IT is every parent's nightmare an illness which hits suddenly and can kill within hours. Even the word "meningitis" is enough to strike terror because it is an enigmatic disease that continues "to claim lives". Its apparent ability to strike at random with devastating speed stirs a primitive fear among communities. It does not differentiate between a young baby or a fit and healthy student.
No-one knows why figures for the disease here are so high or when we can expect a downturn. The Republic currently lies second only to Iceland in the European table for incidence of meningococcal disease.
"It sneaks out of nowhere," says Siobhan Moulter-Lee, Ireland co- ordinator of the Meningitis Research Foundation. "Meningitis is every parent's big fear. It starts off like a normal cold or flu that kids are always getting and within a few hours they can be dead." It is really very frightening.
A death in a particular area can cause panic among parents, teachers and other members of the community, often with calls for the closure of a particular school. Recently a team of schoolboys from Killorgin, Co Kerry, were asked not to travel to a GAA football competition in Donegal because of suspected meningitis cases in the next parish. But according to a doctor with a knowledge of meningitis there is no sound medical basis for this sort of "quarantining".
Meningitis is the inflammation of the membrane lining the brain and spinal cord and is caused by either viral or bacterial infection. It can affect anyone - although babies, children, teenagers and those in their early 20s are more susceptible to the disease. Part of the problem is the seeming innocuousness of the early symptoms which can include a headache or vomiting. Parents or doctors can miss these early signs - and even if spotted it can be too late in some cases.
There are two main forms of meningitis: bacterial and viral. Of the two, bacterial meningitis is by far the worse and is often accompanied by septicaemia (blood poisoning). At any time 10 per cent of the population will carry the bacteria which cause the most common form of bacterial meningitis. This figure increases to 20 per cent in teenagers, perhaps because they are more sociable. It seems to be harmless in most people. Very few who carry the bacteria will develop meningitis or septicaemia. However nobody knows why some people get it and others don't. The bacteria is spread by droplet transmission - sneezing, coughing or kissing.
The bacteria that many people carry break through the protective mucosal tissue that lines the inner surface of the nose, mouth and throat. Once in the bloodstream they are free to circulate and cause damage. Without antibiotics they can easily kill.
Nobody really knows why the bacteria break through the mucosa. The random nature of the disease makes it difficult to study and detailed figures in Ireland are not available for a number of years.
Those most at risk appear to be babies, because their immune systems have not fully developed. Teenagers and students, who are more socially interactive, are also in a high-risk group. The mortality rate in Ireland is up to 10 per cent. The incidence has been rising here. There has been an almost threefold increase in the past five years. In 1993, 203 reports of bacterial meningitis were made, rising to 241 in 1994 and 382 in 1995.
Twenty eight people died from meningitis in 1995, 14 in 1996 and so far this year there have been 22 children, teenagers and those in their early 20s are more susceptible to the disease. Part of the problem is the seeming innocuousness of the early symptoms which can include a headache or vomiting. Parents or doctors can miss these early signs and even if spotted it can be too late in some cases.
There are two main forms of meningitis: bacterial and viral. Of the two, bacterial meningitis is by far the worse and is often accompanied by septicaemia (blood poisoning). At any time 10 per cent of the population will carry the bacteria which cause the most common form of bacterial meningitis. This figure increases to 20 per cent in teenagers, perhaps because they are more sociable. It seems to be harmless in most people. Very few who carry the bacteria will develop meningitis or septicaemia. However nobody knows why some people get it and others don't. The bacteria is spread by droplet transmission - sneezing, coughing or kissing.
The bacteria that many people carry break through the protective mucosal tissue that lines the inner surface of the nose, mouth and throat. Once in the bloodstream they are free to circulate and cause damage. Without antibiotics they can easily kill.
Nobody really knows why the bacteria break through the mucosa. The random nature of the disease makes it difficult to study and detailed figures in Ireland are not available for "a number of years.
