In February 2013 college student Emily Stillman died of meningitis. She was well-liked, smart, and healthy. And she had received her meningitis vaccine. What went wrong?
Meningitis is an infection of the membranes that line the brain and spinal cord. It can begin with cold-like symptoms but it’s usual symptoms are headache, stiff neck, fever, and sometimes a splotchy rash. Even if treated properly, it often leads to long-term health problems, and is too-often fatal. Because of this, prevention has been an important public health goal.
In the U.S., we’ve done a great job of preventing meningitis. Three of the most important bacteria that cause the disease now have effective vaccines.
Haemophilus influenzae type b (Hib) was a very common cause of childhood diseases, including ear infections. It was a common cause of epiglottitis, a disease that could quickly suffocate a young child. It also causes meningitis. As a medical student, we were instilled with a healthy respect for the disease. We learned the signs of epiglottitis, its appearance on X-ray. But we didn’t see that many cases. Since the introduction of the vaccine in the late 1980s, the incidence of severe disease due to Hib has dropped 99%.
Streptococcus pneumoniae (pneumococcus; sorry, no better nickname available) is a common cause of pneumonia, and like Hib, it can cause ear infections in children. It can also cause meningitis. Before the wide use of the vaccine, about 200 kids died every year of pneumococcus infections, including meningitis. Routine vaccination has led to a 99% decrease in severe pneumococcal disease in children.
The “classic” type of meningitis is caused by Neisseria meningitidis (meningococcus; also no good nickname). This is a bacteria that lives harmlessly in many people, but under the right conditions can migrate into the lining of the brain causing a devastating disease. Our success with vaccination against this disease has been a bit more complex than with the other two. There are many different types of this bacterium, identified by a capital letter. The most common in the U.S. are B, Y, C, W-135. Vaccination against Y, C, and W is has been very effective. In the U.S., type B is rare after infancy, and no vaccine is available. This is the type that killed Emily.
Emily’s case likely occurred outside of an outbreak, as most cases do. There have been, however, 2 outbreaks of type B on college campuses recently, at Princeton and at University of California Santa Barbara. The FDA and CDC allowed the use of a type B vaccine in these outbreaks, but this vaccine hasn’t been approved in the US. It has been used safely for years in Europe and Canada.
Meningitis caused by type B meningococcus is still very rare, and rarer still in outbreaks, but parents of kids heading off to college are worried, if my phone line is any indication. Families here, near the Canadian border, have crossed the bridge to get their kids vaccinated, sometimes in organized groups. I’m often asked if this is a good idea.
The absolute risk of a college-age kid dying from meningitis is very, very small. If it’s your kid though, that’s little comfort. I can’t tell my patients if they should get a vaccine that hasn’t been approved. Unapproved drugs have caused all sorts of problems over the years. But European and Canadian equivalents of the FDA are pretty good. It seems likely that a type B vaccine will be approved for use in the US at some point, but until then, I haven’t discouraged anyone from heading over the border to get one.
Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.