'Tomorrow is too late to learn'

Most parents these days are aware of the danger meningitis poses to babies and toddlers. But teenagers are the second most vulnerable group, and the signs and symptoms may be much harder to spot. Linda Watson-Brown reports

Christine Morrison doesn't subscribe to the adage that lightning never strikes twice. The mother of two from Wishaw, near Glasgow, has good reason for her cynicism. Twenty-four years ago, her son Scott, then 12, was stricken with bacterial meningitis. Her memories of seeing him unconsciousness in intensive care are still vivid. So she reacted with disbelief when, last year, her 16-year-old daughter Fiona was diagnosed with septicaemia, another form of meningitis.

Most parents now are extremely vigilant with their babies and toddlers when it comes to watching for meningitis symptoms, but the teenage years are also a time when children are vulnerable. The age group most at risk is the under-fives, which accounts for about 46 per cent of all cases. But the next highest risk is the 15 to 24 age group, which accounts for about 13 per cent of cases.

Julia Warren, spokesperson for the Meningitis Research Foundation, says: "We've got to get the message over about teenage susceptibility. Over the last three years in the UK, there have been almost 10,000 cases in total of meningitis and septicaemia. Tragically, 1,200 of these resulted in death. Both meningitis [the inflammation of the lining around the brain and spinal cord] and septicaemia [the blood-poisoning form of the disease] can kill in hours.

"We are really concerned that people think they know about meningitis; that they think it isn't a threat any more, and that they believe it only really affects babies and toddlers. We have found that the success of recent vaccination programmes has led many people to believe that meningitis and septicaemia are diseases of the past. This is far from true. We can't afford to be blasé about meningitis - it's a killer, and it can be a quick killer, too."

Warren has a point. The meningitis vaccination programme rolled out since 1999 has led many parents to believe that the disease has been conquered. But the vaccination available does not protect against all forms of meningitis and septicaemia; there has been no widescale elimination.

"It's a parent's worst nightmare," says Christine Morrison. "To have it happen once is awful; the second time round, I just felt I couldn't go through it again." The Morrisons' story emphasises how quickly meningitis can strike, and also how the intervening years between her son's and daughter's illnesses have seen very little change in terms of awareness.

"Scott woke up one morning and said that he wasn't feeling well," Morrison recalls. "He had pains, he was off colour, complaining of a headache. The GP didn't come out until 6.30pm that evening, and Scott was getting progressively worse. I knew about meningitis when he was a baby - there wasn't as much information available as there is now, but I was aware of it - but I never thought it could strike a healthy boy almost in his teens."

Ninety minutes after the GP's diagnosis of German measles, the Morrisons were in an ambulance rushing to hospital. "They immediately said that he had meningitis and we should prepare ourselves." Scott Morrison, who is now a 36-year-old father, remembers only one thing. "I felt that the wind was going to pull me out through the windows," he says. "I felt so weak, and so incapable of doing anything."

His mother's memories are more vivid. "He was completely out of it, but to this day I can hear his screams as he was given a lumbar puncture. We were told at that point that he could be left mentally or physically damaged - or both. Over the next few days, he did get better. But we were given few details. When he was discharged, there was no mention that this could impact on Scott's life. We were just trundled out as if everything was fine."

And Scott was affected. From being among the top three students in a large school, he struggled with his studies. He received exam grades way below his teachers' expectations, and his concentration was severely reduced.

The pattern was repeated when Fiona Morrison developed septicaemia 23 years after her brother. "Of course, I knew what Scott had gone through," she says. "But by the time I was 16, it never occurred to me I might be at risk. When we were little, my mum would check our reflexes as soon as we so much as mentioned that we felt a bit poorly. You couldn't have a cold without her wobbling your neck back and forward."

Fiona was preparing for her mock exams when she began to feel unwell. A few years earlier, she had reacted badly to her meningitis vaccination, but her illness this time was alarmingly quick to develop, as is generally the pattern. "I had been bowling with friends and came back home with my boyfriend. I felt a bit off, but nothing too bad. The next day my mum was taking my boyfriend home and when we arrived, I said I had to go to the loo. I went in there feeling wobbly, and came out at death's door.

"I went into the kitchen where Mum was talking, and almost collapsed. She somehow got me home, and the stomach pains and faintness kept coming. As I was getting into bed, she noticed the spots. The rash was behind my knees and under my arms - I had thought it was a deodorant reaction. I was weepy and panicking and my mum had me at the doctor's surgery straight away. He started me on medication and sent me to hospital. They were waiting with a drip."

Fiona's initial recovery was quicker than her brother's - she was discharged in less than a week - but a few days later the rash returned and she was re-admitted. "Even though that was cleared up too, septicaemia has changed me. I had always wanted to be a primary-school teacher; I loved children and got on brilliantly with them. After the illness, I went on a placement. I just couldn't stand it; the noise, the constant demands. I had no interest in it, and I was so narky. I have terrible mood swings, I have awful concentration. It's just not like me any more."

The two forms of the disease have different symptoms, and may leave sufferers with a range of after-effects that can dramatically alter their lives. The exact transmission route of both forms is unclear, although it is believed that a susceptibility can be enhanced through illness. Meningitis is usually bacterial or viral. While viral meningitis can be unpleasant, it is almost never life-threatening and most people make a full recovery reasonably quickly.

Bacterial meningitis is more serious and can be caused by a range of bacteria, although most cases in the UK are caused by meningococcal bacteria. Meningococcal bacteria can cause meningitis or septicaemia, or both. Septicaemia is the more life-threatening form of the disease and is more dangerous when there are no signs of meningitis.

There is no doubt that the vaccination programme has drastically reduced the number of cases of group C meningococcal disease (a contagious form responsible for most outbreaks of infection) in the age groups that were targeted for vaccination (initially those less than one year old). But the Meningitis Research Foundation is keen to emphasise that many equally deadly forms of the diseases are not vaccine-preventable, which is why symptom recognition is so vital. "Teenagers are moving into a phase where they are becoming more independent - we need to make them aware of meningitis, and where to go for help, whether it's for themselves or for a friend," says Warren.

"There's a danger that the symptoms will be overlooked, with tragic consequences. I know of one 18-year-old boy who came home on New Year's Day and told his parents there was something wrong. They assured him it was a hangover and nothing to worry about. They were with him in the ambulance only a few hours later as he died on his way to hospital.

"People just don't realise the speed with which meningitis can spread. You can actually watch the rash come up in most cases. Someone can be fine at lunchtime and fighting for their life six hours later. Tomorrow is too late to learn about this disease - parents and teenagers need to know now."

Christine Morrison got her two children through meningitis by relying on gut instinct. "I just knew both times that it was bad. Parents do know. They know when their child is acting out of character, much more than a doctor does." However, she is keen to point out that parents have to be constantly vigilant - at all stages of their children's lives. "It's no good thinking that this only happens to babies. The danger for teenagers is that they are moving away from you, anyway. You don't bathe them any more, you don't provide all their food. On top of that, they're moody anyway, they don't always talk to you. It makes it even harder to spot when something's wrong."

The Meningitis Research Foundation has a free 24-hour helpline (call 080 8800 3344) and offers a free information pack and a teenage guide called 'Get it Sussed' (see www.meningitis.org)