- 3 months ago
Clinical microbiologist from Great Ormond Street Hospital, Eliza Gil, answered your questions as the Kent outbreak left two young people dead.Source: The Independent
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00:00Meningitis. If we imagine the brain inside the skull there's a layer of fluid and membranes
00:05around the brain that kind of protects it from being damaged bouncing against the skull so that's
00:09there normally. In meningitis we have inflammation of that space of those membranes and that fluid
00:16and in this outbreak what we're talking about is bacterial meningitis so that bacteria have ended
00:21up in that space. We also do have meningitis caused by other things including for example
00:26viruses but that's not what we're seeing here. What normally happens for any outbreak really
00:30actually of any infection is that you get the introduction of a potentially disease-causing
00:35bug into a population that doesn't have protective immunity and obviously we all lived through that
00:41in Covid so sort of you know that was a really real-world example of kind of terrible introduction
00:45of a new pathogen new bug into a vulnerable population. So if we think about this meningitis
00:51outbreak we have students that were born before the rollout of meningitis B vaccine because that
00:58was introduced in the UK in 2015 for babies and actually the UK was the first country to introduce
01:04it so it wasn't that we were slow off the mark but obviously the students that are there today they
01:08were born before 2015 so they didn't get that vaccine as a baby they will have had been offered
01:15whether they've had it or not it's another question meningitis ACWY vaccine as a teenager but they
01:20have a gap in their immunity for meningitis B so what looks like to have happened is that someone
01:26carrying meningitis B in their throat which is where it normally starts has spread that bacteria
01:31amongst the community and unfortunately because these students have no immunity and perhaps this is a
01:38particularly aggressive type of meningitis B it may be we don't know that yet we've got this big
01:42outbreak now amongst the students. Bacterial meningitis we would normally expect around 10% of people
01:48affected sadly to die so it's not sort of entirely out with what we would expect in a kind of
01:55big
01:55outbreak of meningitis that has sadly been two fatalities. If we're thinking about really to be
02:00worried about meningitis the classic things to present with would be a really bad headache often
02:05a high temperature often a stiff neck and sometimes people find their eyes are very bothered by light
02:11they may have a rash although that does not have to be there and that can look like anything but
02:16the
02:16classic one is this non-blanching rash that if you press on with a glass then it doesn't go away
02:25but it's also worth noting that outside of these like really typical meningitis symptoms
02:30there are also other things that people can present with especially if they've got what's
02:35called meningococcal septicemia where it's in the bloodstream rather than the brain so that might just
02:40be feeling like you had very bad flu people sometimes feel very sick they may have vomiting
02:46or diarrhea sometimes they're very cold peripheries so the symptoms can be quite non-specific and it is
02:51also a thing in young children they sometimes just seem irritable or out of sorts obviously outside of
02:57this outbreak those symptoms are still most likely to be something else but if you are in the outbreak
03:02area and have any of these symptoms you should be seeking healthcare advice urgently if you're outside the
03:07outbreak area then i would recommend phoning 111 and just chatting it through with someone who'll be
03:12able to help you work out how urgently you need to get assessed meningitis bacteria not just this one
03:17all of them start living in the throat and actually they only very rarely become invasive into the blood
03:23or into the brain so most people they never go anywhere they just stay in their throat for a period
03:27of time and then eventually your body clears it um that means that the spreading basically requires
03:33people coming into contact with secretions from someone's throat and it normally requires quite
03:38close proximity so that may be as you say for sharing something that's been in someone's mouth
03:44we've often talked about kissing or intimate contacts but equally being in a small space with
03:50lots of people if people are sneezing talking singing you know there will be respiratory droplets
03:54being made that people can also then pick up carrying this organism in their throat this bacteria
04:00most of those people even if you pick it up won't ever get meningitis but obviously in a proportion of
04:05those people they will end up developing an invasive infection like meningitis vapes this is obviously very
04:12topical to this outbreak um and i will caveat this whole thing by saying there is no evidence of a
04:19concrete type no concrete evidence that we know that vapes are involved at the moment but i think it's
04:26safe to say that anything that has sharing things that go in your mouth does increase the likelihood
04:31obviously of transmitting an oral bacteria and we know these are bacteria that around that area
04:36so it is sensible not to share vapes as a general rule from a hygiene point of view and also
04:41in this
04:42context of an outbreak certainly if you're in kent i would not be sharing vapes with other people
04:46because there is a risk that people have this bug in their mouth we know that vaping even outside of
04:52the
04:52sharing bugs we know that vaping inflames the airway and inflamed airways are easier for bacteria
04:58to cross so it is known to be a risk factor for lots of respiratory infections um and it is
05:05very
05:05plausible that it could increase your risk of your bacteria from your throat becoming invasive so in
05:11general better avoided if possible i've seen these the footage of people in the queue using face masks
05:17and i guess it makes sense if you unavoidably need to be in close contact at the moment with people
05:22um you know and you are at the university of kent then i understand it i don't think people
05:28outside the university of kent need to be taking those sorts of measures it's not like measles or
05:32covid or any of these kind of more easily transmissible infections it does require quite close content
05:38contact overall the most vulnerable people from nb are actually babies that's why they were targeted
05:44in the vaccine campaign and that's why they've been the priority and that risk falls away quite
05:49quickly even into kind of preschool years so babies are by far the most at risk um then we have
05:55young
05:56adults and that's a product of social mixing it's just an exposure they just get exposed a lot more so
06:01it's slightly different to the babies who are actually more vulnerable the at the young adults we
06:05don't think more vulnerable it's more that they get exposed more often but there are also other people
06:10in the population who we know their immune system doesn't work as well against these bacteria so
