MENINGITIS AND VACCINES
When you hear about meningitis, you have the idea that it is a serious disease. Meningitis is an inflammation of the membranes that surround the brain and spinal cord. This inflammation is usually due to an infection by a pathogen (virus, bacteria and others).
The symptoms that meningitis affections usually present are fever, headache, general malaise, vomiting, muscle aches, later stiff neck among others. Faced with these symptoms we have to go to the emergency room of a medical center.
Viral meningitis as the name suggests are caused by viruses and although they can sometimes be serious or very serious, they are usually not as serious as bacteria. This type of meningitis is more common than bacterial, with about 7 cases per 100,000 inhabitants.
We will influence bacterial meningitis because although they are much less frequent, even infrequent, they can be very serious, causing amputations of large limbs (arms, legs), deafness or cognitive delay and even death. The incidence of these does not reach 1 case per 100,000 inhabitants but this is still only a statistic because you can be that case and when it affects you or your child you are in a serious situation.
The bacterium that most frequently causes bacterial meningitis in children is meningococcus. This can also be the cause of infections throughout the body known as sepsis and that is why many times it is referred to as meningococcal disease. There are several types or serogroups of meningococci (Serogroup B, Serogroup W, Serogroup C, Serogroup Y, Serogroup A) and this means that to combat you we also have several types of vaccines.
We are going to talk about these serogroups and the vaccines that we have:
The most frequent serogroup to date is meningococcal B but even so I want to emphasize that meningococcal B disease is not frequent but it is very serious (approximate mortality 10% and a risk of permanent sequelae of 20-30% among survivors (deafness, amputations, hydrocephalus, kidney failure).
The incidence in Spain is 0.30 cases per 100,000 people and per year (data from 2017-2018). The highest rates corresponded to those under 5 years of age (with an incidence of 5.85 cases per 100,000 inhabitants in children under one year of age, hence the importance of vaccinating as soon as possible) and with another peak in adolescents (15-19 years).
Thanks to vaccines, serogroup B cases are decreasing every year in Spain.
Meningococcal B vaccine
Yes; we have two vaccines, neither of them is financed by social security.
· Bexsero: can be administered from 2 months of age and thereafter.
· Trumenba: From 10 years of age (2 doses 6 months apart). It is a vaccine against meningococcus B widely known already in the States.
That is, if your child is 10 years old or older or and has not been vaccinated, you have two vaccines: Trumenba and Bexsero.
Yes, the Vaccine Advisory Committee of the Spanish Pediatric Association recommends vaccinating all children. It is recommended, if possible, to do it soon, at 3 months: THE BEFORE YOU ARE VACCINATED, THE BEFORE YOU WILL BE PROTECTED.
Until 2001 it was the most frequent of all serogroups. It was then that we started vaccination against meningococcus C. This vaccine is included in the funded vaccination schedule and is administered at 4 months, 12 months and 12 years.
The vaccination strategy has been so effective that meningococcal C meningitis rates have dropped dramatically around the world.
Meningococcus W and Y
Meningococci W and Y are strong, doubling and tripling the number of cases in the last 2-3 years.
They began to gain importance in 2000 when there was an epidemic outbreak in connection with the annual pilgrimage to Mecca. And since then, various outbreaks of meningococcus W and epidemics have been described in several countries, so the quadrivalent vaccine against Meningococcus A, C, W, Y is included in the vaccination schedule in England, the United States, Canada and others. It is mandatory in Saudi Arabia for all pilgrims to Mecca and essential if you go to Sub-Saharan Africa.
Meningococcus W and Y in Spain:
The incidence of meningococcus W and Y in Spain is low, although we are facing a worrying increase in the number of cases in the last 5 years.
Meningococcal W, Y and A vaccine
This vaccine exists in Spain with 2 trade names Nimenrix (from 6 weeks of life) and Menveo (from 2 years of age)
Nimenrix and Menveo, can be purchased in pharmacies at a price of 54 euros.
It is increasingly common to replace the 12-year-old meningitis C dose with the quadrivalent Men ACWY vaccine.
Today we find that health depends on each autonomous community and this vaccine has been included (financed) in the vaccination calendar of some communities and not in others. And that in some communities it is put at 12 months and in others at 12 years. We hope that in the near future there will be a common consensus on the administration of this vaccine and at the time of administration.
In summary, I join the opinion of the vast majority of pediatricians that although meningococcal disease is rare, the impact on families is so great (10% mortality and 20-30% serious and very serious sequelae ) that the vaccine against all serogroups should be included in the schedule and that in the meantime the families that can afford this economic cost vaccinate their children.