TCS Daily

Well at Breakfast, Dead by Dinner

By Steve Haynes - May 25, 2004 12:00 AM

Sue-Anne Sanig is one of those special people that from time to time you have the privilege to meet in life. At our first meeting she recounted in a controlled but sensitive way how her son Stephen was perfectly well at school that day: full of energy when he arrived home.

Later he put on his sweater complaining of cold. In fact he was burning hot.

That evening Sue-Anne and husband Michael took Stephen to hospital with fever and severe pain in his joints: they thought he was having a heart attack. By 8:40 the next morning the seven-year-old Australian was dead: a victim of Neisseria meningitides, a lethal bacteria responsible for meningococcal meningitis.

Such is the ferocity with which the bacteria takes hold. One microbiologist and infectious disease expert professes, "I've seen cases where someone has been well at breakfast and dead by dinner!"

Under the banner of the Stephen Sanig Foundation, Sue-Anne Sanig is now "working with all Australians in the fight against meningococcal disease," dedicating her life to ensuring that her day of absolute grief is experienced by as few parents as possible.

On a global basis the pain that was suffered by the Sanig family is experienced more than 170,000 times a year, more so by African and Asian families.

Meningococcal disease includes meningitis (inflammation of the brain lining -- meninges) and septicemia (blood poisoning). Meningococcal meningitis (Neisseria meningitidis) is only one of three potentially lethal forms of meningitis caused by acute bacteria infection: the other causative agents are Haemophilus influenza and Streptococcal pneumonia.

Acute bacterial meningitis is a serious life-threatening disease, the specific causes of which vary at different ages and in different communities. Without treatment, the mortality is 70 to 90 percent. It occurs most commonly in children, the highest incidence being in the first month of life; the incidence is relatively low in young adults but increases again in the elderly.

Bacterial meningitis remains a major threat to global health, accounting for an estimated 171,000 deaths worldwide per year. Case fatality rates from bacterial meningitis remain at 5-10 percent in industrialized countries, and are even higher in the developing world. Between 10-20 percent of survivors develop permanent health problems such as epilepsy, mental retardation or sensorineural deafness.

Since the introduction of Haemophilus influenza type b (Hib) vaccines, Neisseria meningitidis and Streptococcal pneumonia have become the commonest causes of bacterial meningitis in the world. Neisseria meningitidis moreover is the only bacterium capable of generating epidemics of meningitis, with the Group A strain being the most devastating.

The group A meningococcus has historically been the main cause of epidemic meningococcal disease and still predominates in Africa during both endemic and epidemic periods.

The highest number of cases and the highest burden of disease occur in sub-Saharan Africa in an area that is referred to as the meningitis belt. This is the area between Senegal and Ethiopia. Epidemics occur in irregular cycles every 5 to 12 years, last for two to three dry seasons, dying out during the intervening rainy seasons.

The size of these epidemics can be enormous, with attack rates as high as 400-800 per 100,000. During the 1996 epidemic in sub-Saharan Africa, around 200,000 cases were reported with 20,000 deaths.

Asia has also had some major epidemics of group A meningococcus in the last 30 years (China, 1979 and 1980; Mongolia, 1994-1995).

A Hajj-associated outbreak of N. meningitidis in Singapore occurred in 2000 and 2001 among Muslim pilgrims returning from the annual pilgrimage.

In 2000, the attack rate was 25 cases per 100,000 pilgrims. After the introduction of the meningococcal vaccine for the Hajj in 2001, no pilgrim developed the disease, but the disease burden shifted to unvaccinated contacts and dissemination into the wider community was observed (17 percent occurred in non-Muslim Chinese).

The estimated attack rates for household contacts of returning pilgrims were 18 and 28 cases per 100,000 contacts for the years 2000 and 2001, respectively. The case fatality rate for infection with this outbreak strain was 37 percent for all Hajj-related cases.

There are now a number of vaccines available to treat Hib, meningococcal, and pneumococcal meningitis.

In Australia for example, the Hib vaccine has been in the routine childhood immunization schedule since 1993 and has eliminated more than 95 percent of cases of Hib meningitis.

There are two different types of vaccine against pneumococcal meningitis (the conjugate pneumococcal vaccine and the polysaccharide pneumococcal vaccine) and conjugate and polysaccharide meningococcal vaccines.

We have learnt from dealing with HIV/AIDS in resource poor countries that it is more about overcoming the barriers of access to medicines (including lack of political will, poor health care infrastructure and inadequate skilled medical and scientific personnel) than the availability of medicines themselves. The same is true in the struggle to reduce the mortality and morbidity associated with meningitis.

There may be global availability of medicines and vaccines, but after that the playing field is far from level, as the incidence and burden of disease in resource poor countries clearly demonstrates. There may be enough medicines and vaccines: there are just not enough Sue-Anne Sanigs.

The author is a freelance journalist and Director with Medicines Australia.


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