The Hindu : Opinion / Editorials : Averting a meningitis epidemic

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Monday, May 16, 2005

Opinion

Opinion - Editorials

Averting a meningitis epidemic

The rapid spread of meningitis in the national capital has brought into focus a potentially deadly disease that requires quick and precise identification and a comprehensive response from health authorities. Meningitis is a general description for an infection of the meninges, the thin lining surrounding the brain and the spinal cord, by one of many causative agents. The wave of infection in Delhi, which has claimed 23 lives so far and is likely to leave many survivors with persisting health damage, is thought to be bacterial in origin. In its advisory to citizens to prevent an epidemic, the Delhi Administration's Directorate of Health Services has outlined a set of symptoms that types the infection as meningococcal, caused by one of a dozen sub-types of the bacterium. This form of meningitis is transmitted from person to person through droplets of respiratory or throat secretions. It incubates in the individual in a matter of four days to present symptoms such as high fever, skin rash, altered sensory perception, stiffness of the neck, and cool dry skin with a weak pulse. A more precise identification of the sub-type will be required to initiate targeted control measures. The experience in Delhi, as elsewhere, indicates that the disease is spread more rapidly in crowded and unhygienic conditions and among less affluent persons with limited access to living space and early medical intervention. There is some literature suggesting that children are particularly susceptible.

Faced with a public health challenge, the Centre and the Delhi administration cannot lose time in identifying the sub-type of the causative organism. A confirmatory test for meningococcal meningitis, the World Health Organisation says, requires a lumbar puncture and testing of the cerebrospinal fluid. Accurate information on the nature of the infection will facilitate the initiation of prophylactic measures and vaccinations for high-risk groups. The experience of several countries, notably in sub-Saharan Africa, in handling meningitis will aid the national effort. There appears to be little agreement among experts on adopting, as a component of general public health practice, universal meningococcal vaccination (where it is effective against particular pathogen types), though some countries do follow such a policy. The British Medical Journal has emphasised editorially the importance of early diagnosis and start of treatment, given the serious consequences of acquiring acute bacterial meningitis; it notes that antibiotics are particularly valuable in treatment. It is in this area that the Union Health Ministry with its present strong focus on public health and prevention can make a decisive intervention, in partnership with the Delhi authorities. There is encouraging evidence to show that early intervention can stem the spread of meningitis and achieve good outcomes. Many backward parts of Delhi may require sustained awareness campaigns to ensure that the residents adopt preventive practices to avoid contracting the infection, without coming under the influence of quacks and unscientific faith healers.

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