06 March 2019
Meningitis is a deadly disease that can kill in hours. Outbreaks occur all around the world particularly in the African Meningitis Belt where close to one million suspected meningitis cases were reported in the last 20 years, causing approximately 100 000 deaths.
Getting fast medical attention is important but, even with optimal medical care, infection can still kill or cause life changing after effects. This means that prevention through vaccination is the best tool of defense.
The World Health Organisation has launched a global plan to defeat meningitis by 2030. This month we consider the history of bacterial meningitis, the vaccines we depend on to defeat it and the people who created them.
Causes of meningitis
Meningitis symptoms have been described in ancient texts throughout history, even Hippocrates described brain inflammation in his work. The first outbreak of meningococcal meningitis was recorded in Geneva in 1805, the first recorded outbreak in Africa was in 1840. The popular ‘miasma theory’ of the time attributed the spread of the disease to ‘bad air’ and it was not believed to be contagious.
John Abercrombie (1781–1844) played an important role in developing the understanding of meningitis. In his textbook of neuropathology, he was one of the first people to use the term “meningitis” and it was only after this work in 1828 that the term came into general usage.
In 1887, Anton Vaykselbaum, a Dutch biologist, linked bacterial infection as a cause of meningitis for the first time. The idea of bacteria causing disease had begun to become popular with the identification of many bacteria during this period.
By the end of the 19th century several bacteria were known about but they could only be identified once the patient had already died. This changed with Heinrich Quincke (1842–1922). Quincke was the first to describe how the lumbar puncture, trapping cerebral spinal fluid with a hollow needle, could be used for diagnosis while patients were still alive.
During the Geneva epidemic of 1805, patients were treated with emetics to induce vomiting, quinine wine and bloodletting by leeches. It was believed that reducing the amount of fluid in the body by bloodletting and vomiting would relieve the pressure of inflammation. Similarly, before lumbar punctures were used for diagnostic purposes, drainage of spinal fluid was used therapeutically to relieve the pressure of ‘too much fluid’ during the late-nineteenth century.
Despite advancements in diagnosis at the end of the 19th century, effective treatment was not yet available.
During extensive epidemics of meningococcal meningitis at the beginning of the 20th century , both Georg Jochmann (1874–1915) in Germany and Simon Flexner (1863–1946) in New York were searching for a way to protect against meningitis. They both produced an immune serum or antiserum containing specific antibodies from animals who had been injected with meningitis causing bacteria. This seemed to protect against meningitis as well as having a therapeutic effect. Direct injection of horse antiserum into the cerebral spinal fluid became the main therapy for meningococcal meningitis and was the first effective treatment. In the First World War it saved many lives.
In 1935, sulphonamides (an agent that kills bacteria) became the treatment of choice for meningococcal meningitis. Sulphonamides were cheaper and less risky than the antiserum. By 1941, following the discovery of penicillin by Alexander Fleming, antiserum was no longer recommended, and penicillin was the first antibiotic that would be commonly used. This marked the start the antibiotic era.
During World War II, several breakouts of meningococcal meningitis were recorded, especially among military personnel. The first reports of large numbers of meningococcal meningitis patients being treated with penicillin came from the American Army and it was remarkably effective. One report described an outbreak among 71 soldiers. After treatment with penicillin only one died.
In the 1960s, sulphonamides became ineffective because the bacteria had developed increased resistance to the drug. It was in fact not the introduction of antibiotics but the development of resistance that brought the sulphonamide era in the treatment of meningitis to an end; anti-microbial resistance is now at the top of the agenda for many health care professionals, raising the question of how long this treatment will remain effective.
Vaccines to prevent meningitis were first attempted in the early 1900s with varying degrees of success. In the 1930s meningitis vaccines that were safe, stable and effective against pneumococcal meningitis were produced for the first time, followed in the 1960s by vaccines against meningococcal meningitis.
Since then, research has been focussed on creating more effective vaccines that protect against the multiple bacterial causes of meningitis. While there is still no single vaccine that can protect against all forms of meningitis, the development of vaccines has had incredible results. Globally, bacterial meningitis is down by 25% and 90% of this reduction is attributable to vaccination.
One of the biggest successes in the history of meningitis prevention has been the MenAfriVac story. Between 1996-97, a quarter of a million people across the so called Meningitis Belt in Africa were affected by meningococcal A meningitis and 25,000 died from it.
Following this particularly devastating epidemic, the WHO, PATH and the Serum Institute of India came together to produce a vaccine that was affordable and developed specifically for Africa. Since its introduction in 2010, more than a quarter of a million people have been vaccinated across the meningitis belt, leading to its virtual disappearance in these areas!
The future of meningitis
What will the meningitis story look like in 2030? Diseases like Smallpox have been eradicated by vaccination. Polio has been brought under control. Defeating meningitis means celebrating the victories of the meningitis vaccines we’ve created until now and making a collective commitment to support vaccination as we look to the future.
Gwen works at CoMO’s head office in the UK and provides administrative support to the CoMO team. Gwen has a background in social justice and has worked in charity organisations that promote equality and opportunity for all.