The meningitis risk that rises at Christmas
Many students bring a deadly strain home from their first term says Matthew Barbour – but there’s a free jab that could save lives
When Shirali Patel took up her place at Churchill College, Cambridge, in September last year, she threw herself into university life. It was only when she returned to the family home at the end of her first term in December that the 19-year-old A* student from Harrow began feeling unwell.
“I just felt really tired, like I had a bad cold with a sore throat,” Shirali says. “My dad took me to our family GP who took my temperature, checked my throat, and told me to take paracetamol and rest. There really were no warning bells, no extreme or unusual symptoms, so I took his advice. I just assumed I was exhausted and run-down.”
Over the next couple of days Shirali’s throat became increasingly painful. All she wanted to do was sleep for most of the day. “I remember waking up on December 23, unable to get out of bed, so I called my brother for help,” she says. Her brother Kelan, 18, realised Shirali wasn’t at all well, and called their father at work, who asked a neighbour to drive her to a walk-in centre. The doctor realised something was seriously wrong and called for an ambulance to take her to Northwick Park Hospital.
Today, Shirali can remember very little of what happened – but over the next fortnight, her family were only too aware of how critically ill she was.
When Shirali’s father, Dee Patel, a 51-year-old property landlord, arrived at the hospital’s A&E department, he was told his daughter might have aggressive leukaemia. She was then rushed to ICU for lumbar puncture tests to confirm the cancer diagnosis. “We were told the next 24 hours were critical, and we had to be prepared for the worst,” Dee says. “That was horrific news, and while we were sent home for a few hours to rest, we couldn’t sleep – everything just seemed to have happened so quickly, it was hard to take in what was going on.”
But back at hospital the next morning, a consultant told them Shirali didn’t have leukaemia, but a meningococcal infection – more precisely, meningococcal W septicaemia (Menw) – a strain of meningitis. “The doctor said this seemed like good news, because they had a definite diagnosis and could treat her,” Dee says. But that “good news” wouldn’t be plain sailing.
Suffering from severe septicaemia that was causing her organs to shut down, Shirali was put into an induced coma. “Foolishly, I googled the disease and saw some pretty horrific stories,” Dee says. “I also read that a free vaccine for Menw is available for young people Shirali’s age and kept thinking that if only we’d known about it, our daughter’s life might not be in the balance.”
The MENACWY vaccination programme was introduced for teenagers in 2015 following a five-fold increase in cases since 2009 of the new and particularly deadly Menw strain of meningitis and septicaemia – identified by a genome library funded by charity Meningitis Research Foundation (MRF). This vaccination programme – which involves a single jab for four different strains of the meningococcal bacteria: A, C, W and Y – is available to first-year university students aged under 25. Most 14- to 20-year-olds are also eligible for this free, life-saving vaccine, whether at university or not.
“Uptake of the MENACWY vaccine among older teenagers, who are eligible to get it free from their GP, has been worryingly low, with only around a third of school leavers since 2015 having the jab,” explains Dr Nelly Ninis, consultant paediatrician at Imperial College London and medical adviser at MRF. “Sadly, this means easily preventable cases like Shirali’s are still too common.”
MRF estimates there to be about 3,200 cases of meningitis and septicaemia every year in the UK. About a quarter of teenagers will carry meningococcal bacteria in their noses and throats – it is spread to others through close contact such as kissing, sneezing or coughing; this compares to one in 10 of the general population. The vast majority of carriers do not become unwell or develop any symptoms. Only rarely, and researchers don’t yet fully understand why, the bacteria will cause serious illness among carriers. MRF’S research within universities has shown how meningococcal bacteria spreads rapidly among student populations. In the first week of term, the bacteria was found to be carried in the throats of 7 per cent of freshers, which increased to 11 per cent on day two, 19 per cent on day three and 23 per cent on day four. Among students living in catered halls of residence, rates peaked at 34 per cent by December of the first term.
MRF warns that there is normally a rise in cases in winter, and people should be especially aware of the symptoms at this time. By getting the free vaccine, young people will be protecting themselves from four types of meningitis and septicaemia, while also stopping the spread of the bacteria to other people, friends and family.
Claire Wright, evidence and policy manager at MRF, says: “All first-year university students aged under 25 urgently need to get their MENACWY vaccine if they haven’t already had it, so that they don’t bring meningitis home for Christmas.” While the death rate for those with the most common strains of meningococcal meningitis is 5 to 10 per cent, for the more aggressive Menw ST-11 strain, it is 13 per cent. About a third of survivors are left with life-altering effects, some as serious as brain damage, amputations, blindness or hearing loss. “As in Shirali’s case, it can spread rapidly, but if caught early enough, Menw can be successfully treated with intravenous antibiotics,” Dr Ninis says.
With Shirali still in an induced coma, inflammatory markers indicated she was slowly responding to treatment. But because her kidneys had failed, she was on full dialysis and also required specialist breathing apparatus. “After a few days, the doctors decided to reduce her morphine and other medication to pull her out,” Dee says. “At first, she didn’t respond, but the next day, her eyes slowly opened and she started using hand signals to communicate.”
“Eventually, I was discharged on January 18, and by the end of March felt almost normal again,” Shirali says. Tests showed some scarring on her lungs and chronic kidney disease, which needs regular monitoring, but crucially no brain damage.
“I was disappointed to miss my second two terms at university and restart my course in September, but compared to what might’ve happened if my brother hadn’t been at home when I deteriorated so rapidly, I feel extremely lucky. All my friends have now had the vaccination, so hopefully some good will come of what happened to me.”
Dr Ninis explains that as with all cases of meningococcal septicaemia, the symptoms are not those of “classic” meningitis and much harder to spot. “It seems to cause fever, with profound vomiting and diarrhoea, but not the typical meningococcal rash that won’t fade under a pressed glass, headache or aversion to light. This will mean the diagnosis is even harder to make than usual.”
First-year university students are particularly at risk because they mix with so many others and many live in halls of residence, says Dr Ninis. “But Menw’s death rate is higher because the symptoms can easily be mistaken for a hangover or fresher’s flu. It is a tragedy to die of a vaccinepreventable disease just as students are starting their own independent lives. It is so unnecessary.”
Dee says: “If my son hadn’t been at home that day, or if Shirali had become ill at university, I doubt she’d be here today. Parents and teenagers simply aren’t aware how dangerous this disease is, and that a simple, free jab can save lives.”