Perhaps no illness strikes fear
like meningitis (often referred to as spinal meningitis). I recall during my freshman year in high school that there was
a case in a neighboring town. The kid died and when we learned he was a
wrestler parents and teachers claimed it came from the mat. We were so frightened of the spongy
devil that I swapped my spot in the gym class wrestling line so that I was
matched up with one of the less athletic kids. That way I could pin him in
under a minute and get the hell off the grimy Petri dish.
There are many types of
meningitis. The previous post was
about fungal type, a rare form and related to pain injections. New York City
has thus far escaped having any cases. The most common type of meningitis is
caused by any number of viruses, but the type of meningitis that provokes
community wide anxiety, rumors and regularly makes its way onto the evening
news is a particular type of bacterial meningitis. It too is rare but possesses
two features that have earned its deserved reputation. The first is that it can
spread in group settings, such as schools. The second is that it kills. About one
out of six or seven victims die, rather high in the modern era of public health
and medicine. The name of this modern day scourge is meningococcal disease. The
bacterium responsible is called Neisseria
meningitidis. My job is to track and stop it.
The city is now in the midst of an
outbreak. Not an epidemic of the scale of AIDS or Swine flu. There have been
two dozen cases this year, but five have died. At the center of the outbreak is
the community of men who have sex with men and reside in several Brooklyn
neighborhoods. The health department has been promoting vaccination but it has
been hard to reach the people that most need it. More efforts are being made to
get the word out to those at highest risk.
Family legend is that my
grandfather died of meningitis. I was shy of my second birthday when he died so
I don’t have any memories of him other than from photos and the items from his
medical practice I found in my grandmother’s Grand Concourse apartment. He was
a physician and the story told me by my mother as long as I can remember was
that he could’ve been saved if they had just given him sulfur. I was already my
way to becoming a junior chemist and didn’t quite understand how the yellow
powder I had used to make gunpowder would’ve saved my grandfather. Last year I
decided to investigate the family story, learn if my grandfather really died of
the disease that it is now my job to watch over for the city. It took a few
months but I managed to get his death certificate from vital records. He died
at sixty-six, just a year or two after retiring from his Bronx medical practice
due to hearing loss. The certificate didn’t list the cause of death, however, the certificate had the name of the physician who attended his death. It was a long shot, but I tried to
locate him. The New York State Department of Education, the agency that
oversees physicians, maintains a website where people can verify licenses. I
found the doctor listed. He had graduated medical school in 1957. That made him
at least 80 years old, if he was still alive. The last known address was in
California and the Internet had two doctors with that name in the town listed
in his license record. I dialed the first number and a woman answered. She
confirmed I had the right physician. But his hearing was too poor to converse
by phone. If I would write a letter, he’d be happy to answer my questions.
Meanwhile I learned that the
city’s office of vital records had a more detailed death record. I got my dad
to sign the authorization form for his father’s record and requested the full cause
of death report. I had almost forgotten about it when the letter showed up a
few days before Christmas last year.
I poured over the report. Laboratory
diagnosis wasn’t common when my grandfather Jack died. I would have to confirm
my suspicion without the definitive evidence I was accustomed to having. Jack had
pneumonia and blood poisoning confirming that a bacterium was responsible. But
was it the notorious Neisseria meningitidis?
And then there it was, listed under the Part II. Other Contributing Conditions.
Printed in black ink by the hand of the physician who was at the bedside were the words Waterhouse-Friedrichson
Syndrome. It was the eureka
moment. Waterhouse-Friedrichson Syndrome is hemorrhage into the adrenal glands
and occurs in overwhelming bacterial sepsis, most notably that caused by Neisseria meningitidis. Sulfur, more
correctly the family of sulfonamide antibiotics, would have cured him. If they
could’ve treated him quickly enough. That is the thing with meningococcal
disease. You don’t have much time. I did end up getting a nice letter back from
the California doctor. He had no
recall of ever treating a case of meningococcal disease. I didn’t ask him if he
remembered treating grandfather Jack.
There is a vaccine for
meningococcal disease. Because of questions about its efficacy and cost
effectiveness, the CDC Committee on Immunization Practice only recommends the
vaccine for teenagers up through the college years because studies have shown
they are at an increased risk, particularly if they reside in dorms. But data
from NYC suggests that people living with HIV and AIDS (PLWHA) are at an even
greater risk. Currently there is a particularly nasty strain circulating among
the MSM community and we've worked to insure that vaccine is available to this population at most health centers and city run
clinics.
A few years ago there was a
meningococcal death in a high school student. The circumstances around the case
were particularly heart wrenching.
If you, a friend or a loved one is in the risk category, please get them
the message to get vaccinated.
