash does not - time for urgent medical attention. "Be aware, be alert and be active," he said.

The Meningitis Research Foundation operates a 24-hour helpline on 01454 413344