The awful legacy of meningitis

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.