Meningitis is back – and here is why | Devi Sridhar

3 hours ago 11

With the tragedy of two young people dying, and a further 13 confirmed cases, meningitis is back in the headlines in the UK, prompting public concern and worry about the risk. What’s happening and why?

Meningitis has been an ongoing public health concern for decades. Back in the 1990s, around 2,500 lab-confirmed cases of meningococcal disease were recorded annually, largely caused by meningococcal group C bacteria – the disease is caused by a range of bacterial strains, each of which require a different targeted vaccine to prepare the immune system. With the adoption of the MenC vaccine in 1999, cases of group C disease fell by around 96% to roughly 30-40 cases per year. Soon after, vaccination programmes were expanded to cover groups ACWY, which caused steep declines in all of those groups, because the vaccines reduce the transmission of infections.

With the restrictions on mixing and protections taken to limit spread of Covid-19 in 2020, meningitis cases dropped to record lows as a side-effect. There were just 80 confirmed cases in England in 2020-21. These numbers have continued to grow since then, of course, with 205 in 2021-22, 396 in 2022-23 and close to 400 for 2024-25.

A key change is that a different group of bacteria known as MenB accounts for the majority of recent cases, especially in young people. Previous vaccination campaigns didn’t cover this group. In 2015, the NHS introduced the MenB vaccine to the routine childhood immunisation schedule, but this only covered children born after 2015. This doesn’t cover children and young people older than 11 or 12.

Now that the group in Kent has been identified as MenB (and not one of the other groups for which teenage vaccination coverage is more than 70%), the major concern is that there’s a large percentage of the population, including university students, without any vaccination protection against it.

Meningitis outbreaks are more common at universities because of the social mixing: the bacteria spread through close, physical contact – think sharing vapes and kissing (saliva), coughing or sneezing (droplets) or even dancing close together in a nightclub or being in a crowded bar or cafe. The first public health step has been to identify who would have been in close contact with an infected person, and possibly exposed, ensure they are put on antibiotics immediately, isolate to prevent further spread, and also have them track their symptoms to see if they develop the tell-tale signs of fever, rash, stiff neck or a bad headache.

Early medical intervention is crucial to reduce the risks of long-term illness including nerve damage or even death.

Once the strain was identified, health officials started a targeted MenB vaccination programme with university students in Kent, which will then work outwards. This is referred to as ring vaccination in public health, and has been used in other outbreaks to protect those who might be exposed and contain the spread of the disease. The evidence is mixed on whether the MenB vaccine reduces transmission, but it definitely offers protection against severe disease. As we know, not all vaccines provide perfect protection. During an outbreak like this it is safer to be vaccinated than not, but vaccines alone likely won’t contain the disease.

Right now, UK government public health teams are working hard to contain the spread of MenB as a priority, and so far, it looks like they’re doing what they can as the data emerges on this particular MenB strain. It’s just another example of why we need investment in public health. The entire field has been in decline since Covid and the start of the second Trump presidency, and a stark reminder that when public health works, it’s invisible. We don’t see the outbreaks that haven’t happened. It’s also a reminder of the power of vaccines and why building up immunity in the population through routine vaccination programmes is so important.