Retired GP on deadly meningitis outbreak among young people in Kent

Two students have died in the outbreak and there are now 27 cases of either confirmed or suspected meningitis, up from 20 on Wednesday.

In this article I will explain what meningitis B meningitis and sepsis is, how it may present and give a round-up of the issues involved with the outbreak amongst young people in Kent so far and how the outbreak is being tackled, writes Dr Wilcock.

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As this is a developing outbreak I will follow up with another article. I have taken medical information mainly from NHS England, UK Health Security Agency (UKHSA) and NICE NG 240 websites to give best advice.

What is meningococcus B?

Meningococcus B is a bacteria, also called Neisseria meningitidis type B, which can live in the nose and pharynx (the pharynx is the back of the throat) in healthy people and cause no symptoms.

Unfortunately for some people it can cause serious infection, with outcomes being recovery, disability or death.

This is called ‘invasive meningococcal disease’ and may present most commonly in two ways; either as meningitis or as sepsis (also called septicaemia or menigococcaemia).

There are other causes of meningitis and sepsis but the outbreak in Kent at present is due to meningitis type B.

How might it present?

Both illnesses can present suddenly in anyone of any age but are more likely in young children, which is why since 2015 children in their first year of life are vaccinated.

This means that the oldest vaccinated children are not yet teenage.

The person may feel they have some infection, like a flu, occurring.

Meningitis is an infection of the meninges.

The meninges are like a plastic wrap round the brain and spinal cord with fluid between the layers to help package the brain against injury and help in blood circulation.

When meningitis occurs the layers are infected, inflamed, with increased fluid which presses upon the brain causing head pain, a dislike of the light and difficulty bending their chin to their chest.

Rather than try to distinguish two illnesses (meningitis and sepsis) from the same bacteria and as both require rapid intervention, it is better to roll them into one condition called invasive meningitis type B. Infected people may have high temperature, shivers (also called rigors), headache, wanting to avoid the light, vomiting, abdominal pains, diarrhoea, painful joints, pale blotchy skin, very cold hands and feet, drowsiness and confusion which can lead to being unconscious.

On examining the person they may not seem their usual alert self, their pulse and temperature may be high and they have a blotchy rash or a rash that is small purple spots under the skin, they do not go on pressing with a glass or see through plastic as they are due to small bleeds from tiny blood vessels under the skin.

Their medical professional may find their pulse weak and their blood pressure low.

Treatment is with antibiotics.

What has happened in Kent?

In Kent a number of young people from local school sixth forms and local universities in Canterbury, Kent have developed invasive meningococcal type B disease.

Some had been to a night club (Club Chemistry) on 5th-7th March.

Awareness of a cluster of cases to UKHSA over the weekend of 14-15th March.

Sadly two young people have died, one a sixth former and one a university student.

The bacteria is transmitted through droplets whilst breathing so increased by coughing, kissing and being in crowded conditions.

However, this outbreak shows much more transmission than expected.

The initial cases (probable and confirmed cases combined) on 16th March was 15, on 17th 20 and 18th 27 cases.

This is a dramatic infection compared to the expected infection rate.

Is it that the bacteria has changed in some way? UKHSA is looking at all factors.

It can take 1-14 days to develop the illness after contact with a spreader, so UKHSA are working to break the transmission by giving people at increased risk a one-off dose of antibiotic (ciprofloxacin) and a vaccination to meningitis B.

This will protect these young people and also reduce the nasal carrying amongst healthy young people who may unknowingly be spreading it.

As these young people will also not be mixing much whilst this outbreak occurs, transmission should slow and stop soon.

Hopefully with the increased awareness youngsters will receive effective early treatment with good outcomes.