Those most at risk appear to be babies, because their immune systems have not fully developed. Teenagers and students, who are more socially interactive, are also in a high-risk group. The mortality rate in Ireland is up to lO per cent. The incidence has been rising here. There has been an almost threefold increase in the past five years. In 1993, 203 reports of bacterial meningitis were made, rising to 241 in 1994 and 382 in 1995.
Twenty eight people died from meningitis in 1995, 14 in 1996 and so far this year there have been 22 deaths. The winter months and early spring see the highest incidence of the disease
This increase in the number of cases caused the Minister for Health, to set up a working group on bacterial meningitis and related conditions. It reported earlier this year making a number of recommendations.
From what we know, meningitis goes in cycles from 10 to 15 years and there are peaks and troughs of,"activity without apparent reason," says Dr Mary Cafferky, director of the Meningococcal Reference Laboratory. "We do not have the figures for l5 years ago in this country so it is difficult to say what stage we are at. But this is what happens in the UK and other countries with a temperate climate and similar conditions."
She says 1995 saw the beginning of our peak. "However we should be encouraged by the fact that there were fewer cases overall last year." ,The laboratory is based at Temple Street Hospital in Dublin.
AT present the rates are particularly high in the Eastern Health Board (EHB) area with 101 cases so far in 1997 and nine deaths. In 1996 there was a total of 155 suspected cases and six deaths.
"Unfortunately we do have a high incidence here at the moment," says Dr Darina O'Flanagan, specialist in public health medicine with the EHB. "In the early 1990s it was occurring in the Southern Health Board region, where it jumped from figures as low as 1.7 cases per 100,000 in 1990 to 6.5 cases per 100,000 in 1993. Their figures since then have taken a downturn but our figures have increased up to 6.5 last, year. What tends to happen is that when you get a new strain into the community you get a lot of cases. Initially the number of cases in teenagers increases and then young babies who have no immunity."
Dr O'Flanagan stresses it is too early to say how the overall figures for this year will look but it appears that they will be higher.
In Gloucestershire in England a long-term epidemic which began in the early 1980s infected 88 people and killed six, four of them children. The area became synonymous with the disease. At one time the town of Stroud had nine times the national incidence of meningitis and people were afraid even to drive through it. As a result, two scientists from the region - Keith Cartwright and James Stewart - did detailed research. Examining the risk factors associated with the disease among those who fell ill, they found links to the respiratory area at the back of the throat which is affected by smoking, and a regularly prescribed antibiotic, erthromycin. However, it was difficult to prove that either link caused meningitis.
Trying to answer the major questions relating to meningitis frequently falls to the Meningitis Research Foundation. More than 100 families have been in touch with the foundation since a branch it was set up in Ireland over a year ago and the numbers are rising
The foundation, which began in Britain in 1989, works with families who have experience of meningitis or septicaemia, and offers a support network. They also work to raise awareness of the disease, help parents spot the warning signs and speak at schools where there have been cases. They have an educational video The Race against Time and information on how to protect children.
According to Siobhan Coulter-Lee, they get a number of calls from parents concerned that a child with a cold, flu or headache may be developing meningitis. Parents are the ones who know their children best, she says.
"Parents need to arm themselves with the necessary information. We always stress that one of the best defences is to know the signs and symptoms. They should trust their instincts. However they must remember that this is extremely hard to diagnose, even for doctors. Unfortunately at the end of the day there will always be cases where it will be too late."
The incidence among young adults, she says, appears to be increasing this year. "Perhaps people are more vigilant with children and check them more but you rely on young people to tell you how they are". But in many cases young people have walked into the hospital and were dead in a few hours. It seems to build up slowly and then wham!"
One in seven people who contract meningitis will experience some form of after-effects including: epilepsy, mood swings, damaged eyesight, stiff joints, hearing and memory loss, loss of limbs and digits, or brain damage. The Meningitis Research Foundation. 01-836-6347. 24-hour helpline is operated from the foundation's office in London. 0044- 1454-413344.