06:15people for example who don't have a working spleen or people with sickle cell disease but those people
06:21they are already offered vaccination so there's already a national policy to identify people who
06:25are particularly high risk and they will already be offered meningococcal vaccines routinely so they
06:31should be covered outside of this immediate outbreak i would not be particularly concerned about a child
06:37coming back from university um because you know the risk as far as we know across the country remains
06:43extremely low if you have a child who's at the university of kent if they have been in contact
06:50with a possible case or been to one of the places that is considered a risk for example this nightclub
06:55where they're contact tracing they should definitely go and get the antibiotics that they are being offered
07:00and i would suggest having a very low threshold for taking up the antibiotics we know that the
07:06antibiotics are really effective at clearing the bug from them from the throat so whilst they've had
07:11their dose of antibiotic i wouldn't be particularly concerned about them coming home um but i would
07:16obviously just want to remain vigilant and just on the off chance of any symptoms but i think by that
07:21point the risk to everyone would be very low i don't think that pregnant women would be considered at
07:26grossly higher risk of um men b than the general population because of the way that the immune system
07:32controls it so to my knowledge they are not considered higher risk than anyone but obviously if they did
07:38acquire it it would not be great from a kind of general health and well-being point of view and
07:43may
07:43be risky for the pregnancy there are lots of viral meningitis that pregnant ladies are better to avoid
07:51um but again i think beyond being sensible about you know trying to minimize your risk of contact with
07:58known outbreak areas and known ill contacts is very difficult to know how you would reduce your risk
08:04which is already very low so i don't want people to be kind of panicked about it the vaccine is
08:10administered two doses very early on in infancy so that it's there it's very unlikely that you would
08:16have extensive contact um before you've been vaccinated it's deliberately given really early on in
08:23life to try and minimize the risk to the baby and so we would i think the in general babies
08:29once will
08:29have had the doses very early but yes it's sensible for anyone to avoid contact with ill cases you know
08:36if they have an infant um or a pregnant i think it's a sensible sort of risk reduction to do
08:41that if
08:42someone had um meningitis and they have an active case rather than trying to prevent it we would give
08:48them intravenous injection antibiotics in the hospital and depending on the type of meningitis
08:53that they had which specific bacteria you may or may not give steroids alongside those antibiotics
08:57that won't that isn't something we normally do for this particular type of meningitis so
09:02the mainstay here will be um antibiotics to kill off the bacteria and then a lot of supportive
09:09care to try and help the body regulate itself so for example if there's dysregulated blood pressure or
09:14blood clotting um all of that will be need to be taken care of as well so it's a kind
09:19of support
09:19and antibiotics the vaccine i believe is going to be used potentially in outbreak control which makes
09:25a lot of sense to try and bring as much immunity to the affected community as quickly as possible
09:30outside of that i don't think anyone needs to be rushing urgently to be getting men b vaccine
09:36because as i said the risk of picking up men b is very very very low across the whole population
09:42the
09:42risk of getting invasive men b meningitis remains very low so i don't think all adolescents need
09:47to be rushing saving up their 220 pounds to get themselves vaccinated i do think there's going to
09:54be a lot of worried parents around and we are going to have a slightly difficult situation now from a
09:59policy point of view where you know some parents will pay for this out of pocket and to reduce their
10:05child's risk and obviously that is not very equitable at a population level but when we think about
10:10individuals you know each person is going to have their own level of risk that they're comfortable
10:16with the risk is tiny but equally i can understand you know if i was a mother of an unvaccinated
10:22child
10:22and i had 220 pounds disposable i would certainly consider it but i don't think people need to be
10:27pressingly urgently outside the outbreak area rushing to get men b vaccine there's clearly been a lot of
10:33messaging around accessing antibiotics to reduce transmission and that is probably priority number one in the
10:38outbreak is to make sure we clear as much carriage as possible because that will stop the ongoing
10:43transmission of this bacteria so that's i think is you know priority number one is try and get rid of
10:48the bug from people's throats in kent that's number one job and that seems to be happening and now they're
10:53going to bring the vaccine as well um i i it's very difficult to think how you improve things i
11:02guess
11:02you know we already have what's called notification so as soon as there's a case of case of invasive
11:08meningococcal infection that gets notified to the public health body and they will check that it's
11:13not part of an outbreak but obviously this outbreak has happened very fast and a large number in one go
11:20and as far as i know they only found out about the first cases on saturday so that you know
11:26it's been a
11:27relatively small window of time to already have rolled out the antibiotic plan
11:31and it sounds like they're now rolling out the vaccination i guess there is education always
11:37around um making sure the public are aware of symptoms of concern i think most people probably
11:43do know i think i find it amazing how many people know about the glass test for example i do
11:47think
11:47there is quite good public awareness about meningitis um but maybe students are an audience that we
11:53should be thinking about making sure when they start that they know what's fresh as flu what's more
11:59concerning and when to get advice um i think that probably would be a useful intervention just to
12:05make sure that freshers at university know what to look out for my key takeaway is that outside of this
12:12outbreak in kent people should not be panicking and know that their risk remains extremely low and i
12:20don't think anyone outside the outbreak needs to be doing anything different in their day-to-day life if
12:25they're not familiar with the symptoms or signs of meningitis it's worth having a look on the internet
12:29to make sure that they know about those and also the signs of sepsis because those are important to
12:33know for everyone um but yes i think the outbreak people the people that are affected by the outbreak
12:40should follow the guidance they've received and outside the outbreak i don't think people need to
12:43take any action at the moment
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