The rare occasion of a meningococcal meningitis death draws major news headlines and vaccination clinics. The rare occasion of a vaccine-caused meningitis death is ignored. A Feb, 2008 press release from the Meningitis Research Foundation of Canada advocated that a new four-valent Menactra® meningococcal vaccine be funded for Public Health vaccination schedules. The foundation listed Dr Ron Gold as its “senior medical advisor”. (Dr Gold was a paid consultant to Aventis Pasteur when he wrote the flagrantly pro-vaccine-biased Your Child’s Best Shot: A Parent’s Guide to Immunization.) With extra promotion by the conflicted Canadan Paediatric Association, sure enough, in Sept, 2008 Health Canada approved Menactra®, to complement or replace the single-valent meningococcal C vaccine, Menjugate®.
Fast forward to Jan 25, 2011: a report from New Jersey told of the meningitis death of an athletic 17 yr old. He’d been vaccinated. According to the report, the New Jersey State Department of Health and Senior Services claimed, “The vaccine covers 90 percent of the most common strains of meningococcal infection.” (see title below: ‘Vaccinated N. J. teen’s death shocks family’) Just one week later, the Alberta government announced a new $2 million Menactra® vaccination program for grade nines.
Perhaps the meningitis which caused the teen’s death was the serogroup B type which isn’t represented in any vaccine currently available. A winter, 2010 cross-Canada study published in the Canadian Journal of Infectious Diseases & Medical Microbiology has shown that, “Due to the reduction in serogroup C invasive meningococcal disease (IMD), serogroup B now causes the majority of IMD in Canada.”
The National Advisory Committee on Immunization (NACI) has explained that the meningococcal C vaccine they previously recommended for infants has likely not protected them in recent years. The April, 2009 NACI Statement informs us that, “The epidemiology of IMD changes over time and varies depending on geographic location, season and age. Serogroup C can occur as sporadic cases or as part of community outbreaks, whereas serogroups Y and W135 tend to occur sporadically. Serogroup A is mainly a risk for travelers to endemic areas…. Outbreaks of serogroup C were fairly common in the past.” but, “In more recent years, there has been a significant decline in incidence of serogroup C IMD, likely, although not conclusively, due to the introduction of meningococcal C conjugate vaccine.” Included in the April 2010 Statement is the following information which needs updating: “After serogroup C, serogroup B has caused the second highest burden of disease within Canada. Rates are particularly high in infants and children < 4 years of age, but disease can occur at any age.”
From the facts provided by the winter, 2010 study and the NACI, it appears that while vaccinations have reduced the C serogroup, this has left an empty niche which the B has filled. But that’s not the only problem; the NACI also admits that, “because of the short incubation period of IMD (range 2 to 10 days, commonly 3 to 4 days) it is now generally accepted that the anamnestic [antibody memory] response cannot be relied upon to prevent disease and that circulating antibodies [from previous infection or repeated recent vaccination] are necessary for protection.” Considering all this, the NACI needs to update their Statement with a recommendation on how parents can protect their children by natural means. They should begin by telling them that it’s inadvisable to use a fever suppressant such as Tylenol. This type of drug inhibits immune response (even the very conservative American Academy of Pediatrics now admits to this) and so could mask the early tell tale symptoms of IMD that this response would otherwise produce. (See ‘Is Fear of Fever Hurting Our Children?’ by Edda West)
NACI statement of April, 2009:
Invasive meningococcal disease (IMD) is endemic to Canada. The epidemiology of IMD changes over time and varies depending on geographic location, season and age. Serogroup C can occur as sporadic cases or as part of community outbreaks, whereas serogroups Y and W135 tend to occur sporadically. Serogroup A is mainly a risk for travelers to endemic areas. Winter is typically a time of increased incidence. Various ages are affected differently in terms of incidence, as well as with respect to circulating serogroups that cause disease.
Since the 1950’s the overall incidence of IMD in Canada has remained
Figure 1 illustrates the trends in incidence of IMD by serogroup and year. Table 1 allows for a comparison of 12-year average rates and numbers of IMD cases for 1995-2006 compared to 2006, the most recent year for which there is complete data. Median ages and case fatality rates are also provided. Table 2 provides a breakdown of the IMD cases and rates by serogroup and province / territory for 2006. Table 3 provides the same data for a 12-year period from 1995-2006. Table 4 provides the IMD number and rates by serogroup and age group for 2006. The data for the figure and tables is derived from the national reporting system which receives and integrates reports from all provinces and territories(4). The figure and tables illustrate the following serogroup specific information:
Serogroup C: Outbreaks of serogroup C were fairly common in the past. Between 1999 and 2001, 8 outbreaks of serogroup C meningococcal disease occurred in Canada(5). In more recent years, there has been a significant decline in incidence of serogroup C IMD, likely, although not conclusively, due to the introduction of meningococcal C conjugate vaccine in routine vaccination programs and/or catch-up programs or mass immunization campaigns in all provinces and territories (see Table 5 for vaccination schedules in the provinces and territories).
Serogroup B: After serogroup C, serogroup B has caused the second highest burden of disease within Canada. Rates are particularly high in infants and children < 4 years of age, but disease can occur at any age. In 2006, Québec had a higher rate of serogroup B disease compared to other provinces. Since 2003, Québec has seen the introduction and increase of a strain of serogroup B Neisseria meningitidis identified as B:17:P1.19 sequence type ST-269(6). From March 2003 to June 2005, 38 cases of IMD have been attributed to this strain. Approximately 45% of the patients were aged 10 to 19 years and 26% were aged 20 to 39. The increase in serogroup B IMD two years after the introduction of a mass meningococcal vaccination program using conjugate C meningococcal vaccine for individuals 2 months to 20 years of age raises the possibility of serogroup replacement. The observed change in epidemiology could also be due to natural fluctuations in the circulating clones or due to capsular switching. There is currently no vaccine available in Canada for serogroup B.
Serogroup Y: Rates and numbers of serogroup Y IMD have remained stable over time. Cases of serogroup Y IMD have a higher median age because of the number of cases in the 25 – 65 and >65 age groups; however, serogroup Y IMD can occur at any age.
Serogroup W135 and A: These serogroups remain rare in Canada.