Every medical student knows that a patient who has possibly contracted bacterial meningitis requires emergency spinal fluid testing and initiation of antibiotic treatment, and that one particular strain of bacterial meningitis, Neisseria meningitidis, can kill healthy humans within hours.
Six years ago, the Chicago Health Department embarked on an urgent, mass vaccine initiative that utterly stopped a Neisseria meningitidis outbreak. The vaccine campaign undoubtedly saved lives.
Both vaccines and a city health department that responded quickly and appropriately to a deadly outbreak are the heroes in this story that underscores the critical importance of public health departments.
My recent post arguing that MMR vaccines are essential in childhood sparked a little bit of controversy. I am following up that post with a real-life example of the life-saving power of vaccines that occurred right here in my own home town.
In October 2003, local doctors and hospitals notified the Chicago Department of Public Health that six men had contracted Neisseria meningitidis during a 10-day period. Three of the six infected men died from meningitis. All six men who contracted the disease were gay, and had been hanging out in Lakeview, Chicago's gay community. In fact, four of the men had visited the same gay bar before getting sick.
The city's health department responded swiftly to the Neisseria meningitidis meningitis outbreak. Workers distributed health alert notices and other written material to doctors and other health care providers treating patients in the gay community. Local bar and restaurant owners provided information to members of the gay community eating and drinking in their establishments. The health department also organized a massive vaccine initiative in the week following notification of the six Neisseria meningitidis cases. Sending public health nurses armed with vaccine doses that arrived from other parts of the country to the community, the health department inoculated 14,267 men with meningococcal vaccine. Following the mass administration of vaccines to men in Chicago's Lakeview neighborhood, no additional cases of Neisseria meningitidis meningitis were noted.
Deborah Wexler, MD, a family practice physician in Minneapolis, and the Executive Director of the Immunization Action Coalition, a non-profit that promotes vaccine use, applauded the efforts of Chicago's health department in stopping the deadly outbreak. "That's a huge success story," she said.
Patients infected with meningitis caused by Neisseria meningitidis generally become gravely ill very quickly. They generally develop a severe headache and a fever, and some may also have a red rash on their extremities. Patients can lapse into a coma within hours of their first symptoms if they do not receive immediate treatment.
I still remember the 18-year-old patient who died from Neisseria meningitidis meningitis not long after she came to the emergency department during the first few weeks of my internal medicine residency. It's been more than 15 years since that event, but I have no trouble remembering her death scene: a beautiful young woman, lying very still in an ICU bed, surrounded by her shocked family.
Vaccination against meningitis is currently recommended for all preadolescents, aged 11 to 12. The CDC notes that young adults who will be spending time in dormitories and other close quarters, such as college students and military recruits, who have not been vaccinated should also receive the vaccine. Anyone working in a lab with possible meningitis strains or anyone exposed to meningitis should also be vaccinated.
Dr. Wexler admits that even though routine vaccination was not yet recommended, she vaccinated her children when they were teen-agers. "I had my kids vaccinated before it was recommended because it was such a devastating disease," she explained. "I was convinced to do so after listening to several parents' public statements at the Advisory Committee on Immune Practices (ACIP) meetings, parents whose children had died or had become severely disabled--- loss of limbs or brain damage--- from meningococcal disease.
These parents were asking that ACIP recommend routine meningococcal vaccine for all U.S. children. They also made public statements that they wished their doctors had told them that there was a meningococcal vaccine - they had no idea, and that it could likely have prevented the disease that devastated their families."
While only 32% of US teens had been properly vaccinated against meningitis, the numbers of vaccinated teens continues to rise.
Maybe watching the gripping video narrated by Glenn Close from the National Meningitis Association on children devastated by vaccine-preventable meningitis will reduce parents to tears, and then action...to make an appointment to have their pre-teens and teens vaccinated.
Who knows? The vaccine may just save your child's life. I know my child will be in line for her meningitis vaccine when she reaches the appropriate age.