Brett Crossley-Coe contracted meningococcal C and was rushed to hospital as his condition deteriorated. Photo / Malcolm Pullman
Brett Crossley-Coe felt so sick one morning last month that he couldn't get out of bed so he texted his mother Jody for help saying he felt hot and puffy.
It was 5.30am but Jody responded instantly. The deaths of two young Northlanders from meningococcal disease had been widely reported.
Brett, now aged 15, had survived viral meningitis as a premature newborn.
Jody stuck a thermometer under his arm and it recorded a temperature of 40C.
It was Tuesday, September 6 and Brett had been feeling increasingly sick after going to a party on the Saturday night. He had been in a drunken fight and on the Sunday his mother thought his lethargy was from a hangover. On Monday he complained of sore muscles and Jody wondered whether he was suffering delayed concussion from the punch to his face and the kicks to his neck and back.
On the Tuesday morning, she knew he was sick rather than just bruised and battered from the fight and she took him to the doctor.
He vomited on his way out to the car from the family home. He was assessed, prescribed anti-nausea medicine, and sent him home with what was thought to be a flu-like illness.
He went back to bed and his mother checked him every hour, which he found annoying at the time but now realises may have saved his life.
"I just managed to get to sleep and she would wake me up. I kept telling her to go away," Brett says.
About 1pm, Jody found the beginnings of a rash - an often-late symptom experienced by some, but not all, sufferers of meningococcal disease. It is the result of the bacteria multiplying in the blood-stream, which can be rapidly fatal or cause severe disabilities.
"It looked like someone had splattered him with a paint brush ... I asked him to look down. He couldn't. His neck must have been getting quite sore."
Stiff neck can be another symptom of meningococcal disease. It can be caused by meningitis - inflammation of the membranes lining the brain and spinal cord.
It was now early afternoon and they went straight back to the doctor. "Everything spiralled from there."
Brett was given an injection of antibiotics, on suspicion of meningococcal disease. An ambulance took him to Kawakawa Hospital where he received more antibiotics and developed a headache.
"They took one look at him and sent him on to Whangarei Hospital. I can't praise them enough. The sirens were going. They left me behind in the dust. I was in the car.
"I got to Whangarei Hospital. Within five minutes he was in the ICU [intensive care unit]. He was starting to get light sensitive."
For Brett, it was a blur.
"It just all happened so quick. I don't really know what was happening. I feel pretty lucky to still be here."
Brett spent 24 hours in the intensive care unit and a couple of days in a ward before going home.
"And he's fine, he's back at school, he's got no after-effects," said Jody. "They said another hour to two hours of not being diagnosed, he could possibly have had some permanent damage. Twenty-four hours and we would have lost him.
"I think because it came so close on the heels of the Ben Brown case and the other death, people are more hyper-vigilant."
She's right. The whole of Northland is considered to be experiencing an outbreak of group C meningococcal disease - the strain Brett had - and a mass campaign of state-funded vaccination for young people against that strain began this week.
Ben Brown, aged 18, died of the C disease in Whangarei Hospital on August 27. His family is deeply upset about the care he received - especially that he was sent home, seriously unwell, by the Whangarei White Cross clinic, and the hospital's emergency department, before finally being admitted to the hospital.
White Cross maintains it handled his case properly and the Northland District Health Board has commissioned an external review of the hospital's actions.
The board, following an internal review, has introduced a new blood test which, although not in wide use, can give an indication within one to two hours if a patient may have meningococcal disease.
The disease is a nightmare illness for doctors because, although readily treated with antibiotics if detected early, its early symptoms can be very similar to flu-like illnesses and the fastest diagnostic test, a lumbar puncture, can be a risky and painful procedure.
Three Northlanders have died from meningococcal disease this year; Brown and 14-month-old Jacob Whyte who died before Brett's brush with the disease and an 82-year-old woman from the Whangarei area who died last week.
Northland is the only region experiencing an unusually high number of meningococcal cases, although the Wellington regional public health service has reminded people to be alert for symptoms of the illness following an increase in the numbers there.
Of the 25 confirmed cases of meningococcal C, eight have died. Typically the fatality rate is 10 per cent.
Northland medical officer of health Dr Clair Mills has no idea why the region has been hit. She says there is anxiety about the group C disease outbreak, evidenced by people asking about it and suspecting their children are affected.
"There have been a lot of phone calls, we have a lot of people going to GPs, a lot of people turning up at ED [hospital emergency department]."
The number of cases may not seem high - Northland has had nine notified cases of the disease this year, of which six were group C bacteria, two were B and one (the third death) is yet to be determined. There are no known links between the Northland cases.
However, the number of cases per capita, particularly in certain age groups, is relatively high - and high enough, public health specialists say, to justify mass vaccination.
"There's a definition for a community outbreak," Mills says, "of three or more cases of the same meningococcal bug within three months, and a rate of more than 10 per 100,000 in a defined population."
Among those under 20 there have been the equivalent of about 18 cases for every 100,000 people in Whangarei, and about 13 per 100,000 in Northland as a whole.
The meningococcal C vaccination programme began on Tuesday at Kamo High School.
The vaccine injection, called Meningitec and supplied by Pfizer, is being offered in stages over 10 weeks - starting in schools, then medical centres and special clinics - to all Northlanders who are between their first and 20th birthdays, about 44,000 people.
