Two people have died of meningitis in Kent: an eighteen year old year 13 student named as Juliette, and an unnamed 21-year-old. The outbreak has centred on a nightclub, Club Chemistry, and on a private party. Since news of the outbreak broke, the newspapers and television have been full of images of students queuing patiently for prophylactic antibiotics. Concerns have been raised that the UK Health Security Agency could have raised the alarm hours, or perhaps a day, earlier.
Some of the cases have been confirmed as meningitis B, a strain for which adolescents are not vaccinated. Infants are offered the vaccine at eight and 12 weeks and at one year, but protection wanes after about five years. The Joint Committee on Vaccination and Immunisation (JCVI) has previously judged that offering a booster in adolescence is not cost-effective.
Nothing diminishes the grief for the bereaved families, but the wider context is one of astonishing improvement. In developed countries, deaths from meningitis have declined by over 80 per cent in the past 40 years. Britain has pioneered childhood meningitis vaccines. Over the same period, starting from a better baseline, British deaths have declined by 70 per cent.
The worthwhile urge to improve care has to be thoughtful, not just urgent
A school friend said Juliette had been in PE only at the start of the week. Such a rapid decline is almost unimaginable. For most of human history, it was normal. At the same age as Juliette, I read Jane Austen for my A-level and could not understand why she made such a fuss of healthy young characters getting a fever.
Like most teenage boys, I underestimated Austen and had little sense of history. Austen was a tough woman, and a realist. She lived in a world where it was perfectly common to be fit and healthy on Monday, mildly unwell on Tuesday, and dead by the weekend. This is not the world we live in today.
Deaths like these get publicity because they happen so seldom. They deserve the attention, and we should be doing everything possible to reduce them further. But amid the usual blaze of bad news, it is worth noting that improvements are real. Modern medicine, at least, offers a Whig view of history. For most of human existence it did more harm than good. About a century ago, that changed. Our public health measures, our technology and our understanding have all improved. The result is that very few parents today have to bury their children.
Around 10 per cent of us carry Neisseria meningitidis asymptomatically at any time. Why does the bug suddenly flare up and cause trouble? Nigeria sees seasonal outbreaks following Saharan dust storms that irritate the mucous membranes of the nose and throat. In Britain, the smaller outbreaks are less explicable.
Being slow to suspect meningitis – when the bug affects the brain and spinal cord – or meningococcal sepsis, when it spreads in the blood and causes the tiny bleeds that give rise to the non-blanching rash, can be fatal.
At the same time, both diseases are over-suspected by frightened patients, parents, and inexperienced doctors, most of whom have read about meningitis but have never seen a case. Similar rashes are common, and mild viruses can also cause neck stiffness and pain from bright light. The result is overuse of powerful antibiotics, avoidable hospital admissions, unnecessary lumbar punctures, and needless CT scans whose radiation brings its own dangers, particularly for the young. Sometimes doctors are insufficiently worried. Often, the reverse is true. The worthwhile urge to improve care has to be thoughtful, not just urgent.
Teenagers are vaccinated against several meningococcal strains. Consideration should be given to adding meningitis B boosters in adolescence, but we should recognise that the question has already been thought about seriously. The JCVI is not frivolous, and their judgements can be wrong, but they are made carefully.
This thoughtfulness, the careful weighing of imperfect data against real-world outcomes, is a hallmark of progress. We undermine ourselves when we minimise our achievements. The academic Karl Popper warned that intellectuals talked us into believing that the modern world was hell and that the misjudgement undermined us. He wrote:
From any history book you can learn for yourselves whether our own age, which has abolished slavery, is not the best age of which we have historical knowledge.
That so few parents see their children die is evidence too. We are perfectly reasonable to be shaken when it does happen, or worried, or saddened by another’s loss – but it’s a mistake to let our horror curdle into pessimism. The deaths in Kent will prompt reflection on what might have been done better and what should change. Our sorrow is evidence of how rare such deaths have become. The attention we pay is evidence of our intent to make them rarer still.
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