A Shot in the Arm : A New Meningitis Vaccine Can Mean the Difference Between Life and Death

IT WAS A SLOW EVENING in the emergency room when a woman ran in with a limp child in her arms,” recalls Dr. Larry Kleinman, a pediatrician currently at UCLA Medical Center. As Kleinman examined the little girl, her parents told him that two days earlier their daughter, 2 1/2, had developed what seemed like an ordinary cold. Her fever shot up to 102 degrees, and she was fussier than usual, but that was not peculiar and did not particularly worry them. On the second day, however, she began to sleep for long periods of time, and her parents had difficulty waking her. Suddenly, her entire body began shaking, then she went limp. Her father recognized the seizure and realized her fever had risen. They quickly left for the emergency room.

The doctor did several tests, examining her blood and urine. But most important, he took a sample of her spinal fluid--the fluid that bathes the brain--by inserting a small needle into her lower back. The fluid was needed to check for the illness that the doctor feared most: meningitis.

Meningitis, an infection involving the brain, is usually caused by the same sorts of bacteria and viruses that cause other childhood infections. But meningitis is much more dangerous. It can cause serious brain damage very quickly and in some cases can rapidly lead to death.

Now, for the first time, the most common form of meningitis is preventable. One of the most remarkable developments in children’s health care is the new meningitis vaccine, the hemophilus influenza B vaccine. Although earlier vaccines have been only moderately effective, new ones that recently came onto the market have proved very effective in several national studies, including one in Los Angeles County. Just a few months ago, the American Academy of Pediatrics recommended that all children be given this vaccine when they reach 15 months of age. Until recently, most pediatricians had not immunized children because the vaccines were not broadly available.

Unfortunately, Kleinman’s patient had not been vaccinated for meningitis and, as the tests showed, she had the leading form of meningitis in children, one caused by the bacteria hemophilus influenza type B that could have been prevented by the new vaccine. This type of meningitis affects 16,000 American children age 5 or younger each year; about 2,000 of them die, and another 3,000 are left with serious neurological impairments including deafness, epileptic seizures and mental retardation.

Pediatricians say that meningitis is frightening because it is so easy to miss. In its early stages, it is indistinguishable from the common cold. Children may complain of an earache, have a runny nose or just seem a bit fussier than usual. These typical coldlike symptoms make early detection difficult, if not impossible. However, once detected, hemophilus influenza B is treatable with antibiotics.

Kleinman explained to the parents that meningitis was too serious an illness to allow the child to be taken home. She was admitted to the hospital, where she received a powerful new antibiotic intravenously and was watched very carefully. She eventually recovered, but the meningitis left its mark--doctors discovered that the girl had residual brain damage, one of the dreaded possible results of meningitis. She will probably need special training and education when she reaches school age. For her, the vaccine came too late.

“The hemophilus influenza vaccine,” says Dr. James Cherry, a pediatric infectious diseases specialist at UCLA Medical Center, “is an extraordinarily safe vaccine, capable of preventing most, if not all, of the hemophilus influenza meningitis in this nation.”

Pediatricians believe that the new vaccine against meningitis may be as great a boon to children’s health as the polio vaccine was two decades ago. During the early 1950s, the peak years of the polio epidemic, 20,000 people contracted the disease. As with meningitis, most were children. Ten percent of those infected died, and scores of others were permanently paralyzed. The development of a vaccine virtually eliminated the disease in the United States; only one case of naturally occurring polio was reported in 1989.

The fact that the meningitis vaccine is very safe is reassuring. Some vaccines can produce illnesses as serious as the ones they aim to prevent. The celebrated swine flu vaccine, administered in 1976, caused side effects ranging from flulike symptoms to a serious form of paralysis in hundreds of people. But the most serious complication of the meningitis vaccine is a sore arm.

“The downside of this vaccine,” Cherry says, “is that it is relatively expensive.” The hemophilus influenza vaccine costs about $20, several times more than most other childhood vaccines such as the shots against measles, mumps and rubella, which children also receive at 15 months. (Current testing shows that the meningitis vaccine may be safe and effective in much younger infants.) But none of these vaccines, all of which are considered safe and effective, can exert their powerful preventive effects if people don’t get them.

The recent rise of measles, especially in young adults, is an unfortunate demonstration of this. During the past decade, as cases of the disease had all but disappeared, many people began to forget its virulence and neglected to have themselves or their children inoculated.

All those born before 1957 are considered immune based on their childhood exposure to the virus. But for those born later, a measles vaccination is a necessity, even, in many cases, for those who have already received one. The most commonly used form of vaccine administered between 1963 and 1967 did not impart long-term immunity, which means that many young adults who believe themselves immune to the disease are not. And although measles in children usually runs a mild course, in adults it can lead to an infection of the brain or lungs, either of which can be deadly. It is now believed that everyone at risk for measles--those born after 1957 who attend or work in schools or colleges, those who work in health care and all those who were immunized between 1963 and 1967--should receive a second measles vaccine. And all children should get two vaccines; one at 15 months and another between their fourth and sixth birthdays.

While many people consider vaccinations a painful childhood experience that they’d rather forget than duplicate, common sense dictates otherwise. Given the recent outbreak of diseases for which safe vaccines are available--measles, hepatitis B and hemophilus influenza B--it is a good idea for everyone, regardless of age, to consult a doctor about keeping up with immunizations. All families should keep a log or diary of vaccines--including the date, dose and type--in a safe place for future reference.