Sarah Christie was three and a half years old last January, when she complained of feeling unwell after her mother picked her up from Montessori. Her symptoms were vague, she had a high temperature and was vomiting. There was nothing significant to indicate she was about to fight for her life. And yet, less than 24 hours later, she was dead.
Meningitis continues to be one of the biggest killers of children under the age of four in this country. In 1997, there were 506 cases in the Republic. The figures were up for 1998, 466 by the end of November, an increase of 19 on the same period for the previous year.
Meningitis is an inflammation of the tissues which surround the brain and spinal cord. Bacterial meningitis is the most dangerous form of the disease. Meningococcal bacteria can also cause meningoccal septicaemia - a life-threatening form of blood poisoning.
Although meningitis and meningococcal septicaemia are not all that common, they are very dangerous and can develop rapidly. The bacteria which cause these diseases are very common and most of us will carry them at some stage in our lives without developing any illness. Early diagnosis and treatment of meningitis still provides the best chance of recovery. Therefore it is vital to know the signs.
Bernie Christie, Sarah's mother, was aware of meningitis when Sarah became ill as there had been two cases in Monaghan just two days earlier which were highlighted in the media. However, when her daughter first complained of feeling sick she had none of the tell-tale symptoms. "I have four sisters who all have children, so we were aware of the basic symptoms. I collected Sarah at 5 p.m from the Montessori. She complained of being tired, but you take it for granted that a child will be tired coming out of Montessori. My sister had been minding her that day and had no complaints about her. "She went to bed at the normal time, 9 p.m. with no complaints. At about 11 p.m. I heard her moving and I went to check on her and found she had vomited. Her cousin had just recovered from a 24-hour bug so I thought that was what was wrong. I changed her and asked her how she was and she seemed fine. She walked back to bed at about 12 a.m. I put her into my bed so I could keep an eye on her.
"I went to bed at about 12.30 a.m. and sat up for about three hours monitoring her temperature every half hour. It did go up to 104, but I managed to get it down. I must have dozed off at about 4 a.m. At 6 a.m. she bolted upright in the bed and I jumped up and held her at the back of her neck, which was very hot and it frightened me. She was vomiting, incontinent and fitting. "I thought she was fitting as a result of the high temperature. I knew the child was seriously ill, but I still didn't suspect meningitis."
Bernie stripped Sarah and checked her all over. There was no sign of any spots, but she did notice Sarah's eyes were glassy and fixed. However, she connected this to the high temperature as well. She called the doctor who arrived within 10 minutes. The doctor administered penicillen and said Sarah was to be rushed into Temple Street. It was now almost 7 a.m. Sarah was limp and incoherent. The team in Temple Street was on full alert. "At that stage it hit me that it may be meningitis, as they hooked her up to various drips. But they said they didn't know what it was yet. By 10 a.m. a spot had come out on her left buttock - like a purple bruise or a boil. Then I knew it was meningitis. The doctors confirmed this but weren't sure what strain.
"By 12 p.m. she had come around a bit and was aware of where we were, so they thought she was responding to the drugs and wasn't in any immediate danger. They moved her to an isolation unit."
Sarah was moved to the special care unit by 2 p.m. The medical team had problems getting her kidneys to function. The spots had started to come out by this stage and Bernie was starting to panic. "I knew she was ill and wasn't responding. I could see she was in pain. The worst thing was I couldn't hold her because it wasn't comfortable for her."
Her blood pressure dropped and the doctor said she wasn't responding as well as they had hoped. Then Bernie heard a nurse saying Sarah's system had crashed. "Sarah was moved to ICU and they put on her semi-life support to calm her system down and put her in a thermal blanket. That frightened me, because I just thought it looked so awful and the rash had started to come out all over. It was a total nightmare," Bernie recalls. "The doctors were going to administer a Protein C drug, but they can only administer it to certain patients as it has side-effects. We agreed for them to give it to her. But by the time they sourced it she had deteriorated and wasn't stable enough to give to have it.
"By 10.10 p.m. she was dead. Less than 24 hours."
Sarah's alarming story highlights just how quickly meningitis can claim a life. Last summer Bernie and her husband, Robert, did a cirumnavigation of Ireland last summer in a diving rig to highlight awareness. While she says it was just a "dry run" she was pleased with the level of awareness it raised and says it will be an annual event.
Knowing the symptoms of meningitis may be a parent's only defence against the speed with which the disease can set in. Dr Darina Flanagan, director of the National Disease Surveillance Unit, said diagnostic facilities have greatly improved and as a result, meningitis can be caught and treated earlier. "Most of us have carried the bacteria at some stage but we develop an immunity to it. Unfortunately some don't and if it crosses the barrier into the blood stream then meningococcal diseases can occur. Smoking can increase the carriage of the organism. Kissing, coughing and sneezing can pass it on. However, you are more likely to pick up the bacteria from a healthy carrier which is why there are rarely outbreaks of the disease but more usually sporadic, isolated cases.
"The danger with meningococcal diseases is that it can seem like the flu in the early stages and if it is presented to a doctor or casualty too early they may not be able to tell it is meningitis if there are not specific signs. This is why we need further research into better diagnostic tests at the early stages."
There is only a vaccine available against one strain of the disease, Group C, and even that is not very effective. Also it is the Group B strain which is most common in Ireland. "We are hoping that a vaccine for Group B will be available here in the next 18 months and we would also hope to make it available as part of the Child Immunisation Scheme," Dr Flanagan said.
The Meningitis Research Foundation was set up in Ireland two years ago by a group of people who had been affected. Mr Colman Byrne, manager of the Meningits Research Foundation in Ireland, said: "We work to prevent death and disability from meningitis by working with health professionals and with families that have been affected.
"We work with health professionals to improve diagnostic techniques and awareness, to do research into cures and causes of the disease. We work with the families to raise funds and awareness with the general public and also to help them through what is obviously a very traumatic period in their lives. We can put them in contact with people who have had similar experiences. A lot of the time we just provide some one to talk to."
The foundation operates a helpline during office hours, (01 8366347) after which there is an answering service which provides a number for a 24-hour helpline based in Britain.
The two areas of research the foundation is funding in Ireland at the moment are an investigation into how the toxins affect the immune system and ways to kill the toxins, and also a system for quicker and more reliable diagnosis without performing a lumber puncture.
The main risk groups are one- to five-and 15- to 24-year-olds. The foundation runs awareness programmes in third level colleges and is trying to place posters in every creche and playgroup in the country, so parents will be aware of the symptoms.
"Those in the 15-to-24 age group are interacting with a high volume of people and are in close contact. If a student has the start of the symptoms of meningitis they often think it is a 'flu or a hangover and they go home on their own, with no one to look after them or monitor them and the reality is they can die very quickly," Mr Byrne said.
He added: "The advice we give people, in the absence of a vaccine, is to follow the three `As' - be Aware of the symptoms, be Alert to any change in condition and Act immediately. The best way to deal with it is to act as quickly as possible and get the child to hospital. Basically, trust your instincts."