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Meningitis
What You Need to Know
By Liz Harris
© Copyright 2001 by Parents' Press.
EDITOR'S NOTE: This article was originally written for a Northern California audience and appeared in the August 2001 issue of Parents' Press. Recent outbreaks of meningitis have not been limited to California, however, and we think this information can be useful for families throughout the.U.S.
On July 15, 2001, Rose and Peter Kwett of Carmichael, CA celebrated their daughter's life and memorialized her tragic death of exactly a year ago. A conscientious girl with a variety of interests, including volunteering at a shelter for homeless women and children, MaryJo died suddenly and swiftly of meningitis within two weeks of her return from a goodwill mission to Mexico. She was one of three teenagers in the greater Sacramento area to die last summer of the bacterial infection.
After the initial shock, the debilitating pain and the intense mourning, Rose Kwett began the inevitable second-guessing: Did MaryJo contract the bacteria in Mexico, or was it a pool party she attended after her return? When she'd asked the family doctor to give MaryJo "everything she needed" before departing for Mexico, why wasn't the meningitis vaccine recommended? Could MaryJo's death at 16 have been prevented?
Perhaps.
Nevertheless, the catastrophic event fueled Rose Kwett's determination to spread the word about meningitis, which can strike with such deadly force that its symptoms often appear and kill within a matter of hours. So cunning are its flu-like effects that meningitis an infection of the fluid that surrounds the brain and is in the spinal cord even fooled Rose Kwett, a registered nurse with some 19 years' experience working in a hospital intensive care unit.
Before leaving for work that Saturday morning, she'd checked in on her daughter, who complained of a sore throat and felt feverish.
"I didn't see anything unusual," recalled Kwett. "I told my husband to watch her closely, and I called home every four hours."
They lost MaryJo before nightfall.
Private & Public Activism
Kwett's activism, including lobbying for legislation at the state and federal levels, was further steeled by a wave of meningitis-related deaths in Northern California so far in 2001. In the Bay Area, the victims include Nandi Phelps, 9, of Berkeley; Michael Gordon, 16, of Livermore; Chloe Foster, 2, of El Sobrante; and Paul Dellapietra, 22, of Pacifica. Another 2-year-old girl died in San Jose, as did a 17-year-old girl and an 18-year-old boy, both of Folsom.
Media reports of those fatalities and of several Bay Area residents who were stricken by but recovered from bacterial meningitis (including the chaperone of a Lafayette elementary school camping trip) fanned public concern, especially among parents.
"MaryJo died of something that could have been prevented," said Kwett, alluding to the fact that the vaccine Menomune is highly effective against the type of meningococcal disease that took her daughter's life. "That's why I became active. Maybe I could make a difference and help someone else."
Inoculation against meningitis "is not a part of the vaccines-for-children program," explained Dr. Rosilyn Ryals, medical consultant to the Division of AIDS and Communicable Disease of the Alameda County Public Health Department.
The vaccine is effective against four
of the five serogroups of bacterium responsible for meningitis,
but "it doesn't guarantee 100 percent absolute protection,
and there is variability in the time of protection," said
Ryals. Also, at $55 to $60 a dose, it's expensive.
But when the cluster of cases popped up in the course of this
year, the agency sprang into action.
Following Gordon's death on April 16 and the determination that a fellow Livermore High School student had also suffered from meningitis (but had pulled through just fine), as had a girl at a nearby middle school, Alameda County public health officials quickly set up a free clinic at Livermore High to administer antibiotics.
"We wanted to make sure that people got the medicine and took it," said Ryals, who estimated that "well over 2,000 doses" of the one-shot pill, Cipro, were administered.
"This is an unusual thing to do," she acknowledged.
Normally in meningitis cases which almost always trigger an investigation and follow-up by the local health department only close friends and family members of the infected person are given prophylaxis.
Prior to the April clinic, health department staff had fielded "hundreds of phone calls" from worried citizens, Ryals said. "School administrators and nurses were very supportive" of the health department's decision to hold the clinic as soon as possible.
A Spectrum of Outcomes
After the May 1 death of Phelps, an Oxford Elementary School student, the Berkeley Public Health Department also held an emergency clinic for students. In this case, a drug more suitable for young children was given twice a day, for two consecutive days. In addition, meningitis screening clinics were established, including one at Berkeley High.
In a detailed letter to parents and guardians of Berkeley Unified School District students, Interim Superintendent Stephen A. Goldstone provided information about public agencies' efforts to keep the disease in check and to comfort students following the death of a classmate. But he also inserted the voice of calm, with an advisory from Berkeley's Health Officer, Dr. Poki Namkung, noting first and foremost that meningitis "is not extremely contagious.
"It is spread primarily through saliva or droplets from the nose of an infected person, i.e., through sharing of food or drinks, kissing, or other direct contact with bodily fluids. Most people carry a harmless form of the meningitis bacterium and remain perfectly healthy," she wrote.
Namkung added that meningitis "can
be treated with antibiotics if diagnosed promptly," and
that preventive antibiotics, such as those given at the Berkeley
and Livermore clinics, "are also effective."
She urged anyone showing any symptoms of the disease to see a
doctor immediately for diagnosis. Treatment is most effective
at the outset of the disease.
