What the MenW vac­ci­na­tion means for you

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The Ad­vo­cate has run re­ports about meningo­coc­cal dis­ease snatch­ing three North­landers’ lives, four cases of those who sur­vived and the med­i­cal au­thor­i­ties’ re­sponse to what may be the deadly MenW strain’s stealthy en­croach­ment into North­land. Lindy Laird writes about the mas­sive pub­lic health cam­paign for mass vac­ci­na­tion, and why.

It’s a dis­ease that likes it when peo­ple live in close prox­im­ity to each other and suf­fer ma­te­rial de­pri­va­tion, but it doesn’t dis­crim­i­nate. It will kill the very wealth­i­est as well as the poor­est.

IT RAINED in the morn­ing and the sun blazed in the af­ter­noon. That did not de­ter the mums or dads with babes in strollers and wrig­gling tod­dlers stand­ing in a snaking line for two or more hours, only some­times un­der shel­ter as they moved for­ward step by step.

It did not de­ter the par­ents wait­ing with un­der-16 teens or the older teens in their small groups — too cool for school, out for sum­mer, but back on cam­pus for an ex­tra­or­di­nary rea­son.

At Whanga¯rei Girls’ High School the line stretched from a class­room block, across the school quad and out the gate, down the street. At Kerik­eri High School and Kaitaia Hos­pi­tal on Wed­nes­day, day one of the vac­cine pro­gramme, there were sim­i­lar queues.

It was an as­ton­ish­ing sight: Hun­dreds of pa­tient, con­cerned par­ents bring­ing forth their chil­dren at the prom­ise of free­dom from a killer dis­ease, the jab in the arm that would stave off sev­eral meningo­coc­cal bac­te­ria strains, in­clud­ing — es­pe­cially — the very scary MenW. Fam­ily by fam­ily edged closer to the vac­cine that would al­lay fears which had been build­ing up for lit­tle more than a month, since news was made pub­lic that seven peo­ple in North­land had con­tracted the un­pre­dictable, dif­fi­cult to di­ag­nose, un­for­giv­ing MenW strain — and three of them had died.

North­ern Ad­vo­cate re­porters had spo­ken to the griev­ing moth­ers of 16-year-old Kerik­eri High School Dion Hod­der, who died from MenW in Oc­to­ber, and 7-yearold Alexis Al­bert, who died in July. Since news broke that seven un­con­nected North­land cases since May con­sti­tuted an “out­break” of MenW cases, the pa­per has shared the pain and pleas of par­ents whose chil­dren fell vic­tim to menin­gi­tis in past out­breaks.

Even as health bu­reau­crats and med­i­cal spe­cial­ists front the brief­ings, reel off the mes­sages and make their black-and-white bul­let-point state­ments, those be­reaved fam­i­lies and their lost chil­dren have been the real hu­man face of meningo­coc­cal dis­ease.

But Wed­nes­day’s first-day up­take of the vac­ci­na­tion pro­gramme, those par­ents and the many chil­dren, the long lines, it was al­most shock­ing in its scale . . . and the hu­man face of this at­tempt to break the North­land out­break was by the end of day one well over a thou­sand-fold. At Whanga¯rei Girls’, one mum had ar­rived with two preschool­ers at 10.45am and at 1pm was still at least 10 back in line from her chil­dren’s turn.

“I don’t mind, it’s worth it,” she said, rock­ing one tod­dler in her arms while her preschooler ran around on the grass with a bunch of other kids.

The par­ents chat­ted to each other, some phoned home for de­liv­er­ies of snacks, drinks, nap­pies, or changed guard — dad tak­ing over for a while or the other way around, chil­dren played, a few bawled, North­land Dis­trict Health Board staff walked the queue as­sur­ing ev­ery­one the line was get­ting shorter, thank you for com­ing, thank you for your pa­tience. All this was a sign of how anx­ious par­ents had be­come and their re­lief that the vac­cine was avail­able, at least for two age groups, from 9 months to 5 years, and 13 to 19 years.

When a silent, un­seen killer could be stalk­ing your drib­ble-spreading lit­tlies or saliva-shar­ing teens, stand­ing in this line is em­pow­er­ing, tak­ing control in a sense. A fa­ther stand­ing with his teenaged daugh­ter said, “At least we can do this. Some other par­ents haven’t had this chance for their kids.”

He may have been talk­ing about the deaths of Dion and Alexis, or pos­si­bly the 5 to 13-year-old group for whom there are not enough vac­cine doses but the med­i­cal wis­dom says will be safer once book­ended by the other two age groups.

It’s called “herd im­mu­nity”.

