One of the worst things that you could ever wish on an enemy is bacterial meningitis. It comes suddenly and it is very painful, difficult to treat, and highly lethal. Many survivors are affected for life by physical disabilities such as deafness, speech impediments, and even limb amputations. In less developed parts of the world, such as Africa, bacterial meningitis causes massive epidemics that disrupt entire communities and disable or kill many of their young people. (Note: viral meningitis, like the one that affected Brad Pitt a few years ago, is also important but not nearly as fatal as bacterial meningitis.)
Visibility for a debilitating disease. This year meningitis gets some long-overdue visibility. For the first time, meningitis will get a slice of the pie. The pie in this case is the pie chart issued each year by the World Health Organization, in which they estimate the proportion of child deaths due to each disease syndrome. Neonatal infections, pneumonia and diarrhea are annually the leading killers of children. But until now this pie has never included meningitis.
Why is this important? Diseases outside the pie just do not get the kind of attention and political prioritization that those inside the pie get. So very simply, by recognizing the toll of meningitis among the world's deadliest child diseases, the WHO will also help meningitis prevention get the attention and resources it deserves.
New vaccines to combat meningitis. One of the real tragedies of bacterial meningitis is that it is largely preventable by vaccination. The leading causes of bacterial meningitis throughout the world are three bacteria -- pneumococcus, meningococcus, and Hib -- and safe, effective vaccines are available against each one. The Hib bacteria almost always affects young children less than 5 years old, yet has been virtually wiped out in countries throughout the world where Hib vaccines are in widespread use. New, safe, and highly effective vaccines against pneumococcal and meningococcal meningitis have been available in the U.S. since 2000 and 2005, respectively, and are just now beginning to roll out in the parts of the world that need them the most.
With support from the GAVI Alliance, Hib vaccines are used or being introduced in nearly every one of the world's poorest countries. By the end of the year, a new meningococcal vaccine made especially for the "meningitis belt" of Africa will begin rolling out in highly affected African communities. And through the Advance Market Commitment, the world's poorest countries will soon gain access to the latest pneumococcal vaccines more than a decade ahead of historical precedent.
Protecting American children. Children and adolescents in the U.S. are also poised to gain increased protection from bacterial meningitis in 2010. Today the US Food and Drug Administration approved a new meningococcal conjugate vaccine to prevent disease in adolescents and college students. And approval should be forthcoming any day for a new pneumococcal conjugate vaccine containing 13 important serotypes.
By a vote of 10 to 1 In November 2009, the FDA's Advisory Board recommended licensure of the new 13-valent pneumococcal conjugate vaccine, citing its safety and efficacy in use among infants and toddlers. This vaccine is designed to replace the highly successful 7-valent version made by the same company in 2000. In short, they took the successful vaccine, and in response to the changes in the circulating strains, they added six more to expand its protection. However, as of today, the FDA has still not followed the panel's recommendation to license the vaccine.
The CDC's advisory panel meets on Wednesday and Thursday in Atlanta to discuss recommendations for meningococcal and pneumococcal vaccines. Let's hope that the FDA gets their licensure decision in place so that the CDC can make their recommendations too. Together these two agencies provide access to life-saving vaccines for many American children, but it all begins with FDA licensure.
Bacterial meningitis will probably never be eradicated like smallpox. Some less common causes like group B streptococcus and serogroup B meningococcus don't yet have great vaccines, so continued research is important. Also as parents we'll have to stay vigilant and be sure to recognize quickly the signs of meningitis. Prompt medical attention and quality care are key when cases do occur.
With increased attention, improved vaccines, and continued recognition of the disease's symptoms, this could be the year that we put bacterial meningitis on the run for good.