Meningitis: The argument for mass vaccinations

The UK may tighten guidelines on vaccinating against meningitis

The argument for routinely vaccinating against meningococcal meningitis is growing worldwide, due to a rising number of cases and new vaccines.

Only Egypt, China and Cuba currently immunise children routinely against strains of the potentially fatal brain disease.

The World Health Organisation says China claims to have its own vaccine against the A and C strains of the disease.

However, no information is available on the immunisation programme outside of China.

Egypt also claims to vaccinate all children under five against the A and C strains.

And Cuba has manufactured a vaccine against the B strain, which it says is effective.

The vaccine is being investigated by an international team.

Dr Yevgeny Tikhomirov, a meningitis expert at the World Health Organisation (WHO), says he would like to see an immunisation campaign against the A and C strains of meningococcal meningitis - particularly as new more effective vaccines will soon come on line.

But he says countries have to balance an immunisation programme against other health priorities.

"New technology, more resources and political pressure are pushing the argument for mass vaccination," he said.

However, the main debate at the moment is over tightening guidelines on how to respond to outbreaks of meningococcal meningitis - the only form of meningitis that causes epidemics.

The USA and Spain, for example, start vaccinating against the A and C strains as soon as one case has been confirmed by laboratory tests.

In Britain, action is not generally taken until there are at least two or three confirmed cases.

In the recent south Wales outbreak, mass vaccination of pupils and staff at local schools was not begun until three people had died of the disease.

The Spanish example

Spain had a big outbreak of meningitis C between 1995 and 1997.

"It created a social panic," said Dr Miguel Asturillo Ramirez, the European Medical Association's Spanish representative.

"Vaccinations were begun after one case was confirmed in the laboratory for anyone who had come into close contact with the person."

Most countries vaccinate after cases have been confirmed by a laboratory or when reported cases rise above a certain threshold.

The average threshold is 15 cases per 100,000 population, but in the USA the number is 10 cases.

Vaccinations are concentrated in areas where the risk is deemed highest.

The UK Primary Care Virology Group is calling for children to be routinely vaccinated against the A and C strains of meningococcal meningitis.

The C and B strains are the most common forms in the UK. There is no vaccine yet for the B strain in the West.

The vaccine for the A and C strains only lasts for up to five years in most patients and in children under four - the group most at risk from the disease - the effects can wear off even more rapidly.

But more effective vaccines are in the pipeline.

Study group

The lack of an effective long-term vaccine means no European country currently routinely vaccinations against the A and C strains, according to the European Medical Association.

The British government has set up a group to study the Welsh outbreak.

The Meningitis Research Foundation says one outcome could be a tightening of guidelines, in line with the Spanish example.

Britain has hit a 50-year peak in reported meningitis cases and the number of cluster cases is growing.

Around the world, many countries are still suffering from a world pandemic of the disease which began in 1996.

So far, at least 300,000 cases have been reported to the World Health Organisation (WHO).

Vaccinations for meningoccocal disease are not 100% effective

The most affected countries are in sub-Saharan Africa and include Nigeria, Burkina Faso, Mali, Cameroon, Chad and Niger.

Meningitis epidemics usually occur in cycles every eight to 12 years, but the gap between epidemics has been closing in recent years.

Apart from epidemics, there are approximately 1.2m cases of bacterial meningitis a year. Some 135,000 are fatal.

Around a third of fatalities are due to meningococcal meningitis.

In developed countries, the greatest risk is from the B and C strains of mengicoccal meningitis.

But in developing countries, there is also a threat from haemophilus influenzae (Hib) meningitis for which there is an effective vaccine.

Only around 10 developing countries routinely vaccinate newborn children against Hib meningitis.

One of the reasons is lack of money for an immunisation programme, but the WHO is trying to ensure vaccination is more widespread.

There is also a risk from the A strain of meningococcal meningitis.

Africa is the main region affected and travellers to countries hit by the disease are advised to be vaccinated before setting off.