Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Is "just use a vaccine" the only answer?
- Hilary Butler (9 September 2001)
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Re: Is "just use a vaccine" the only answer?
- Robyn Whittaker (11 September 2001)
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Response to Robyn Whittaker's letter.
- Hilary Butler (22 September 2001)
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Meningitis and Later life Cancer
- Eric Westhagen (18 January 2004)
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Hilary Butler, Free-lance Journalist Home
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Dear Sir, In this issue's wide ranging Editorial on the global burden of meningitis, the New Zealand author, Keith Grimwood, Professor of Paediatrics At Wellington School of Medicine and Health Sciences, discusses data from Canada and Melbourne, which is interesting, as is Bedford et al's questionnaire results. He also briefly touches on the disease burden in countries which don't use certain vaccines because of cost. New Zealand is hoping to be at the forefront of the development of a vaccine against Meningitis type B. According to media files, we are in the 11th year of an epidemic estimated to have another 10 years to run, and have a unique sub-type. As of August 5th this year, there had been 296 cases, and 15 deaths. Last year, there were 476 cases, nationwide, and 18 deaths. In 1999 there were 505 cases and 23 deaths. The total is now well over 3,000 for the 10 1/2 years. This year, the disease burden in Auckland has been primarily in the adolescent age, from 10 - 14, and according to Public Health Unit registrar, Dr Robyn Whittaker, "These teenagers include white, middle- calss kids. Everyone is susceptible...) (New Zealand Herald, August 2, 2001, A7). Up until this year, the bigger numbers of the cases in Auckland have hit the under-ones in South Auckland. This being the eleventh year of a predicted 21 year epidemic, a unique opportunity exists for someone to publish a study, not only using the parameters Keith Grimwood discusses to clarify the outcomes for those already having had the disease (educational intervention) but also about other factors not investigated thoroughly enough to date. The worldwide vaccination call may be the mood of the moment, but from the long-term New Zealand statistics, the causes of death from any sort of meningitis have gone in swings and roundabouts. Sometimes it is meningitis A, sometimes Hib, sometimes meningitis B. But overall, when you look at New Zealand deaths in general, while the Hib vaccine may have dealt with one problem, it could be said that it simply assisted in clearing the way for another pathogen to step into its shoes. Because unlike the state, the total annual deaths from meningitis of any sort, do not appear to have decreased. It is no co-incidence, that in this country, the meningitis disease burden was primarily seen in the lower-socioeconomic group who suffer major inequities in housing, education, parenting skills, nutritional knowledge, and job opportunities. Which are the very living skills also lacking in the under-developed countries who cannot afford the vaccine. Though they also have the additional problems of civil war, or political goonism, and often not being able to obtain good food, skills, and necessities of life. At least here, everyone has a choice as to what to buy with what monetary resources they have. Observation of many middle-class white adolescents - and some upper class one for that matter, shows that while the monetary problems of this "class" are perhaps not as pressing as those previously stated to be at risk, some other living skills (in particular, nutrition and habits which increase the spread of pathogens of any kind) would appear to be equally as bankrupt as many lower-socioeconomic people. That aside, as we know in this family, at a certain age, teenagers congregate far too regularly in little tribal huddles under the big M sign, or whatever fast and cheap option is available to them. To sit in a food hall, and observe what these teenagers fill their tanks on, is akin to wondering how a car, supposed to be fueled on 91 octane, will function on sugar-water. As parents, getting a good diet and life skills into this age group is hard work. And requires ongoing persistence, and skillful maneouvring - something many parents opt out of. But the mental image adolescents have, that junk food is okay as a primary nutritional source, is certainly not helped when you go to the major children's hospital in this country, to find that right in the major entry-way is ... a MacDonald's. In a world in which the bacteria types often change, new types arise, and health finances are becoming increasingly more restricted, to think only of a vaccine, is missing a huge opportunity. Which is that of identifying the preventable risk factors at both a societal and immunological level, to any meningitis, no matter the type, and reducing those by deliberate social intervention by the front line medical profession who see these cases. This could lead to a grass roots plan to assist in reducing the global burden of actual meningitis cases - no matter what the pathogen. More importantly, it is also possible that the attempt to educate those most susceptible to menigitis might also fix the problems of rampant diabetes, obesity, heart disease, other respiratory infections, and other diseases rampant through life-skill deficiencies. There may come a time, when someone looks at how Hospital funding is actually used in this country, that such a study will be an economic necessity. Since without it, there might be no end to the rapidly burgeoning funding being put into being ambulances at the bottom of the life-skill-deficiency cliffs. While other who have problems not of their making, are placed on endless waiting lists. Sincerely, Hilary Butler. |
