When adults wave their kids off to boarding school or university, it's often with hopes and dreams on board - but it should also be with vaccines against meningococcal disease.
In New Zealand, there are five main types of meningococcal disease and about half of it is caused by Type B – the one you've probably heard of which mostly affects infants, young children, and adolescents. It has higher rates amongst Māori and Pasifika communities, and with infants living in low-income situations. It's the one that, despite the best medical care, can see children losing limbs or dying from it. Utterly heart-breaking.
Because strain B reached epidemic levels, vaccines were funded through a national campaign between 2004-2008. Over time the epidemic rates dropped, and the vaccine was no longer used but B disease remains in our community.
The rest of the disease burden is caused by four other types, A, C, Y and W. And in recent years type W has increased its spread. That's one we particularly worry about because it can be even more difficult for doctors to diagnose and can be even more lethal than the other types.
Meningococcal is a very frightening bacterial disease that leads to meningitis or blood poisoning (septicaemia). The early disease can be mistaken for other illnesses such as flu but can then progress very rapidly and within a few hours lead to severe illness or death.
Early medical intervention with antibiotics is vital, but even with excellent medical care the disease can still maim and kill.
New Zealand does have two types of vaccine that cover these strains of meningococcal but these are not on the national schedule because overall the disease is rare across the community and the cost-to-benefit ratio is not considered high enough to publicly fund these vaccines for everyone.
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The exception is that there is funding for a small group of children with very high medical risk, and young people aged between 13 to 25 who are living in boarding school hostels, tertiary education halls of residence, military barracks, or prisons because transmission of the bacterium is increased between people living in close quarters.
The disease is no less dangerous for other children and young people, but it's less likely that great numbers of their peer group are living together.
However, the availability of the vaccines for infants, children and young adults, or their funded status for specific groups, isn't always well known so I encourage everyone with infants, young children and adolescents (and their accompanying adults) to ask their GP about it next time they visit, or make a special appointment.
Any infant, child or young person who doesn't fit the funding criteria can ask for the vaccines and pay privately, although they are not cheap, which sets up a real equity issue within our community especially when you consider that those at highest risk of meningococcal disease are least likely to be in a position to purchase the vaccine.
There's a lot more that we could do as a country to manage this awful disease, but like many health conditions, it's complicated. While we can and should put more effort into community and health service awareness, and rapid access to antibiotics, that will never fully stop the disease.
Vaccines do have a place. But overall, we need big picture change; a reduction in poverty, massive and urgent improvement to the housing stock, and improvement to nutrition, particularly in those low-income, high-deprivation communities where poverty-driven issues like meningococcal disease, rheumatic fever, and bronchiectasis are creating life-long damage for (and sometimes killing) our kids.
• Dr Nikki Turner, Fellow of the Royal New Zealand College of General Practitioners and director of the Immunisation Advisory Centre.