Monday March 16 2015
Meningitis leads to a red rash that doesn't fade when a glass is rolled over it
"A vaccination for meningitis is to be offered to all 14-18 year-olds in England and Wales, after a spike in a rare strain of the disease," The Guardian reports. The strain – meningitis W (MenW) – is described as rare, but life-threatening.
There has been a year-on-year increase in the number of meningitis cases caused by MenW since 2009, and infection has been associated with particularly severe disease and high fatality rates in teenagers and young adults. The increasing trend looks set to continue unless action is taken, so the government’s Joint Committee on Vaccination and Immunisation (JCVI), the body that advises on vaccination for England and Wales, has advised that immunisation against MenW should be routinely offered to all 14 to 18 year-olds.
What is meningitis?
Meningitis means inflammation (-itis) of the membrane (meninges) that covers the brain and spinal cord. It can be caused by infection with bacteria or viruses, but bacterial infection causes the most severe illness. The most common type of bacterial meningitis is meningococcal, caused by the bacteria Neisseria meningitidis. There are six main types of this bacterium – A, B, C, W, X and Y – with group B responsible for the majority of cases to date (over 90%).
Meningitis can cause different symptoms in different people, including:
- fever with cold hands and feet
- severe headache
- stiff neck
- dislike of bright lights
- in some cases, convulsions or seizures
In babies, the soft spot on their head (fontanelle) may bulge. If infection spreads to the bloodstream (septicaemia), this can cause a non-blanching rash. This appears because the toxins released from the bacteria cause damage to the blood vessels, causing them to bleed.
Meningitis is a life-threatening medical emergency and requires immediate medical attention if suspected.
How many cases of MenW have there been?
Since 2009, Public Health England (PHE) reports a steady rise in the number of cases of meningitis caused by a particularly virulent W strain of meningitis. There were 22 cases in 2009, rising to 117 cases in 2014. In January 2015 alone, there were 34 confirmed cases in England, compared to 18 in January 2014, and nine in January 2013.
Andrew Pollard, Chair of JCVI, said: "We have seen an increase in MenW cases this winter, caused by a highly aggressive strain of the bug. We reviewed the outbreak in detail at JCVI and concluded that this increase was likely to continue in future years, unless action is taken. We have therefore advised the Department of Health to implement a vaccination programme for teenagers as soon as possible, which we believe will have a substantial impact on the disease and protect the public’s health."
When will the MenW vaccine be introduced?
The JCVI advises that immunisation against MenW should be offered to all 14 to 18 year-olds.
There is a quadrivalent MenACWY conjugate vaccine currently available that can give protection against MenW. However, this vaccine is currently not included in the UK’s immunisation schedule. It has, to date, only been recommended for groups at increased risk, including those with splenic dysfunction or who are travelling to certain parts of the world.
There doesn’t appear to be a set date for the introduction of the vaccine, but the Department of Health says it accepts JCVI’s advice on routine introduction of the vaccine and is now planning the implementation of a combined MenACWY immunisation programme.
John Watson, Deputy Chief Medical Officer for England, says on the PHE website: "We accept JCVI’s advice for an immunisation programme to combat this devastating disease. We are working with NHS England, PHE and the vaccine manufacturer to develop a plan to tackle the rising number of MenW cases."
Until the vaccine is introduced, remaining vigilant to the signs and symptoms of the disease will be the best form of protection.
As Dr Shamez Ladhani, Paediatric Infectious Disease Consultant at PHE, advises: "Meningococcal group W disease is a rare but life-threatening infection in children and adults. It’s crucial that we all remain alert to the signs and symptoms of the disease, and seek urgent medical attention if there is any concern. The disease develops rapidly ... be aware of all signs and symptoms – and don’t wait for a rash to develop before seeking urgent medical attention."
PHE is also reminding health professionals to be aware of the increase in MenW disease and to keep a high index of suspicion for this strain of the disease, across all age groups.
What other meningitis vaccines are currently available?
The current NHS immunisation programme offers protection against various other bacterial causes of meningitis.
The meningitis C vaccine is given as part of the childhood immunisation programme, with a routine booster jab given at ages 13 to 15 years. For non-vaccinated children and adults, like those going to university, they can also receive a single catch-up booster. Two decades ago meningitis C was responsible for a number of severe cases and deaths, particularly among adolescents and young adults at college. Introduction of the meningitis C vaccine in 1999 caused a big fall in the number of cases caused by this bacterium.
A new meningitis B vaccine was introduced last year, and the JCVI also recommended this is given as part of the child immunisation programme. However, there are still some cost-effectiveness issues to be resolved before it is routinely offered. There are also no current plans for this to be given as a booster jab in adolescence or young adulthood.
Protection against other non-meningococcal bacterial causes of meningitis is also given through the routine child immunisation programme. These are:
- the MMR vaccine
- the 5-in-1 vaccine – which provides protection against diphtheria, tetanus, whooping cough (pertussis), polio and Hib (Haemophilus influenzae type b)
- the pneumococcal vaccine
Regardless of immunisation status, as PHE advises, being vigilant to possible signs and symptoms of meningitis is the best protection against this potentially life-threatening disease.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.