Meningococcal infection is a frightening disease for doctors and parents alike. Symptoms can evolve rapidly, and, despite improvements in antibiotic treatment and intensive care, about 10% of patients still die, sometimes within hours of onset. Over 200 people die from acute meningococcal infection in Britain every year; it is now the single most common infectious cause of death in children.
These are some of the factors that make meningococcal infection such a high profile issue with the media. In general, public health risks that seem to strike suddenly and unpredictably are triggers for intense media interest, particularly when the rapid progression of the infection and the need for early diagnosis and treatment increase the sense of vulnerability. It is therefore not surprising that the recent outbreak in Pontypridd, south Wales, captured the media’s attention. The story was further fuelled by a political dimension, with the announcement last week in parliament by the Welsh health minister of an inquiry into the whole issue of meningitis in Wales. The high profile given to the story was predictable, given the size of the outbreak (13 cases, one of the largest in recent years), the fact that it occurred in a closely knit rural community against the background of a national increase, and that three people died (including a schoolboy and a teacher).
Beneath the rather sensationalist headlines the media reports were, on the whole, reasonably accurate, although many stories gave the impression that a new, more virulent strain of meningococcus had appeared for the first time. In fact, infections due to Neisseria meningitidis serogroup C type 2a (the strain responsible for the outbreak in Wales) are common in Britain, accounting for about 70% of all serogroup C meningococcal infections since the mid-1990s. This early misunderstanding of the microbiology highlights the importance of presenting complex public health issues as accurate and accessible “take home” messages for a non-specialist audience. Even with careful media management, early misunderstandings are difficult to correct later.
Inevitably, some journalists blamed the health authority for delaying the implementation of a vaccination programme and for not extending the programme to other, unaffected schools in the area. The reaction of parents in this situation is understandable, but there were good reasons why the health authority, following national guidelines, chose not to extend the vaccination programme: the currently available polysaccharide vaccines provide only suboptimal, short lived immunity, and they are ineffective in younger children (the group at greatest overall risk from disease).
The media both reflect and shape public opinion of events, and we must recognise the value of the media in communicating important public health messages to a wider audience. It is interesting to compare the media reaction to this outbreak with the recent furore over the measles, mumps, rubella (MMR) vaccine. It illustrates the public’s different perceptions of diseases such as measles, which has almost been eliminated, and meningococcal infection, for which no effective vaccine yet exists. When a new vaccine is first introduced and the disease incidence is high, concern about vaccine safety is low. As vaccine coverage increases, so inevitably do temporally (although not necessarily causally) associated adverse events after vaccination. As the disease incidence declines, attention shifts from the disease to the safety of the vaccine. Loss of confidence in the vaccine may occur at this stage, with a drop in vaccine coverage. This is followed by an outbreak, whereupon confidence in the vaccine is restored. This is exactly what happened with pertussis vaccine in the 1970s and is now happening with MMR vaccine.
For meningococcal vaccines, we are at the beginning of the cycle. Improved vaccines against serogroup C meningococcal disease are undergoing clinical trials, and if found to be safe and effective should be introduced to the childhood routine immunisation schedule within a few years. No doubt they will be greeted with great enthusiasm all round. We must address these sorts of issues up front with the media and with the public if we are to reinforce the importance of vaccination and break the cycle of fluctuating vaccine coverage. Correctly addressed, the media can help reinstall confidence in MMR vaccine by reminding the public of its extraordinary safety record and also of the potential for the return of epidemics. In 1965, three years before measles vaccine was introduced, 115 children died during a measles epidemic. The outbreak in Pontypridd is a sad but timely reminder of the potential for infectious diseases to kill young children.
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