The Doctor’s Surgery Tom Stuttaford
Doctors are privileged. They are able to ask patients and even friends personal questions without causing offence or evasion.
The fear of meningitis is widespread, almost universal in the parents and grandparents of young children, but even so not widely discussed. However, if a doctor were to ask a young mother what her greatest dread for her child was, a great number would say ‘meningitis’. This is unsurprising because few people have not heard stories of neighbours, colleagues or relatives who have happily gone off to work leaving behind a jolly and happy family only to find out later that one of their children was seriously and dangerously ill. Meningitis was suspected and the prognosis was uncertain.
So far so good, so long as meningitis suspected, and an appropriate antibiotic is given immediately, by injection, in which case the child will have a reasonable chance, no more than that, of surviving. The situation is not so hopeful if the doctor is a jolly optimist, provides unjustified reassurance but fails to give immediate treatment and arrange transfer to hospital.
The effect of the sudden death or disability of a child is so heart-rending that it not unexpectedly has stimulated huge and determined medical research into meningitis.
There are several different types of meningitis and the causative organism may be viral or bacterial. Viral meningitis, unpleasant as it is, is relatively benign: most cases are self- limiting and the patient usually improves within a fortnight. Some of the types of bacterial meningitis such as those caused by tuberculosis, streptococcal infections, staphylococcal infections following head injuries or the pneumococcal bacteria also respond to appropriate antibiotics. But infections with meningococcal B bacteria have defeated doctors despite decades-long concentrated worldwide research. Unfortunately it is one of the most vicious forms of meningitis: one in ten cases die and one in four patients survive but have a lasting disability, which can range from loss of a limb to deafness or learning difficulties.
Much of the research into meningitis B was devoted to discovering a vaccine to provide protection from it. Doctors remembering the success of a vaccination programme against haemophilus influenzae type B meningitis, which had previously been a hazard, struggled to find a vaccine that would produce the same level of immunity for patients with meningococcal B. A year or two ago there was huge relief that a new vaccine had been found and was being manufactured by Glaxosmithkline and marketed as Bexsero.
The hopes and jubilation of the medical profession and parents and grandparents were short-lived, however. Trials had shown that the vaccine was safe, relatively free of serious sideeffects and would provide people with protection against eighty to ninety per cent of strains of meningococcus B. Despite this revolutionary advance in medicine, it was rejected by the appropriate government committee on grounds of ‘cost effectiveness’. How an accountant can measure the value of a live baby or child against one that is dead or disabled is unknown. However, in 2014 Jeremy Hunt, the then new Health Secretary, started new negotiations with the appropriate committee and Glaxosmithkline. Eight months later, in March 2015, an agreement was reached over the cost of Bexsero to the NHS. A vaccination programme was started later that year but unfortunately it only covered young babies. A million doses have now been given, 5,000 babies have been vaccinated and to date there has been no evidence of serious problems.
Meningitis B is most common in young children under five and there is a second peak in adolescence when ‘close bodily contact’, as it is known in the trade, becomes more common. A surprising number of adolescents are carriers of meningococcal B. The Americans have introduced a new vaccine know as Trumenba that is licensed in America for use for people aged between 10 and 25. Regrettably it is not yet licensed for use in Europe.
Bexsero, the Glaxosmithkline vaccine, has been available privately but such is the demand that doctors in private practice have been asked not to start new patients on it until the summer when GSK hope there will be enough Bexsero for those who are able to find the money – not an approach to medicine that appeals to doctors whether in private practice, the NHS or both.