Alice Mittelman was an otherwise healthy and lively two-year-old, yet within two days of developing a slight temperature she died. Her family believe that, had they been living in America, where her father was born, she would be alive and well thanks to a routine childhood vaccination.
When Alice had first shown signs of illness, she was given Calpol and “was soon her old self, dancing around with her older sisters”, recalls her mother Laura. But the next day, Saturday, Alice had a high temperature and the family called out the doctor to their home in Dulwich, South London. “He gave her a thorough investigation and said it was just one of those things,” says Laura.
On Sunday, however, Alice was worse and another GP said she needed to be in hospital; the senior house officer said it was flu and sent the family home.
That evening Alice “was on the sofa moaning and not getting any better so we took her back to hospital,” says Laura. “By the time we got there — and it is only ten minutes down the road — she’d lost consciousness and had started to fit.” Although the family was assured that the illness had been caught in time, “after sedation Alice was fitting again and in the early hours her body started to shut down: her heart stopped, she had to be resuscitated and they told us she was severely disabled.
“We were in shock. After a brain stem test showed there was no activity and a diagnosis of meningitis was confirmed, she died.”
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It is a tragically familiar and frightening story; at least 50 babies and young children under the age of 5 in the UK die every year from serious pneumococcal diseases such as meningitis, septicaemia, bacteraemia and pneumonia. Many of those who survive are left brain damaged, epileptic and deaf. One infant in six who has pneumococcal meningitis dies.
This strain of meningitis has a slightly higher rate of death and disability than others such as meningitis C and Hib because it is particularly difficult to diagnose, often with no tell-tale septicaemic rash, which leads to delay in treatment. But what makes stories such as the Mittelmans’ even more heartbreaking is the fact that there is a vaccine, Prevenar, which offers a high degree of protection against 80 per cent of the invasive pneumococcal diseases that affect children between six months and two years including pneumococcal meningitis.
The vaccine is already given routinely in the US (where it was introduced in 2000) and in Australia, at two, four and six months of age.
It is available in the UK, but it is offered only to infants deemed at risk — those with immune deficiency, cochlear implants, CSF shunts, heart disease, sickle cell, liver, kidney or chronic respiratory diseases, and those who have previously had pneumococcal meningitis or other pneumococcal diseases.
This is in spite of the fact that many cases occur in otherwise healthy infants, according to RAPPID (Raising Awareness of Paediatric Pneumococcal Infection and Disease), which is campaigning for the vaccine’s introduction.
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RAPPID, whose members include parents who have lost a child or are bringing up a child damaged by pneumococcal disease, and healthcare professionals, also claim that even those infants in the “at risk” category are not being vaccinated, because GPs appear either not to have read or fully understood the Department of Health’s recommendation (in 2004, just 2,800 young children were vaccinated with Prevenar under the NHS).
Dr David McIntosh, consultant paediatrician at the Royal London Hospital and senior lecturer at Imperial College, London, says that even if GPs are aware of the recommendation for children at risk, it is very difficult for doctors to recognise the “at risk” factors. “These are so subtle that they often go unnoticed until the child suffers a serious infection and it is too late. The recommendation also fails to address the point that all babies and young children are at risk.”
Dr McIntosh says that by the age of five, a child’s risk diminishes sharply. But he thinks that those over two would benefit from catch-up programmes and herd immunity.
Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae, which is often found in the upper throat — the bacterium is responsible for life-threatening illnesses such as meningitis as well as for more common childhood illnesses such as chest and middle ear infections, and sinusitis. It is the lack of distinctive symptoms, and the speed with which pneumococcal meningitis takes hold, that makes it so dangerous.
Hannah Walker was eight months old when she contracted the disease. She became ill one Saturday morning but her parents, David, a sales rep, and his wife, Alison, were not overly concerned. But by lunchtime, with Hannah’s condition worsening, Alison called the emergency doctor, who suggested that the baby might have measles or chickenpox. Hannah was still poorly the next day, so her parents took her to Cheltenham General Hospital.
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There she was kept her under observation and given Calpol. Alison stayed with her until 10pm and went home. “When I phoned at 11pm they said she was asleep and I could collect her next morning,” she says. “But the next day I got a call saying she had taken a turn for the worse and they suspected meningitis.”
Hannah was transferred to Bristol Children’s Hospital, where she was put on a life-support machine; Alison and David were told there was little hope for her. Neurological scans and brain stem tests followed. Hannah responded to only one of these. Her parents took the agonising decision to switch off her life-support machine. “We were numb from shock,” says Alison. “A week before she had been a perfectly healthy baby.”
At a review of the case a doctor told the couple about the vaccine that can prevent the disease. In one of the largest studies into the safety and efficacy of Prevanar, conducted in northern California involving more than 37,000 children, the vaccine was shown to be 97.4 per cent effective. Statistics from the US Centre for Disease Control show a steep downward decline (78 per cent) in the incidence of those pneumococcal diseases covered by the vaccine in children under 2 after routine vaccination.
A year ago the Joint Committee on Vaccination and Immunisation, which advises the Department of Health, accepted in principle the introduction of a pneumococcal vaccine for infants and young children; in October it set out its recommendations for the number of doses required and at what ages these should be given. While the Department of Health is now considering these, RAPPID is concerned about the length of time it is taking for the vaccine to be introduced. (Of course cost may be a factor — it is estimated at up to £160, including booster — per child; there may also be the public’s concern about so-called “vaccine overload” to consider.)
As Dr Paul Stillman, a GP from Crawley, Surrey, who runs a vocational training scheme for young doctors at East Surrey Hospital, Redhill, and who is an adviser to RAPPID, points out: “Fifty infants are dying every year; this tragedy will continue until we get early childhood vaccination for all. Early diagnosis of pneumococcal meningitis is virtually impossible. Vaccination seems the only sensible way forward.”
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www.meningitis-trust.org; 24-hour helpline: 0845 6000800
Private vaccinations are available through clinics that offer single MMR vaccines.