>> So, Dr. Offit, as a pediatrician, I've seen a lot of meningitis in young babies,
but I'd love to know a little bit more about the history about the meningitis vaccine.
>> Sure. Well, I mean, I did my pediatric residency in the 1970, so that was before
the development of three vaccines to prevent bacterial meningitis. One was Haemophilus
influenzae type b. The other was pneumococcus. And then the third was meningococcal. So, I saw
a lot of meningitis when I was training. I mean, there would be 20,000 cases a year, 25,000 cases
a year. We would admit several children every week to the wards with bacterial meningitis,
which could be devastating. Although there is, there are antibiotics to treat bacterial
meningitis; nonetheless, children often suffered sequelae, meaning post-infection problems, like
hearing loss, vision loss, difficulties, you know, with movement, etc. So, bacterial meningitis was a
nightmare and occasionally fatal. Now we have a vaccine to prevent all three of those diseases.
So, most people your age actually don't see a lot of bacterial meningitis, which is interesting. So,
we're not as good at doing these lumbar punctures, or spinal taps, as we used to be.
>> Yes, absolutely. You don't have as much occasion, I think. I remember being with
attendings in the ICU and they would say, we used to do these all the time when we
admitted kids with meningitis, and you all are really learning on the fly right now.
>> It’s, it’s, you know, we take it for granted. I think because we don't see meningitis at nearly
the rate that we saw it before, I think some people think, you know, it's not a problem. Vaccines
are often a victim of their own success, and I think that’s at some level the case here.
Actually, I used to have this trick that I used to do when there was a baby that had bacterial
meningitis, like someone between 6 say and 24 months of age. I used to have this little measuring tape,
just a little, blue plastic measuring tape, and I would pull out this thing,
and then you would push this little white button, and it would snap back in. So,
you would show that to the young child, now they're interested, right? They're interested
in what you have. And then I would bring it up. And typically, what happens is children will
normally maintain their eyes in the midline, so they'll look up to see it as best as possible. But
children who had neck stiffness would lift them up because they didn’t want to move their neck.
>> Oh, what a good clinical trick, Dr. Offit. That's really neat.
And you know, I think that it's important with meningitis to really know, like you say,
how sick they can be, how sick kids are. Because even though we don't see it that frequently,
when you do and you see a child with meningitis,
it's very frightening. It seems very emergent, and they look very, very sick.
>> And it's a word that scares parents. That word, “meningitis,” scares parents. And it's
not just bacteria. I mean, there are viruses also that can cause meningitis, viruses like
measles or mumps which can cause meningitis. Although typically when bacteria cause meningitis,
they sort of infect the lining of the brain and spinal cord. But when viruses cause
meningitis, it's really not just meningitis, it's often called meningoencephalitis,
which means it's not just the lining of the brain and spinal cord but also the brain itself.
Again, vaccine preventable with a measles and mumps vaccine.
>> Did you see a lot of GBS meningitis?
>> Yeah. So, group B strep is a bacteria that can sort of colonize or live on the lining of,
sort of the, the birth canal. And so, children would acquire that bacteria then when they pass
through that birth canal. Yeah, so we saw some group B strep,
but mostly it was Haemophilus influenzae type b and pneumococcus
and less commonly meningococcus. But those diseases dominated my residency.
>> So interesting, because now when I counsel parents during those early visits when they
have babies like 2 months and 4 months, and we go through a roster of the different kinds of
vaccines, everyone says, oh yeah, I've heard about pneumococcal or I've heard about DTaP,
but meningitis Hib is the one that they really don't know that much about. So,
you're right, it's sort of a victim of its own success. It's really interesting
to talk to parents about it and explain how serious it can be.
So, you know, it's interesting in terms of the meningitis vaccine, I’ve seen a lot of
it before the pandemic hit with travel. So, a lot of our families that we see are going to places
like Africa or Asia or different parts of the world. And it's interesting to think about even
now you don't see that much meningitis because we have preventable vaccines to help during travel.
>> I think that's right. And again, I think it's something we often take for
granted. I think we don't think about all those diseases that are out there when we
travel and are not always great about getting those vaccines, but we need to.
>> I had a patient when I was in training in DC, and they had had meningitis. It was
a 17-year-old. They have been completely unvaccinated, and they'd gotten it.
And they had headaches and a question of some seizures and a lot of lingering effects after that
when you don't see meningitis that much, you might not think about because we think about
it as sort of a disease that's of our past, but it does linger those effects afterward.
>> Absolutely. That's why it's so important to prevent it. I mean, talk about fears of long COVID
now, but there are a lot of diseases which have long-term consequences, so prevent them.