The headlines are arresting, the hope almost palpable:  Vaccine 'could beat meningitis'; Scientists: Meningitis Vaccine Breakthrough; Meningitis experts pin hopes on new vaccine;

Research Raises Hope for New Meningitis Vaccine.

But what is this "meningitis" and can a vaccine really protect us from it?  According to the CDC, "Meningitis is an infection of the fluid of a person's spinal cord and the fluid that surrounds the brain. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. Knowing whether meningitis is caused by a virus or bacterium is important because the severity of illness and the treatment differ. Viral meningitis is generally less severe and resolves without specific treatment, while bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability. For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis, but new vaccines being given to all children as part of their routine immunizations have reduced the occurrence of invasive disease due to H. influenzae. Today, Streptococcus pneumoniae and Neisseria meningitidis are the leading causes of bacterial meningitis."

Sounds pretty scary, and it certainly can be.  But as with anything involving for-profit drugs and other biological products, the hype must be separated from the hope. 

First, it must be determined what the incidence of the disease has been, both before and after introduction of vaccination, in order to ascertain if there has been a benefit from vaccination, i.e., it has caused a decline in disease incidence.  As part of determining whether or not the vaccine is responsible for any declines, incidence of meningococcal disease among the vaccinated must then also be compared to those receiving no meningococcal vaccine, particularly those who have never been vaccinated, period.  Finally, the cost (as in negative consequences) of vaccinating must be honestly and fairly compared to the costs of not vaccinating. 

Sadly, even the incidence of meningitis is not all that well-established. Currently (as of year-end 2002), only Haemophilus influenzae and certain forms of Streptococcus pneumonia are separately notifiable, with all other meningococcal disease being reported together.

What is known is fairly reassuring, though:  bacterial meningitis, although dramatic and frightening, is thought to be quite rare and not highly contagious, only affecting "about 2,400-3,000 people" in the United States each year.  (Although the data are a bit confusing.  For instance, although in 2000, according to the CDC, there were fewer than 2400 cases reported in the combined category "meningococcal disease", it is unclear whether or not that figure includes both bacterial and viral meningitis.  On the other hand, it does not include the over 4500 cases of Streptococcus pneumoniae reported that year as well. Still, the numbers are relatively small.)

Being armed with historical morbidity and mortality data is of little value without additional information, however.  Unfortunately that information is also not available.  Little to nothing is known about whether or not vaccination is necessarily causally related to either a decline in deaths or a decline in incidence, since no long-term studies comparing the vaccinated to the never vaccinated have ever been conducted.  Nor is much known about the possible negative consequences of vaccinating, if there are any.  (Although it is true that there have been 644 adverse meningitis vaccine-associated reactions reported to VAERS so far, indefensibly, it is unknown if they represent 644, 6,440 or even 64,400 cases!  Nor do we know if and when the vaccine actually caused the reported events.)

Regardless, it is becoming increasing clear that the consequences of vaccinating against meningitis may well be regrettable in the long run.  The bacteria targeted by vaccination, rather than remaining content to retreat into the background like a dutiful troop of shrinking violets, seem determined to survive and thrive - and one way they appear to be doing so is by changing serotype and serotype prevalence.  Thus vaccination, rather than removing or diminishing the threat of disease, may instead create an endless ostensible need for additional vaccines by causing pathogens to re-emerge in different forms.

At some point might it not be prudent to question "Public Health's" debatable vaccination policy, the strategy it has adopted in what increasingly appears to be a misguided "war against disease"?  At some point wouldn't it make sense to take a stab at fashioning some other disease prevention/disease survival plan?

Perhaps now would be a good time to start - by not buying into the hysteria about a rare disease and by questioning the drug company solution to preventing it.  For while it is eminently clear that the vaccine manufacturers and those with financial ties to them benefit from the ever-increasing putative need for vaccines,  the more important question is, does anyone else?

(To read a related column on this topic, go to Scandals: Changing Disease Epidemiology Via Vaccines - Are We "Robbing Peter To Pay Paul"?.)

Sandy Mintz               

"Eternal vigilance is the price of liberty." - Wendell Phillips (1811-1884), paraphrasing John Philpot Curran (1808)