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Thursday, April 19, 2018


Meningococcal disease

Meningococcal disease

Approximately hundred cases of 'invasive meningococcal disease' are reported each year in the Netherlands. The most common cause is the meningococcus type B, and this type is not included in the new ACWY vaccine.

Firstly, what is the reason that as of May 1, 2018, all babies aged 14 months and from October teenagers aged 14 years will be vaccinated with ACWY?

The invasive meningococcal disease is a sub-acute infectious disease caused by the bacterium Neisseria meningitidis- meningococcus, that penetrates the bloodstream. On the basis of the capsule of the bacterium, twelve groups are distinguished, of which in the Netherlands mainly B and further C, W, X, Y, Z and 29E occur.

Why sub-A is in the vaccine is not clear because it does not actually occur in the Netherlands. For Y: 10-20 out of 100 reports of meningococcal disease are type Y.5. The 'RVP News' is a newsletter for professionals who are involved in the Dutch National Vaccination Program (RVP).

The April 2018 issue, informs doctors that: “As previously announced the Meningococcus A, C, W, and Y is added to the RVP. The reason for this vaccine changes Men, and C replaced by Men. ACWY is the increased number of cases due to a meningococcal infection.

With a vaccination against meningococci ACWY, we want to prevent a further increase in the number of cases. Posters will be sent for in the waiting room, and flyers for the parents. The flyer says:

In the National Vaccine Program, children receive vaccination against meningococcus, type C since 2002. Because the number of infections with meningococci type W has increased over the past 3 years, a vaccine with broader protection is now being used.

Unfortunately, what posters didn't mention is the fact that the largest part of the increase has not taken place with babies...., but at the age of 65+ers.....! How's that?

The 'guidelines for professionals' concerns the number of cases broken down by age group. In 2016,  20 of the 50 cases of illness are older than 65 years of age. Only two are younger than four years, the target group for the new vaccine.

The most common cause is type Men.B

The focus is on type W, but type B causes many more cases of meningococcal disease. It is surprising though that there is a clear decrease from 1992 to 2016. Type C decreased, as this is vaccinated since 2002. Type B also decreased, there has never been a vaccination against it.

Information from the Dutch Institute for Health RIVM shows the increase in type W between 2015 and 2017. The number of reports among children under five years has increased from 0.1 per 100,000 to 1 per 100,000. And children in the age group of 5-14 years that is 0.1 to just under 0.2 per 100,000.

This figure looks like the biggest increase has occurred in children younger than five years old. But the increase is a certain number per 100,000. And the Netherlands will have 3.1 million elderly people in early 2017 and only about 170,000 babies.

What is the necessity of Men and ACWY for babies?

Approximately 170,000 children are born each year. Let us say 200,000 for the arithmetic convenience, then we double the increase and we get an increase of two for the age group under five and less than 0.2 for the age group 5-14 years. So there is an increase in Men.W from let's say two children in both age groups together?

And that is suggested as the reason for the need for a 'broader protection'? The official figures do not concern deaths, but disease cases, therefore, the disease can be treated with antibiotics. Why all the fuss about the need for a new vaccine?

Meningococcen disease

Meningococcal disease is undoubtedly a serious disease, but it is relatively uncommon in children. In addition, there are still some bottlenecks regarding this vaccine. Does vaccination against bacteria that are not the main cause actually make any sense?

There is no type B in this vaccine, the main cause of meningococcal disease. Do the costs of the new vaccine outweigh the benefits? And more importantly: the seriousness of the disease against the risks of the vaccine?

What do we know about the bacteria?

It is estimated that 10-20% of people at any time carry meningococci in the nose and pharynx. The percentage of carriers in the population varies from 5% among young children to 35% among teenagers at the time of a peak.

Infection takes place from person to person via drops from the nasal pharynx, but infection does not mean that there is an infection. It only means that the bacterium is present. Students run a little more risk of becoming a carrier by kissing with many different fellow students, sharing glasses, toothbrushes etc.

More than 100 trillion bacteria live in our body, mainly in the intestines, but also in, for example, the nose and throat cavities.

Meningococci are commensals, innocent 'host bacteria, that live in the pharynx. Do they have a function? Who will say it, perhaps they're there for natural immunization?

It is not known why in a rare case the bacterium causes an infection, but it is plausible that reduced resistance has to do with it.

In its worst form, the infection becomes an 'invasive Meningococcal disease', in most cases by Meningococcus type B - because the bacterium penetrates the bloodstream. This is, without doubt, a very serious situation.

What are the disabilities of meningococcus disease?

In meningococcal disease, a child or adult can become very ill within a short time (within a few hours). There are two forms of the meningococcal disease, namely meningitis, and blood poisoning.
High fever with chills, vomiting, and headache occurs during meningitis.

Bending of the head is sometimes painful because of neck stiffness. Babies with the disease are sleepy and drink badly. They are irritable and cry in a different way than usual. Sometimes they cry when changing the diaper.

In case of a blood poisoning caused by meningococcus, the patient becomes drowsy. It is difficult to get in touch with him or her. Bleeding under the skin, which can be seen as small reddish-purple spots in the skin. If you press a stain with a transparent drinking glass, the skin becomes lighter, but the stain remains visible.

If there are many spots close together, they can form a blue-purple spot. The red-purple spots are an alarming phenomenon that one has to take it seriously because they indicate a blood poisoning. 

This form of the disease can lead to death in severe cases after a few hours to 24 hours, it would be good if the Dutch RIVM poster informs the parents about this.

Parents should not only know that the chance is very small, but also how they can recognize an 'invasive meningococcal disease' so that they can react quickly if necessary. The vaccine does not protect against the most common cause, Meningococcus B.

These side effects mostly occur in adults but there is not much experience with this vaccine for children. Men-ACWY has only been admitted to the European market for administration to children in 2016. Why would the manufacturer put this all on the package leaflet? If it is not true, then it is not really advertising his product, is it?

Is there a vaccine between nose and lips added to the RVP without parents well informed about it? Could it be that, in order to prevent three cases of Men.W, thousands of children will experience dizziness, rash, diarrhea etc.?  The answer is NO...


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