The Northland District Health Board campaign aims to vaccinate at least 38,000 of them - more than 85 per cent. This seems optimistic given Northland is the lowest-performing area on the Government's immunisation target.
On top of this, teenagers can be a hard group to persuade to take up preventive health care.
And then there's the complication that some will remember being vaccinated against meningococcal B during the 1991-2008 nationwide epidemic of group B disease. Promoters of the current campaign fear that people will think the B vaccination will protect them from C disease. It won't. Different bacteria, different vaccine.
The health board says Meningitec is 90 to 95 per cent effective and provides protection after about 10 days. Pfizer says there have been no protective efficacy studies of the vaccine. But it points to British surveillance data following the use of Meningitec and similar "conjugate" C vaccines. It says that, excluding young babies: "Effectiveness in all other age groups (up to 18 years) primed with a single dose has in four years of surveillance, remained approximately 90 per cent, both within and more than one year after scheduled vaccination."
Dr Nikki Turner, head of the Immunisation Advisory Centre at Auckland University, says Meningitec is "91 to 100 per cent effective in getting a very good antibody response. That's what will protect you when you are faced with the meningococcal bug".
She says the vaccine has an excellent safety profile and its effects last for at least five years for those aged 5 or older when vaccinated, and probably less for younger children.
In addition to providing personal protection to most recipients, it will - unlike the New Zealand B-strain vaccine - induce a broader immune response leading to eradication of the bugs in the back of the throat.
"In meningococcal disease, most of the carriers tend to be young adults or late teens. We have got it at 10 per cent of the community [who are carriers], up to 25 per cent of teens and as low as 4 per cent in young kids."
It's not certain why the carriage rates are higher in teens, but it may be social factors like sharing of drinks, cigarettes or marijuana joints and kissing. The bacteria can be spread by coughing, sneezing and saliva - which has led to the re-activation of the public health message: "Don't share spit."
Nor is it certain why some people can harmlessly carry the bacteria in the back of the nose or throat, while in others - a tiny minority - the bugs within several days of arrival invade more deeply and cause serious disease. People may have four or five episodes of group B or C carriage in their lifetime and each episode can last for 8 to 10 months.
People who develop the invasive disease are likely to have acquired the infection from others who were unknowingly carrying the bacteria.
Close contact with a carrier is thought to be necessary to catch the infection as the bugs don't survive for long outside the body. Living in a crowded house is one of the biggest known risk factors. First year tertiary students living in hostels are one group at particular risk.
On the streets of Whangarei this week, some knew nothing of the outbreak and vaccination campaign; others knew all about them.
High-school girls chattering outside the public library chorused "Yes yes yes", when asked by the Weekend Herald if they planned to be vaccinated, except one who yelled: "No, I'm scared of needles".
They were aware of the outbreak and one said: "I'm scared of catching it".
Megan, a mother wheeling her three-year-old son in a pushchair, knows the Crossley-Coes and has heard about Brett's near miss. She wants to research the vaccine for herself before agreeing to her boy having it.
"Last time he got his vaccinations he got bumps all over his arm. Since he was 15 months they were trying to say it wasn't the vaccine."
Jeremiah Bristow, 24, hasn't heard of the outbreak, but recalls "Don't share spit" from school a decade ago. He'll think about the meningococcal C vaccination for his 23-month-old daughter Jayahna, who has had her childhood vaccinations.
Some Northland school principals report heightened community awareness of meningococcal disease and strong interest in the vaccination.
"I know many of the boys have been keen to get involved because they knew ... [Ben Brown]. That gave a fairly sharp edge on it," says Whangarei Boys' High School deputy principal Allister Gilbert.
Whangarei Girls' principal Anne Cooper says, "There's a level of concern, but I wouldn't say alarm about the outbreak."
Kerikeri GP Dr Nigel Cane says he's had numerous inquiries about meningococcal disease following the two confirmed and one suspected case in the town. "We have to have a high index of suspicion, both us [doctors] and parents."
Mills says that for the high schools where the vaccination took place this week, around 55 per cent of consent forms were returned by students, with a "yes" rate of around 97 per cent.
Some people are asking why New Zealand doesn't follow Australia and Britain and put a meningococcal C vaccine on the childhood vaccination schedule, instead of just using them against outbreaks, such as Huntly in 2005 and on the West Coast in 2003 and now Northland.
Turner says a C vaccine has been considered, and will be again, although New Zealand's rates of C disease have historically been relatively low. It also has to compete with other vaccines - chickenpox and rotavirus - for a place on the schedule.
After Brett's near miss, his mother Jody was initially annoyed that meningococcal disease wasn't diagnosed at the first medical visit, but later came to feel sorry for the doctor's plight with such a difficult illness, especially when she reflected on the "brilliant" response at the second visit.
And not surprisingly, mother and son are advocates for the vaccination.
Says Brett: "I don't want anyone else to get sick".
Safety first
Saliva on . . .
drink bottles and cans;
lip balm;
chewing gum;
smokes and joints
can pass on . . .
colds;
coldsores;
the flu;
meningococcal C disease.
For more information contact Northland DHB:
0800 430 123 www.northlanddhb.org.nz
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