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Robyn Whittaker, Public Health Medicine Registrar Public Health Protection, Auckland District Health Board
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RESPONSE TO HILARY BUTLER LETTER (BMJ 2001; 323: 523-4) We would like to respond to Hilary Butler's letter regarding a recent BMJ editorial. While we share Ms Butler's view regarding the need to address socio-economic determinants of this disease we would like to correct several statements that might mislead your readers. Firstly, it must be stated that the group with the highest incidence of meningococcal disease remains the under one year-olds. Unfortunately Ms Butler's quote was based on a misquote from the New Zealand Herald that was later retracted. Secondly, we would like to point out that New Zealand has not been ignoring potentially modifiable risk factors. This unit has been involved in a large case-control study attempting to identify potentially modifiable risk factors for this serogroup B meningococcal disease epidemic . Risk of disease in children under 8 years of age was strongly associated with overcrowding, as measured by the number of adolescent and adult (10 years and older) household members per room [odds ratio 10.7, 95% confidence interval 3.9-29.5], resulting in a doubling of risk with the addition of 2 adolescents or adults to a 6-room house. Risk of disease was also associated with analgesic use by the child, number of days at large social gatherings, number of smokers in the household, sharing an item of food, drink, or pacifier, and preceding symptoms of a respiratory infection in a household member. Many of these risk factors are potentially modifiable. In particular, this has sparked collaboration between regional health agencies and the state housing provider (Housing New Zealand) in tackling overcrowding in those areas with the highest rates of meningococcal disease and the highest proportion of crowded homes in New Zealand. This intervention, which is not yet evaluated, involves adding rooms, improved insulation, and linking families to support agencies. R. Whittaker (Public Health Medicine Registrar), C. Bullen (Public Health Medicine Specialist), N.Jones (Public Health Medicine Specialist) Public Health Protection, Auckland District Health Board, Private Bag 92-605, Symonds St, Auckland, New Zealand |
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Hilary Butler, Freelance Journalist Home
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Dear Sir, It is reassuring to see that someone in this country has been involved in looking at a few of the many potential modifiable risk factors for meningitis. Persuading the Government housing provider to add rooms to crowded houses, improve insulation, and getting the medical profession to link families to support agencies could potentially be useful,... providing the families who rent these houses, can be persuaded not to bring in more people to fill up the additional rooms, as is their culture... and actually use the support agencies to which they are recommended. The problem is that these minor state funded home adjustments, and referral to support agencies, don't actually address what the importance of what goes on in the top two inches of the at-risk population's cranial grey-matter. For instance, how does this eliminate smoking - a major risk factor in this group for SIDS as well as meningitis? The study mentioned found an association with the use of analgesics (which not only worsens the outcome for meninigitis, but also for chickenpox and all other viral infections). The inappropriate use of Pamol by parents to keep children quiet has become rampant in this country, yet little is done to educate any parents as to the risks to a child's immune system of paracetamol. Yet the studies in the medical literature are legion. Keeping people drier and warmer may make them feel more comfortable, but it does not deal with the other vital issues related to the fact that we are what we eat, and what we put into the body dramatically affects the way the immune system works. To bring up children well and appropriately, requires head knowledge and an understanding as to why. These are life skills which can be applied, no matter where, or under what circumstances you live. A start has been made on the "brick and mortar" aspects. But is this enough? All people concerned about Meningococcal meningitis world-wide would be equally as interested in any studies done on the impact of improving "parenting skills" and whether "habit re-education" this might have far broader reaching implications on meningitis and health in general. Sincerely, Hilary Butler. |
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Eric Westhagen, Brandon Consultants, Lmtd. 537 Washington Street, Brandon, Wisconsin
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Indeed the association with developmental problems associated with certain deficits resulting from early age bacterial meningitis is a worthy topic. But I have yet to find recognition or analysis of a possible link between the complications which are a legacy of bacterial meningitis and certain cancers developed at a much later time. Conceivably their might be a neoplastic response to early tissue damage and could take the form of any of the CNS cancers. But my question concerning this is more than curiosity. Such cancers with their origins from an early insult might have a far better outcome than neoplasms appearing spontaneously or resulting from developing genetic failures. In fact individuals who have experienced surprisingly favorable outcomes for such cancers as glioblastoma multiform, might be the beneficiaries of such a process. In their cases, excising and radiation could amount to a cure. Competing interests: None declared |
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