At around 1.15pm at Whanga¯rei Girls’, Ken­dra Bos is well pre­pared even af­ter wait­ing for nearly two hours — but then as the mother of three un­der-5s she’s used to tot­ing around bags of kiddy stuff. She said she wasn’t sur­prised so many had come on the first day; they couldn’t wait, such had been the level of anx­i­ety. Her youngest, 5 months old and too young to qual­ify for the vac­cine, slept in her arms, obliv­i­ous.

“I’m here be­cause I just want to keep my fam­ily safe,” Bos said. ”Get­ting the two older ones done means there is less risk to the baby.” RISK — it’s a word used a lot around the meningo­coc­cal sub­ject. Most par­ents don’t will­ingly put their chil­dren at risk, but some house­hold con­di­tions do in fact heighten the risk of spreading com­mu­ni­ca­ble ill­nesses.

Like many more com­mon ill­nesses, trans­mis­sion is helped by over­crowd­ing and poor liv­ing cir­cum­stances. In that case, some com­mu­ni­ties as well as fam­i­lies are also at risk. No com­mu­nity is an is­land — they travel, work, go shop­ping, go to school, play to­gether, pray to­gether.

DHB spe­cial­ists have pleaded for par­ents to get their chil­dren vac­ci­nated — even those op­posed to pub­lic im­mu­ni­sa­tion pro­grammes. As the early days of the three-week jab cam­paign shows, a great many par­ents or care­givers of the 20,000+ tar­get group have taken the plea on board.

It had added pres­sure to the DHB’s team that its own and other so­cial me­dia sites have been spammed by an an­ti­vac­ci­na­tion cam­paign largely com­ing from the US.

The anti group’s use of what’s known as “non-violent di­rect ac­tion” in­cludes ad­vis­ing North­land par­ents to make fake ap­point­ments with GPs to have the vac­cine pri­vately, then not turn­ing up. That would lock up some of the few avail­able doses which have to be or­dered

in ad­vance, thus in­ter­fer­ing with the sup­ply chain — or so the anti-cam­paign imag­ines.

The un­pre­dictable na­ture of the MenW strain that has caused a world­wide short­age of vac­cine and which has been re­spon­si­ble for all the North­land cases is per­haps help­ing push the vac­cine case.

No con­nec­tion has been found be­tween the North­land cases — the pa­tients did not catch it from each other or peo­ple in their im­me­di­ate cir­cle. It leaped and landed where it would.

Re­tired NDHB pae­di­a­tri­cian Roger Tuck, help­ing out on the front line this week, said this meningo­coc­cal breaks the rules.

“It’s a dis­ease that likes it when peo­ple live in close prox­im­ity to each other and

suf­fer ma­te­rial de­pri­va­tion, but it doesn’t dis­crim­i­nate. It will kill the very wealth­i­est as well as the poor­est.”

Be­fore the MoH de­clared the free North­land vac­ci­na­tion, only two weeks ago, the NDHB ex­ec­u­tive had fielded flak about keep­ing the first two, then two more, cases of MenW quiet — at least as far as the pub­lic went.

The DHB coun­tered say­ing it hadn’t wanted to “panic” par­ents, but said MoH had been in the loop about de­vel­op­ments.

Three peo­ple died be­fore the ex­tent of the North­land “out­break” was known by the pub­lic. By then, even while stick­ing to its “don’t panic” stance, the DHB was also say­ing “be vig­i­lant, be care­ful, act quickly”.

Pub­lic or­gan­i­sa­tions al­ways use phrases like “talks are at a del­i­cate stage” when fob­bing off me­dia ques­tions, so the pub­lic re­mained out of the loop con­cern­ing the sever­ity of or con­cerns about MenW un­til the MoH an­nounced its ap­proval of a North­land vac­ci­na­tion pro­gramme.

MenW had gone from be­ing some­thing the pub­lic should not know about to some­thing more than 20,000 teens and preschool­ers needed pro­tec­tion from.

“The only ef­fec­tive way to man­age this out­break is with a vac­cine pro­gramme,” chief ex­ec­u­tive Nick Cham­ber­lain said just over a week ago at a me­dia briefing about the planned roll-out.

Sit­ting at that briefing was DHB mi­cro­bi­ol­o­gist David Ham­mer, a sin­cere, pleas­ant man who is liked and re­spected by his col­leagues. Be­cause Ham­mer first raised the spec­tre of an out­break af­ter the first two cases at Whanga¯rei Hos­pi­tal back in May, he car­ried the can to a de­gree for a sit­u­a­tion some saw as a nearly six-month DHB cover-up.