But one of the problems with bacterial meningitis to which children under 5, teenagers and young adults, and those over 55 are more susceptible than others is that its early symptoms appear so mundane: in children, the sudden onset of fever, stiff neck, lethargy, vomiting. Adults may complain also of joint pain, or have seizures.
A purplish rash may develop very quickly and is a sign of blood poisoning (septicemia). When this occurs, immediate treatment is essential.
It was the telephone call from MaryJo at 2:30 p.m. on July 15, when she complained, "Mommy, I have brown sports on my face," that sent Rose Kwett racing home from work, then calling 911 when she got there. Though paramedics were able to stabilize MaryJo and get her to the nearest hospital, she was pronounced dead within a matter of hours.
"From 2:30 to 6 p.m., it was like a bomb that just went off," said Rose Kwett. "It can go that fast. That's what I'm trying to make people aware of."
About 3,000 cases of meningococcal disease are reported in the United States every year, according to a 1999 report by the Centers for Disease Control in Atlanta, Ga. Of the total, about 10 to 13 percent of the patients will die, while about 10 percent of the survivors will be left with severe after-effects, such as retardation, loss of limbs, or hearing loss.
In California, several hundred cases of meningitis are reported annually, though only a handful result in death.
So when a cluster of fatal cases crop up such as those in the Bay Area this winter and spring alarms start ringing.
To Vaccinate or Not?
"We have just been deluged with calls," Dr. Philip Chamberlain, an Orinda pediatrician whose practice has spanned decades, said in mid-June. He estimated that the Summit Pediatric Medical Group where he works had received some 4,000 meningitis-related calls.
"They call when their child has a fever and fevers in kids are so common or when they complain of a headache.or a stiff neck." Nearly all are false alarms.
But one can't assume so. Meningitis is "extremely difficult" to diagnose when someone is describing symptoms over the phone, Chamberlain explained. It is helpful, he said, "to know the parents; there are some who call for everything." But if things sound "the least bit suspicious, we see the patient that day."
If meningitis is found, often it's the viral variety, which is far more common and less serious than bacterial.
All parents should make an attempt to inform themselves about meningitis, said the health department's Ryals.
"There is an abundance of information, from the county health department, the CDC. They can always talk to their [family] doctor, and if their concern stems from symptoms that their child is having, then they should immediately talk to their doctor."
Kwett is pushing for a federal resolution "encouraging the medical community to mention meningitis to teenagers and parents: its transmission, debilitating effects, and the availability of vaccine."
She is slightly more optimistic, though not overly so, about her efforts on the state level. She has testified before the California State Assembly Health Committee on behalf of AB1452, sponsored by her local Assemblyman Dave Cox of the 5th District.
The bill would require the state's Director of Health Services to develop an information sheet on meningococcal disease and provide it to all public and private colleges and other postsecondary educational institutions. They, in turn, would have to pass the information along to all students accepted for admission; those enrolling would then indicate whether they wanted to be vaccinated.
Currently, there is no uniform requirement
for such shots.
However, in response to published studies showing that college
freshmen living in dormitories are at slightly higher risk of
getting bacterial meningitis, the Advisory Committee on Immunization
Practices (ACIP), with the support of the American College Health
Association (ACHA), has modified its position regarding use of
the meningococcal vaccine.
Because of the weak nature of the ACIP's stance, however, a minority of colleges and universities (mostly on the East Coast) require the shots, while others just make them available or launch awareness campaigns.
"It's a recommendation that's not really a recommendation," said Dr. Leslie Elkind, director of the University of California at Santa Cruz Student Health Center. "They recommend that students be educated about the risks of the problem, and that the vaccine be made available.
"The issue stirred debate in the medical community," he explained, because "the vaccine itself is expensive, it doesn't last that long, and it doesn't universally cover the problem."
However, most schools "are trying to live up to that recommendation," he said. "All the UCs and most large schools are running programs."
Last fall, UC Santa Cruz sent a mailer to the homes of incoming freshmen advising them of the ACIP's position and noting that a special vaccination clinic would be held on campus. A few thousand students showed up to get the shot, which cost $75.
This year, said Elkind, rather than hiring a firm to give the shots, as was done last year, the Student Health Center has taken over the public awareness campaign and will be holding "smaller clinics, and many more of them" than last year.
As to where he comes down on the issue, Elkind acknowledged that the shot "is expensive" (though students are given an medical insurance reimbursement request to submit to their carrier). Other than that, there appears to be no medical reason not to get the shot. "It's benign, as far as we know," he said. "There is no problem with the shot."
Asked his recommendation to parents and students, Elkind answered this way: "I would never want to be a parent who, having heard about this immunization, didn't have it done, and then have my child get sick and have a bad outcome.
"I would [have the child] do it just for that reason."
Meningitis is a mysterious disease, he continued. "Ten percent of the population have this bacterium in their throat at any one time. Many think that's what gives you your immunity. Physicians don't normally try to eradicate it from people without symptoms."
What actually causes people to get sick from the bacterium, Elkind added, "is a great mystery.
"It's a very difficult problem because the stakes are so high."
Liz Harris is a frequent contributor to Parents' Press and Parent.TEEN
|
RESOURCES Centers for Disease Control: (800) 311-3435; www.cdc.gov Meningitis Foundation of America: (800) 666-1129; www.musa.org American College Health Association at www.acha.org Rose Kwett: 2613 Walnut Ave., Carmichael, CA 95608; or e-mail makfund@hotmail.com |
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