Meningitis is a mysterious and frightening illness.
The number of cases and deaths worldwide – and especially in Western countries – have fallen precipitously since the early 1990s, thanks to vaccination.
But meningitis is back in the headlines again because of large and unusual outbreak in Britain.
To date, there have been 29 confirmed or suspected cases of meningitis B. in Kent County. The toll includes two deaths, university students aged 18 and 21.
In the pandemic era, where we saw hundreds of millions of COVID-19 cases and at least seven million deaths, 29 possible cases and two deaths may seem insignificant.
What to know about meningitis and the outbreak in England
But the Kent outbreak is a reminder that you never know when the next infectious disease threat will arise.
Healthy young people rarely die, except of traumatic injuries in car crashes, and the occasional freak accident.
Yet, this meningitis outbreak began in a Canterbury nightclub, Club Chemistry, where young people were dancing, vaping, and snogging.
In other words, everyday activities for the college and university age demographic.
Meningococcal disease is an infection caused by a bacteria, Neisseria meningitidis.
There are many different subtypes of this bacteria, but five of the subtypes (A, B, C, W and Y) are responsible for the majority of meningitis cases.
Babies, who are at high risk because of their underdeveloped immune systems, are vaccinated against serogroup C meningococcal disease, and teens between grade 7 and 9 are vaccinated against MenC or MenACYW (depending on which province they live in.)
In Britain, babies are also vaccinated against MenB, but that program was only rolled out in 2015, so the students partying at Club Chemistry are not part of the vaccinated cohort.
Canada does not routinely offer vaccination to protect against serogroup B meningococcal disease. But two provinces, Nova Scotia and PEI, offer the shots free of charge to university students living in residence. (Between 2021 and 2023, there were meningitis cases and deaths at four Nova Scotia universities, all of then linked to students living in communal settings.)
Vaccination is not just for kids.
About one in 10 people, and one in four young adults, carry the MenB bacteria in the nose without causing symptoms or illness. On rare occasions, the bacteria can invade the body and cause serious illness, like inflammation of the lining of the brain and spinal cord (meningitis) or septicemia (blood poisoning).
Scientists really don’t know why the bacteria sometimes pass the barriers in the nose (a key part of the immune system) and invade the body. But it’s likely owing to a combination of the bacteria itself, behaviours and the environment.
In the Kent outbreak, it’s unclear if the bacteria itself is more invasive. (There are hundreds of strains and they all behave a bit differently.)
But there are concerns vaping played a part because it can damage the throat and facilitate the bacteria entering the body. And, of course, the bacteria spreads with close contact, of which there is much in a packed nightclub.
A fascinating aspect of the outbreak is that it involves members of Generation Lockdown, young people who, as teens, were holed up at home during the pandemic.
Are their immune systems weaker as a result? This is known as the “immunity debt” theory.
That being said, why did so many people get infected at Club Chemistry when they were doing exactly what students around the world do every day?
That’s the million dollar question.
The good news story in this outbreak is the public health response, which was swift and thorough.
To date, more than 9,300 young people in England have been vaccinated against MenB, and another 12,700 have been given antibiotics as a preventative treatment.
There is every indication the outbreak has peaked.
But now the debate is beginning in earnest about whether there should be catch-up MenB vaccination program for young adults in Britain.
And in other countries, like Canada, the discussion needs to happen on whether we should consider broader vaccination coverage to avoid a Kent situation.
The problem is that the vaccine for MenB doesn’t seem to be as effective as those for MenC and MenACYW. It’s not clear it prevents transmission, but it does lessen symptoms in those who are infected.
That leaves us with the old standby, a brisk public health response if a case does arise.
The outbreak, if nothing else, serves as a timely reminder that public health matters, locally as well as globally, and we can’t afford to skimp, even in non-pandemic times.