Winning The Fight Against Bacterial Meningitis With Immunization

Image credit: Public domain image of Neisseria meningitidis
(ID#: 2678) courtesy of Public Health Image Library (PHIL).

Bacterial meningitis is often, but not exclusively, caused by the bacteria Neisseria meningitidis (also known as meningococcus). It involves the inflammation of the membranes of the central nervous system (including the brain) and depending on the stage of the disease, the symptoms include nausea, vomiting, confusion and severe pain. If the bacteria invade the bloodstream, it can damage the blood vessels and giving you internal bleeding. This is a potentially life-threatening disease and even if you receive antibiotic treatment, about 10-15% of people will die. According to the WHO, almost 1 million cases have been reported during the past 20 years in the so-called meningitis belt (ranging from Senegal in the west to Ethiopia in the east).

Yet, there are important improvements occurring thanks to large-scale vaccination campaigns against meningococcus serotype A (the other most common serotypes are B, C, Y and W135). The number of cases of meningitis reported annually has been declining since 2010 and in 2014, it was down to 11 500. CNN recently ran a news item on the struggle against meningococcus serotype A in Africa that is worth examining in greater detail. We will also look at the aftermath of a recent meningitis death of a toddler due to anti-vaccine parents using alternative medicine for two and a half weeks before attempting to seek real medical attention.

What is the background of the disease?

The CNN article is spares on background details of the pathogen and the disease, but gives us some information about recent outbreaks:

The bacterial disease infected a record 250,000 people — and caused 25,000 deaths — during an outbreak in 1996 and numbers have since come in annual waves, with rates of new infections as high 1 in 100 people in some areas. A second peak of almost 90,000 infections occurred in 2009.

A quarter of a million infections in 1996 with a 10% fatality rate. These figures are so large that they are hard to grasp for most people. For comparison, that is about the same number of people who get seriously harmed in Swedish traffic during approximately 83 years (using current estimates of about 3000 per year).

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Is the end in sight?

But now, less than 20 years after the record outbreak, elimination of the disease is in sight in this region across Africa — thanks to a vaccine. “It’s the first vaccine developed solely for a strain that’s Africa-centric,” says Steve Davis, President and CEO of PATH, the non-profit organization that led the development of the vaccine in collaboration with the World Health Organization (WHO). […] Six strains (types) of the bacteria can cause epidemics and are seen globally, but one dominates within this region — Strain A. “There was simply no vaccine for this strain,” says Davis.

There are many things that are impressive with this vaccine. It is very effective and has sharply reduced the number of cases. What is more is that this vaccine is especially developed for the serotype A that is one of the most common serotypes in Africa. This demonstrates the importance of tailoring the vaccine to the population it is supposed to be used with. Lastly, it is a vaccine that is the first of its kind, as there was no prior existing vaccine for this serotype.

What are some more details about this vaccine?

The new vaccine, known as MenAfriVac, began development in 2001, as part of the Meningitis Vaccine Project (MVP). […] Less than a decade later the vaccine was ready to go and was first introduced in Burkina Faso in 2010.

The fact that it took almost a decade from initial development to being ready for deployment shows how meticulous the research and testing is for a vaccine. This is in stark contrast to anti-vaccine activists who do not seem to think that vaccines go through any safety or efficacy testing at all.

The CNN article tells us that almost a quarter of a billion people (more precisely 235 million people) in the meningitis belt. The population vaccinated was primarily younger than 30 years old. What was even more interesting is that the vaccine not only prevents people from developing meningitis, it also provides sterilizing immunity since it also eliminates carriers from carrying the pathogens around passively without having symptoms. This is important because asymptomatic carriers increase the spread of the pathogen.

But the benefits do not end here. The vaccine can survive scorching temperatures of 40 degrees Celsius for several days, which loosens the requirement for constant cold storage that otherwise might get in the way of a successful vaccination program.

How does the article describe the results? As a whopping “Near-elimination of this form of the disease.” This is an enormously beneficial result and a stunning victory for meningitis vaccines. They show a cautions optimism, but warns that immunization rates have to be maintained for the protection to work. Despite the massive success, the disease is not yet eliminated.

What are the next steps?

Severely reducing the spread of the A serotype has been a stunning success, but there are many other serotypes that also need to be handled:

Numbers affected by Meningitis C have been rising in both Nigeria and Niger, resulting in 12,000 cases and 800 deaths in these countries within the first six months of 2015, and greater numbers are expected in this year. […] Stuart warns this is not the end of the epidemic and stresses the need to develop a pentavalent vaccine protecting against multiple strains, including A, C, W, X and Y

In other words, the next step is going to involve developing a vaccine that covers all of the serotypes to deal the final blow to this scourge. Yet researchers warn that they must not let serotype A creep back, and a top priority is to maintain high vaccine coverage.

How do anti-vaccine activists react?

Because a lot of anti-vaccine activists are privileged people living in their own personal anti-science bubble, not a lot of them have heard about this success.

There was recently a case of a toddler who got bacterial meningitis (currently unclear what pathogen it was caused by, but was likely vaccine preventable), but the parents refused to provide science-based medical treatment and instead preferred to use alternative medicine such as maple syrup. The parents, David and Collet Stephan, were recently convicted of “failing to provide the necessities of life”. They now face up to 5 years in prison (their sentencing date is June 13), but the most severe punishment for their ignorant stupidity is surely losing their son. These parents were also part of an alternative medicine company called Truehope that has been critically discussed on this website before.

In response to the conviction, David has posted a Facebook rant letter to the jury, where he promoted paranoid conspiracy theories and refused to take any personal responsibility for the death of his son:

Dear Jury,
I deeply Love each one of you and appreciate the tremendous sacrifice that you have made over the last 8 weeks. I only wish that you could’ve seen how you were being played by the crowns deception, drama and trickery that not only led to our key witnesses being muzzled, but has also now led to a dangerous precedent being set in Canada. The flood gates have now been opened and if we do not fall in line with parenting as seen fit by the government, we all stand in risk of criminal prosecution.

This conviction sets no such precedent because it is an uncontroversial application of the law. David and Collet gave various sorts of alternative medicine (such as maple syrup, hot peppers and horseradish) to their toddler who had meningitis instead of calling an ambulance right away. They sat by for over 2 weeks before taking real action. This is an obvious case of negligence and a failure to provide necessities for life.

Remember what the crown prosecutors closing remarks were to combat the fact that the ill equipped ambulance (sic) resulted in Ezekiel’s brain death. She communicated that this was not about him dying, but rather about whether or not his life was endangered at any point due to our actions.

Instead of accepting responsibility for the death of their son, the couple merely blames it on an “ill equipped (sic) ambulance” two and a half weeks later. He even goes so far as to insinuate that this was impossible to have foreseen:

How many parents have lost children for various reasons, all of which could be concluded that the child’s life was endangered and that the parents should have been able to foresee it? How many parents have had close calls to losing a child, wherein it could be concluded that the child’s life was endangered and the parents should have been able to foresee it? Whether medical attention is sought or not and your child lives, it is of no consequence. It is only about whether or not it can be proven that at some point your child’s life was endangered, and if so you may find yourselves in the same boat as us.

No, the entire point was that the parents did not seek medical attention in an emergency, but instead fed the child useless alternative medicine. This was not unpredictable or unforeseeable. It is not about whether or not the child’s life was in danger, but whether parents could have provided the necessities of life, but chose not to.

The flood gates have now been opened and my main concern is no longer for Collet and I, but rather for Canadian’s as a whole.
May Heaven help us all!

Bullshit.