Early detection of meningococcal meningitis

The World Today - Thursday, July  25, 2002 12:25

COMPERE: Medical specialists are facing increasing pressure over public concerns for the detection and early treatment for patients presenting with potential meningococcal meningitis. But the experts admit there are no fail-proof methods of detection.

The attention given to the Australian backpacker in Venice, aged in his late 20's, and the further death of a 7-year-old in NSW has exacerbated public fears.

The young girl was the fourth fatality from the bacterial disease in the state in a number of days, the 13th so far this year.

The girl's parents have complained that they were kept waiting for several hours before their daughter was diagnosed and treated by medical staff at the hospital. They say earlier diagnosis may have allowed prophylactic antibiotics to save their daughter.

But as Tanya Nolan reports for us specialists also point out that the rates of infection and fatalities across Australia are no greater than they were last year.

TANYA NOLAN: The death of 7-year-old Rebecca Calverley is the latest example of how difficult meningococcal meningitis is to detect and treat.

Vomiting and complaining of bad pain in her legs, the little girl was admitted to the emergency department at Wyong hospital late on Monday night.

Her mother describes how she watched her daughter's condition worsen, while they waited for six hours before a blood test was done to determine whether she was suffering from the deadly bacterial infection.

But by then it was too late, and just hours later, the child was dead, her parents left wondering how it could've happened, when they responded quickly in seeking medical attention.

Chief executive of the Central Coast area health service John Blackwell says while he can't discuss the case in detail, any concerns will be investigated.

JOHN BLACKWELL: I understand that the parents have some concerns in relation to the clinical treatment.

Now, we've offered to discuss those concerns with the parents and of course, understandably they're very distressed at this very sad time for them and as parents they would want to know that everything possible was done for their daughter.

TANYA NOLAN: And was it?

JOHN BLACKWELL: What I've done is asked for a report on the clinical treatment of the case and I don't have that to hand as yet and that will take a week or two to prepare. But what we need to do first is sit down with the parents and understand what their concern in relation to the treatment may have been.

Mr Blackwell says the hospital adheres to national guidelines when it comes to dealing with potential cases of meningococcal meningitis.

But even the man who helped draft those guidelines according to world's best practice concedes there is no perfect testing method by which to detect the disease within 48 hours.

And doctor Robert Hall, chair of the meningococcal committee for the Communicable Diseases Network of Australia, says it's ultimately a combination of factors that will determine whether the disease is diagnosed early enough.

ROBERT HALL: There are a number of tests that are available for the diagnosis of this disease. They're not all 100 per cent reliable and they all take time.

TANYA NOLAN: So, given that the disease can act so much quicker than that in claiming it's victims, are there adequate testing procedures available?

ROBERT HALL: Well, this is a question of the available technology. At the present moment, certainly for the rapid onset, rapid development forms of disease; the clinical judgements need to be made.

TANYA NOLAN: Is it one of the first things that medical specialists should be checking for if someone presents with symptoms that they suspect to be meningococcal meningitis?

ROBERT HALL: My view would be that meningococcal disease is something that should be borne in the back of the mind.

But after all is said and done, even though it is a very serious disease it is not common and it is likely that a person who's got a temperature for instance will in fact turn out to have another disease.

TANYA NOLAN: But Dr Hall doesn't advocate that antibiotics are administered as a first course of action before the disease is diagnosed, and he says the only two vaccines available don't cover the most common strain of the infection, and aren't effective in young children.

New south Wales health minister Craig Knowles says a clinical review will be conducted into the case of the 7-year-old girl, but opposition health spokeswoman Jillian Skinner says that's not going far enough.

JILLIAN SKINNER: Staff in emergency departments right across the hospital system have been telling me they fear that because of the short staff, because of the delays in getting to patients that there are patients who are at risk and one has to wonder whether this is not a case in this young child's very tragic death.

TANYA NOLAN: The health minister though, says that you can't extrapolate this situation and the resourcing issue.

JILLIAN SKINNER: I'd like an independent review to determine that. The minister is very good at spin doctoring, and of course he'll try and find excuses that will get him out of political embarrassment.

The reality is, his very expert staff, the clinicians at the coal face in emergency departments are now saying that patient safety is jeopardised. He needs to be able to show that it is not.

COMPERE: Jillian Skinner is the NSW opposition health spokeswoman. Tanya Nolan with our report there.