Not an epidemic

Much has been made of meningitis as a random killer of children, and there is no doubt that it is horrendous and frightening in its rapid, potentially fatal onset. But just how much actual risk does your child face?

Although the plan is to give all children the vaccine, rather than simply individual groups at high risk, children between five and fifteen are at virtually no risk of contracting meningitis C. In the five year period between 1994 and 1999, group C meningococcal disease killed approximately 20 babies under one, 21 babies aged one, 18 two year olds, approximately 15 three year olds, a handful of four, five and six year olds, and almost no other children under adolescence.

After babies are a year old, they develop active immunity by being exposed to a non pathogenic form of meningococcus.

Casualties did not pick up again until the age of fifteen through twenty, the so called highest cluster. In this age category, meningitis killed some 12 fifteen year olds, approximately 30 sixteen year olds, 12 seventeen year olds, about 18 eighteen year olds, about 18 nineteen year olds, and 10 twenty year olds over five years. So, in total, the disease killed approximately 200 young children, or an average of 40 children a year (70 a year in 1999).

While no one wishes to denigrate the tragic loss of these lives, in strictly epidemiological terms, the death rate of this form of meningitis is small potatoes.

It rates well behind many accidents as conditions which account for appreciable numbers of childhood deaths. For instance, your baby is five times more likely to drown in his bathtub and 86 times more likely to die of cot death than die from meningitis C. Six times as many children and young adults get knocked over and killed by cars than die of meningitis C. British traffic deaths of all varieties among children representing the highest fatalities among this age group in all of Europe claim the lives of 1,309 children and young adults every year more than 32 times the rate of meningitis deaths.

If there were an average of 50 childhood deaths from meningitis C in 1998 and there are 14 million British children, generally speaking, your child's chances of catching this disease at the moment are one in 200,000, with slightly higher risks in babyhood and late teens. However, it is the tragic swiftness of the disease's deadly progress and the existence of so called local clusters that placed the disease on the front pages. Media coverage, more than the actual prevalence of the disease, accounts for its high profile and also for the irrational fear instilled in the public mind about it.

No one would wish to put a price tag on the heads of these dead children. But one must question the wisdom of throwing such heavy economic resources at a disease with such relatively small fatalities, rather than simply concentrating on groups at high risk: those without spleens, with chronic underlying illness, and in crowded or impoverished conditions.

Heikki Peltola, professor of infectious diseases and pediatrician at the University of Helsinki and the Hospital for Children and Adolescents, confirmed that although the UK has a higher per capita incidence of this disease than other countries do, including his native Finland, "The question was whether the incidence of this diease was high enough to merit mass immunisation. In no country is there an epidemic of this disease". As he wrote recently in an article about meningitis vaccination (Drugs, 1998; 55: 347-66): "Generally speaking, the incidence of meningococcal disease is too low to indicate vaccinations for the whole population, or even children, but some risk groups and epidemics are important exceptions."