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meningitis B toddler dies

The death of a toddler from meningitis B while an effective vaccine exists, which is  not given to her age group has led to a massive outcry. A petition to give the vaccine to other children has become the ‘most signed petition’ in the UK. The vaccine costs £75 a dose and children may need three doses but many in the media have said that is a small price for a life of a child. True but of course that is faulty logic; you would have to vaccinate the whole population spending many millions in order to save the life of a few as thankfully meningitis B is a rare disease with just 33 fatalities in the year.

The ethical problem this scenario presents is around the pillar of justice [see the four pillars of medical ethics in my book Medical School Interviews The Knowledge], particularly the concept of distributive justice – the fair distribution of resources. A utilitarian [greatest good for the greatest number] analysis showed that even if the vaccine cost nothing the cost of distribution, treating the side effects out weighed the benefits and resources would save more lives if spent elsewhere. Spending money on extending the vaccination  would divert funds from other services because there is a limited budget to be spent on health. NICE usually looks at affordability issue but Joint Committee on Vaccination and Immunisation is given the task regarding vaccinations. The majority of cases of meningitis B occur in infants so it was decided to protect this age group and not others.

Facts about meningitis 

Meningitis can be caused by numerous bacteria and viruses – meningitis simply means inflammation of the meninges of the brain.  One of the commonest causes is a bacterium called  Neisseria meningitidis.

There are thirteen different types of the neisseria meningitidis bacterium. Six of these – types A, B, C, W, X and Y – cause most of the disease cases worldwide. The most common types in the UK are B, C, W and Y. Since the MenC vaccine was introduced in the UK in 1999, there has been a big fall in cases of type C meningococcal disease (MenC). Around 90% of cases of meningococcal disease in the UK are currently caused by type B disease (MenB). Since 2009, cases of MenW disease have been on the increase in the UK

Overall, 1 in 20 cases of meningococcal disease result in death; death rates are higher for teenagers and young adults. 1 in 5 survivors have permanent effects such as skin scars, limb amputation(s), hearing loss, seizures and brain damage.

Between 5% and 11% of adults carry the bacteria harmlessly in their throats without any signs or symptoms of the disease. In teenagers this rate rises to 25%.

In the UK, three types of vaccine are offered to different age groups to protect against different types of meningococcal disease.

  1. The MenC vaccine: this protects against type C meningococcal disease. Babies receives doses at 3 months old and at 12-13 months old.
  2. The MenB vaccine: this new vaccine protects against type B meningococcal disease. Babies receives doses at 2, 4 and 12 months old.
  3. The MenACWY vaccine: this protects against four types of meningococcal disease – A, C, W and Y. This vaccine is given to teenagers and student freshers.  A new aggressive strain of Men W is affecting the UK , particularly teenagers and university students so this was introduced last year. {Those of you leaving school and heading off to Uni -make sure you have it!}