Meningococcal meningitis difficulties

PM - Thursday, July  25, 2002 18:25

COMPERE: A spate of deaths from meningococcal meningitis has shone the spotlight again on one of the last deadly infectious diseases to affect children, left in the developed world.

Doctors say it's immensely difficult to diagnose and will infect several hundred people in Australia each year, probably killing about 10 per cent of those who contract it.

In Perth this week alone, two children have been treated in hospital for meningococcal disease, while a 25-year-old Wollongong man died on holidays in Italy.

The death of central coast 7-year-old, Rebecca Calverly, has sparked calls for a full review of the NSW hospital system, after the girl was apparently left in the waiting room for hours, her symptoms visibly worsening, before she succumbed to the disease.

But doctors say the risk is still comparatively small, and it's so difficult to diagnose there's probably little more that can be done.

Annie White reports.

ANNIE WHITE: Modern medicine has delivered to the developed world perhaps an unprecendented ability to control the health of its people. While they can't always be beaten, there are tests and treatments for many ailments. But some diseases remain frightening hard to catch and cure. AMA Vice President, Dr Trevor Mudge, says meningococcal meningitis is one of those diseases.

TREVOR MUDGE: Modern medicine, by and large, has eliminated deaths from most infectious diseases in children, and we're left with this almost only this particular unpleasant, very nasty and potentially very fatal, but fortunately quite rare disease.

ANNIE WHITE: 13 people have died in New South Wales alone this year from meningococcal meningitis, more than last year. But according to the NSW Health Department's communicable diseases director, Dr Jeremy McAnulty, an average result for the last decade.

JEREMY MCANULTY: We monitor this carefully with view to better understanding it, and improving the way we respond to it, for this disease, and in other diseases too. However, in recent months we've gone to a lot of effort to actually get information out to both the public, but also health professionals.

And there's been a number of initiatives nationwide, one being new guidelines that were used nationally, in every state and territory, for both public health professionals and clinicians. So, there's a lot of information out there, I guess, that's part of our strategy to raise the awareness so that people are informed, so if they get the symptoms they can go right away.

ANNIE WHITE: But the recent death of a 7-year-old girl, who died despite having been taken to hospital when she first appeared to get sick, has shaken confidence in the ability of doctors to catch the disease. NSW Shadow Health Minister, Jillian Skinner, believes there may be systemic problems in the health system which need to be addressed.

JILLIAN SKINNER: What I want is an independent inquiry that stretches across the whole hospital system. I mean, how many nurses, how many doctors, how many relatives have to tell us that there are systemic problems through the hospital system, particularly in emergency departments, before more patients die, and we get something done?

ANNIE WHITE: There will be clinical and coronial inquiries into Rebecca Calverley's death, but Dr Mudge says it must be remembered that meningococcal meningitis is extremely difficult to diagnose.

TREVOR MUDGE: The early symptoms are indistinguishable from the common cold or influenza, and by the time the rash appears, which is a characteristic of this particular disease, then it is often, if not usually, too late.

So, it is, by its very nature, going to be impossible to live up to the community's expectations that doctors will always diagnose it at a time when it can be cured. This isn't going to happen, I'm afraid.

ANNIE WHITE: But Dr Mudge is not convinced that presuming the worst of every patient with possible meningococcal disease, is the best way to go.

TREVOR MUDGE: Well, I think if we were to do that, to give everybody that presented to a general practitioner with a fever or rash, or symptoms of flu an antibiotic, then we'd probably cause more deaths from penicillin allergy than we'd actually save from those who might have meningococcal disease.

So, look, it's a terrifying prospect for all of us, but the reality is that the chance of any of us dying from meningococcal disease is probably about one-thousandth of the risk of any of us dying from the effects of cigarette smoke.

ANNIE WHITE: Do you have any concern that it is becoming less rare, that we are hearing of any more cases, or is there nothing to back that up?

TREVOR MUDGE: There is some evidence that there may be more cases, but it's hard to know whether that's the real increase or whether that's the increase capacity to make the diagnosis. We've got much better testing procedures for it, and I suspect that the increase is more apparent than real.

ANNIE WHITE: While Dr Mudge and Dr Mcanulty say there's no cause for alarm, people who think they have the symptoms of meningococcal meningitis are urged to see their doctor.