Ham­mer said he made his call at that early stage “based on med­i­cal ex­pe­ri­ence and in­tu­ition”. Noth­ing was done back them to re­as­sure or in­form the pub­lic, but MoH was in­formed and watch­ing the sit­u­a­tion closely, he said. THE SPEED a dis­ease spreads, the sever­ity of symp­toms and med­i­cal out­comes and the size of the most vul­ner­a­ble de­mo­graphic form the ba­sis for vac­cine pro­grammes.

Among other num­bers crunched by epi­demi­ol­o­gists, health-dol­lar dis­trib­u­tors and drug sourc­ing agen­cies when it comes to de­ter­min­ing “the out­break thresh­old” are the num­ber of cases-vs-pop­u­la­tion.

MoH uses the thresh­old of 100 cases per 100,000 to de­fine an epi­demic. North­land’s MenW rate is 5.7 per 100,000 peo­ple; else­where in the coun­try it is at most 2.5 per 100,000 and in some ar­eas zero.

MoH in­for­ma­tion tells us that one to two peo­ple in ev­ery 10 will die, even with rapid treat­ment. Up to 20 per cent of New Zealan­ders are likely to carry the bac­te­ria but never get sick them­selves.

While he doesn’t dis­pute those fig­ures, Whanga¯rei MP and for­mer GP Dr Shane Reti says he doesn’t quite buy some of the oth­ers.

“It doesn’t add up,” he said of the maths and the tim­ing.

There are, give or take a few hun­dred, 180,000 peo­ple in North­land so the “thresh­old” equa­tion is out.

Reti is not op­posed to the $1 mil­lion to $2m vac­ci­na­tion pro­gramme it­self but as an op­po­si­tion MP, and Na­tional’s as­so­ciate health spokesman, he’d be re­miss if he didn’t ask ques­tions in the House about a ma­jor pub­lic health de­vel­op­ment on his own patch.

He said a spe­cial­ist at­tend­ing Re­gional Royal New Zealand Col­lege of GPs Con­fer­ence in North­land raised con­cerns about the ris­ing meningo­coc­cal in­fec­tions in May this year, and ac­cused the MoH of be­ing “very quick to sit on their thumbs … I fear we are go­ing to see a lot of deaths this win­ter”.

“Trag­i­cally that’s ex­actly what went on to hap­pen and it’s in­ap­pro­pri­ate for the Health Minister David Clark to con­tinue prais­ing the ‘swift re­sponse to the dec­la­ra­tion of the out­break in Novem­ber’,” Reti said.

“The de­lay in act­ing on the out­break may mean that the re­sponse won’t be enough for the needs of the com­mu­nity.”

Also some­what baf­fling, only last Thurs­day — af­ter the go-ahead for the North­land vac­ci­na­tion — the Health Minister cat­e­gorised the cur­rent meningo­coc­cal out­break as a “slight rise” in the dis­ease, Reti said. He sug­gested the minister was not quite up with the play.

Reti told the Ad­vo­cate “out­breaks don’t hap­pen overnight”, and said he had ques­tioned in the House how two of the North­land deaths oc­curred af­ter May, when the MoH had al­ready sig­nalled an out­break could oc­cur.

Reti be­lieves all par­ties should have gone into gear at that time, per­haps hav­ing time then to se­cure enough doses for all over-9-months and un­der-19-years young­sters in North­land to be vac­ci­nated. Is the re­sponse heavy and fast enough? Roger Tuck, whose daugh­ter Ailsa Tuck now holds his for­mer role as the DHB’s head pae­di­a­tri­cian and is do­ing a ster­ling job ex­plain­ing and fronting the vac­ci­na­tion cam­paign, says yes.

“It was ap­pro­pri­ate given in­ter­na­tional guide­lines. With a dis­ease like this, your nat­u­ral in­stinct is to say: Could we have saved an­other life if we had started ear­lier? But I think we ba­si­cally did it by the book.”

Pho­tos / John Stone

Right, hun­dreds of peo­ple stood for hours in slowly-mov­ing queues at North­land vac­ci­na­tion cen­tres.

Pae­di­a­tri­cian Ailsa Tuck says the first day’s re­sponse is a sign of how anx­ious par­ents have be­come. As for the long lines: ‘It has been a lit­tle over­whelm­ing but ev­ery­one has been fan­tas­tic. There are still three weeks to go so we want to as­sure par­ents there are enough doses for the tar­get ages.’ Above, left, through Phar­mac, North­land DHB got hold of just over 25,000 doses of MenACWY Vac­cine.

Sta­tions at schools, com­mu­nity cen­tres and clin­ics will en­sure the ma­jor­ity of the tar­get age groups are vac­ci­nated be­fore Christ­mas.

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