Meningitis is, among other things, a reminder that many diseases are examples of what the biologist Conrad Waddington called canalisation: the way in which diverse biological causes can produce much the same physiological result. Disease is generally defined not by the cause but by the outcome: in this case, an inflammation of the tissue surrounding the brain and spinal cord, which can be caused by various strains of bacteria as well as by viruses and even by fungi.
That inflammation can provoke fever, headaches and sickness, but the most serious worry is sepsis, which can cause death or permanent brain injury. That’s why a meningitis outbreak like that at the University of Kent in Canterbury is a grave matter, as the two deaths so far have indicated. All of the confirmed cases have required hospital admission.
The Kent cases are specifically of meningitis B (MenB), which is caused by a particular type of bacteria that normally lives in the throat. Around 10% of the population, and perhaps as many as 25% of students and young people, are asymptomatic carriers, but the bacterium becomes dangerous if it gets into the blood or spinal fluid.
It’s not yet known why some people are susceptible and others not. The disease is only mildly infectious, transmitted for example by intimate bodily contact, sharing vapes, or coughing. Anyone can get it, but children and young adults are most at risk. The treatment is a course of antibiotics, which is generally effective in both suppressing the disease and reducing transmission. But early intervention is needed to prevent a risk of the most serious effects.
Meningitis offers a textbook case for the value of vaccines. Each strain demands a different vaccine, but vaccination programmes have been effective in reducing infection rates. The variant of the disease caused by so-called meningococcal group C bacteria (MenC) has become rare since a vaccine was introduced in 1999, falling from a few thousand to a few tens of cases annually in the UK.
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The vaccine was tragically too late for some, like the poet Michael Rosen’s son Eddie, who died of MenC in 1999. Vaccines for other bacterial groups are also now used, and around 70% of teenagers are covered by them.
But a vaccine for MenB wasn’t introduced until 2015, so only those younger than 11 or 12 have had it. Several hundred students at the University of Kent deemed to be at high risk are being given the vaccine now, and thousands have been offered preventative antibiotics.
The scheme has been extended to students at some other Kent schools and colleges; one student at a London college has also been diagnosed with meningitis linked to the Kent outbreak.
About 20,000 doses of the vaccine have also been released by the NHS to pharmacies for private jabs, although it’s not clear if this will meet the demand. The Joint Committee on Vaccination and Immunisation is considering whether the vaccines should be made more widely available at universities and sixth forms. Right now, though, the risk is low. At the time of writing, it looks as though the number of cases (both confirmed and suspected) may have peaked on March 20 and is falling.
The sight of people in masks queuing for a vaccine of course invokes memories of the Covid pandemic, and the comparisons are instructive. MenB is considerably less infectious, as the bacteria are not airborne. But the current outbreak has been traced to a nightclub in Canterbury, where the conditions – crowded and with plenty of physical and romantic contact – were ideal for transmission: a “perfect storm”, as Andrew Pollard, director of the Oxford Vaccine Group, told the Guardian.
It seems possible there may have been a “superspreader”, an asymptomatic individual with a high bacterial load. This lower transmission and the existence of a vaccine and an antibiotic prophylactic all make an outbreak like this much less alarming than Covid.
It’s a reminder too that there are different demographic risk profiles for different infectious diseases – this time it’s the young, not the elderly, who are at most risk. While the Covid pandemic showed the serious consequences of school closures for the education and mental well-being of children and young people, there’s no one-size-fits-all answer to that problem for potential future pandemics.
Perhaps most of all, this is a reminder of the importance of effective vaccination programmes and of the significance of behavioural patterns (including mask-wearing) for transmission of infectious disease. With a growing appetite on the right for revisionist pandemic history and libertarian future plans, the lessons are worth repeating.
