Source: Medscape.com

Vaccines Decrease Rate of Bacterial Meningitis

A recent, retrospective study revealed that the incidence of bacterial meningitis decreased by 31% over 10 years, likely the result of vaccinations (Thigpen et al. 2011). In addition, the median age of those infected increased from 30.3 to 41.9 years, evidence that vaccinating the young has protected them from infections while leaving older, unvaccinated people more vulnerable.

The authors analyzed data on bacterial meningitis from 1998-1999 to 2006-2007 in 8 surveillance areas of the Emerging Infections Programs Network, which includes 17.4 million people. The 5 most common pathogens for bacterial meningitis were Haemophilus influenza type b (Hib), Streptococcus pneumonia, group B streptococcus (GBS), Listeria monocytogenes, and Neisseria meningitides. Cerebrospinal confirmation of the clinical diagnosis was required.

The beneficial effect of vaccines during the surveillance period is striking. The incidence of bacterial meningitis from Haemophilus influenza decreased by 35%. For strains of bacterial meningitis from Streptococcus pneumonia included in the PCV7 vaccine, infections decreased by 92%. Conversely, rates of meningitis from group B streptococcus, for which there is no vaccine, did not change.

Deadly Choices

In a recent Medscape One-on-One video interview, Eli Adashi, MD, discussed the dangers of the anti-vaccine movement with Paul Offit, MD, Chief of Infectious Disease at Children’s Hospital, Philadelphia, PA. Dr. Offit is a pediatrician and author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All, Basic Books, 2011.

It’s a Conspiracy…

According to the Centers for Disease Control and Prevention (CDC), “Unfounded claims can cause harm to children if they result in less protection for them against potentially serious diseases.”

However, judging from some of the online comments to Dr. Adashi’s program, not all health care workers are convinced of the value and safety of vaccines. Their uncertainty may be contributing to the 40% of parents who refuse or delay vaccination of their children, a factor that appears related to the increase in measles, mumps, and other outbreaks.

A recent blog written by Steven Salzberg published in Forbes regarding the importance of measles vaccination was attacked by Robert Schecter of “The Vaccine Machine,” a website that “fights the misinformation and propaganda disseminated by the Machine and its unwitting media allies and stands firmly in opposition to the forced vaccination of America’s children.” Schecter argues that the health risk from measles is exaggerated, “but more importantly we must begin to dismantle the hidden police [state] which already exists and has as its foundation mandatory vaccination.”

Yikes! If there’s a “hidden police state,” I guess it’s well hidden, because I haven’t found it yet. But I’ll keep looking…

While those who choose not to vaccinate themselves or their children may consider this their “right,” their refusal not only puts themselves at risk, but others as well, particularly those who are immunocompromised or with chronic medical conditions [Thigpen et al. 2011]. Unvaccinated newborns, who have yet to have a say in the matter, are the most vulnerable (Thigpen et al. 2011).

A Global Concern

The problem of bacterial meningitis may be better appreciated when examined from a global perspective. Data from the CDC are enlightening:

Haemophilus influenzae type b (Hib) is a bacterial disease that each year causes pneumonia and meningitis in young children, resulting in three million illnesses and 400,000 deaths. Bacterial meningitis alone kills more than 65,000 young children in the developing world each year. The United States has been able to virtually eliminate pediatric bacterial meningitis through several interventions including the introduction of Hib vaccines.

Your Son is Going to Die

Here is an excerpt from the Introduction of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.

On February 17, 2009, Robert Bazell, a science correspondent for NBC Nightly News, told the story of an unusual outbreak in Minnesota: a handful of children had contracted meningitis caused by the bacterium Haemophilus influenzae type b, or Hib. What made this outbreak so unusual was that it didn’t have to happen; a vaccine to prevent Hib had been around for twenty years. But most of the Minnesota children-including one who died from the disease-weren’t vaccinated. The problem wasn’t that their parents couldn’t afford vaccines, or that they didn’t have access to medical care, or that they didn’t know about the value of vaccines. The problem was that they were afraid: afraid that vaccines contained dangerous additives; or that children received too many vaccines too soon; or that vaccines caused autism, diabetes, multiple sclerosis, attention deficit disorder, learning disabilities, and hyperactivity. And despite scientific studies that should have been reassuring, many weren’t reassured. When the outbreak was over, one mother reconsidered her decision: “The doctor looked at me and said, Your son is going to die. He doesn’t have much time.’ Honestly, I never really understood how severe the risk [was] that we put our son at.”

Infants Don’t Get to Choose

While working as an ER physician several decades ago, I vividly remember treating one febrile 7 month old boy. Unlike most of the children I saw in the ER, this one wasn’t cranky, crying, or screaming. He just lay there, limp and quiet on his mother’s shoulder. I had never done a lumbar puncture on a 7 month old, but meningitis seemed likely. A spurt of green pus that shot through the needle and splattered onto my white coat confirmed the diagnosis. A helicopter ride to a tertiary medical center and vials of antibiotics saved the child’s life.

It would be nice if no one ever needed to participate in that scenario again, not doctor, parent, or patient. I hope that little boy never developed any neurological sequelae such as cognitive and behavioral dysfunction, deafness, seizures, speech and language deficits, spasticity, or vision loss. Moderate to severe sequelae of bacterial meningitis occur in approximately 25% of survivors. (Chandran et al. 2011).

Less vaccinations, more epilepsy

As an epileptologist, I have treated people suffering from intractable epilepsy due to meningitis. Of course, they were “lucky,” since they survived. The overall mortality rate of meningitis is 15%, which did not change during the 10 year surveillance period (Thigpen et al. 2011).

Conclusions

It’s ironic that modern science provides the power to eradicate epidemic infections (like measles), but irrational human behavior limits our ability to apply these tools, resulting in unnecessary morbidity and mortality for individuals and a costly societal burden. The educational efforts of the CDC, Dr. Offit, and others, as well as the observations presented by Thigpen and colleagues may convince some of those who doubt the value of vaccines to change their minds. Given the ongoing “debate” about the merits of vaccination, this New England Journal of Medicine study should be front-page news.

Adverse events may occur with any treatment, but the rigorous approval process of vaccinations by the Food and Drug Administration (FDA) as well as the excellent safety track record of current vaccines should reassure those who hesitate to vaccinate themselves or their children. Expanded coverage of the new PCV13 pneumococcal vaccine promises to be even more beneficial than the older PCV7 vaccine. However, for those who contract meningitis, case fatality rates remain at a stubborn 15%. Our limited ability to improve fatal outcomes further emphasizes the importance of vaccination for meningitis prevention.

Believe it.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.