Meningitis fight goes on despite jab success

23 August 2001 14:32 GMT+1

Independent http://www.independent.co.uk/story.jsp?story=12707  

By Jeremy Laurance, Health Editor

04 January 2001

Britain will face the annual scourge of deaths and serious illness caused by meningitis for at least another five years despite the success of a 20m vaccination campaign which has all but eliminated one strain of the disease, officials admitted yesterday.

Professor Liam Donaldson, the chief medical officer, announced that 50 deaths had been avoided and 500 cases of meningitis C prevented since the launch of a vaccine against the C strain of the disease in November 1999.

More than 18 million doses of the vaccine had been offered to every child under 18 in the biggest vaccination programme since the drive against polio in the 1940s. "We have thrown a shield of protection round young children," Professor Donaldson said.

However, the group C strain of the disease accounted for fewer cases than group B and there was "no immediate prospect" of a vaccine being introduced against group B, Professor Donaldson said.

In 1998, group C in England, Wales and Northern Ireland accounted for 1,465 confirmed cases and 205 deaths. Group B accounted for 2,154 cases and 141 deaths. Group B and C account for most cases of bacterial meningitis in Britain, which is the most serious form. Viral meningitis also occurs but is generally less serious and there is no vaccination against it.

Professor Donaldson said: "We urge there should be no complacency. It is important parents, doctors and nurses remain vigilant because early treatment can save lives."

Development of a vaccine against the B strain is proving much harder than against the C strain. The Department of Health is working with the Dutch national authority, which has a prototype group B vaccine which has been tested on British children, and other work is going on in the United States. Dr David Salisbury, head of the department's immunisation programme, said: "The excitement which is just beginning comes from work last year when the genetic code for group B meningitis was sequenced. We now have a rational approach to developing a vaccine that could work but it is five to seven years away."

A group B vaccine, produced in the same way as the group C one, also stimulates the production of antibodies, but these do not provide the same protection against group B disease, for reasons scientists do not fully understand. An effective group B vaccine will therefore have to be produced in a different way. Dr Salisbury added: "There is light on the horizon but vaccine development does not happen overnight."

A group B vaccine developed in Cuba was unlikely to be effective in the UK because the strain was different in Cuba and the vaccine provided protection for adolescents but not for under-fives, who carry the biggest burden of disease in the UK.

Yesterday, however, the Department of Health was celebrating the success of the group C campaign. Yvette Cooper, a Health minister, said it was a vindication of the Government's decision to start the programme at the earliest opportunity, despite problems with supply in the first few months. The UK was the first country in the world to develop, fund and introduce the vaccine, and other European Union countries, such as Spain and Ireland, were following the UK's lead. "It shows the Government was right to bring this vaccine in as rapidly as possible and vaccinate so many children once it was shown the vaccine was safe," Ms Cooper said.

In 1999 there were 238 confirmed cases of meningitis C among under-18s. There were 60 cases last year, a 75 per cent reduction. The number of cases is expected to be lower this year, the first full year after completion of the vaccination programme.

There had been 16 deaths linked with vaccination but all had been explained by other factors, Dr Salisbury said. Common side-effects included nausea, dizziness, headache, rash and injection site reaction, but they only occurred about once in 10,000 cases. "That is a very small price to pay for protection against meningitis," he said.

Officials would next examine the practicality of extending the vaccination programme to the over-18s by examining where the disease was occurring, what the supply of vaccine was and who should be targeted. However, there had been no outbreaks in universities since the vaccination programme started and the jabs provided to the under-18s would protect them for life, Dr Salisbury said.

The health department will regard the 20m cost of the programme as a small price to pay for eliminating a disease. On Tuesday it announced the same amount would be invested in equipment for monitoring heart disease, which kills more than 100,000 people a year. That may save more lives - but in a less dramatic fashion. Meningitis strikes with unnerving speed and ferocity and mainly kills the young. Heart disease is slow and insidious and tends to carry off the old.