HC Deb 02 December 1996 vol 286 cc669-75 3.30 pm
Mr. Jon Owen Jones (Cardiff, Central)

(by private notice): To ask the Secretary of State for Wales to make a statement on the meningitis outbreak at the University of Wales, Cardiff.

The Secretary of State for Wales (Mr. William Hague)

An outbreak of meningococcal infection has occurred among students at the University of Wales college of Cardiff, in which there has been a total of six cases, with two deaths.

The first case occurred on 14 October, when a student normally resident at university hall became ill at home. Her close social contacts, both at her own home and at the university hall, were traced and given antibiotics. That is the recognised course of action in an isolated or sporadic case—which this was thought, and may still prove, to have been. That student has now made a complete recovery.

Over one month later, between 16 and 20 November, two further cases occurred, one of which affected a student normally resident at university hall. Both those students are still recovering in hospital. Again, antibiotics were administered to close contacts.

Three further cases arose between 27 and 29 November. Two of those affected died within hours of exhibiting symptoms. By late morning on 29 November, clinical and public health physicians decided that there was evidence to suggest that all the cases were linked and were probably all group C organism cases, although complete diagnostic information was not by then available from the laboratory. An outbreak control team of experts was established by the health authority.

The same day, antibiotics were offered to all residents of the hall, and the students were told that a vaccination programme would commence. Advice to students includes avoidance of close physical contact. They are being advised to stay on campus, where expert medical surveillance is available. A help line and counselling service is being manned by the Meningitis Trust. A hotline has also been set up for general practitioners treating students, to obtain clinical information and advice.

Yesterday, 550 students were vaccinated, and the total will rise to 900 by the end of today. Vaccination is also on offer to any guests who may have stayed overnight at the hall since 16 November.

A special ward has been opened at the University hospital of Wales for observation of residents of university hall. Several students have been admitted overnight, although only one has symptoms suggestive of meningitis, which is possibly of the viral type, and therefore not linked to the other cases.

I am confident that the health and university authorities have instituted all possible means of preventing further spread of the infection. My chief medical officer has discussed the position with the outbreak control team and has visited university hall to assess the situation. Contrary to some press reports, she said that the atmosphere at the hall—although, understandably, tense and sober—does not demonstrate any panic. The students are behaving very responsibly.

Detailed information about the epidemic will be available only when the results of all tests are known and the epidemiological studies are completed. This may take several weeks. For that reason, I intend to await the report from the health authority on the outbreak before deciding whether to undertake any further inquiry.

Finally, the House will wish to join me in sending deep sympathy to the relatives and friends of the students who have died of this very serious infection. The health authority and the university authorities have collaborated very well in co-ordinating their action, and we are grateful to all those who have worked so hard over the weekend, including the staff at the University Hospital of Wales NHS trust, the Public Health Laboratory Service and the Meningitis Trust, for their help and support.

Mr. Jones

First, I associate myself with the Secretary of State's latter remarks and offer my commiserations to the families who have lost their young and gifted children, and to those families who are understandably anxious at this time. I thank the Secretary of State for his statement; I also thank the Secretary of State for Health for joining him in the Chamber.

What assurances can the Secretary of State give that there is now adequate communication between the health authorities and those students who are no longer in the hostel, or indeed in Cardiff, but who have gone home? I understand that between 140 and perhaps even half of the students who were in the hall of residence concerned have gone home. I imagine that it is important to communicate with them and their families to ensure that they receive vaccinations or other medical treatment.

Will the Secretary of State instigate an inquiry into the earlier incident of meningitis which occurred, I believe, on 14 October? If it was not an associated incident, it is an enormous coincidence that there have been two separate outbreaks of meningitis in the same hall of residence within a month. If it was an associated incident, perhaps the guidelines for dealing with meningitis need to be re-examined.

I understand that meningitis is perceived to be a disease of close family connections, and students living in a hall of residence are in many ways living in a large, close and extended family. It may well be that we need to reconsider the way in which we deal with cases involving many people who are living in close proximity to each other, and that we need to act more quickly in instigating preventive treatment.

Mr. Hague

I thank the hon. Gentleman for his comments. I assure him that full communication is taking place with the students. They have been advised not to hold parties; all their GPs have been notified: a special ward has been opened at the University hospital, as I said a few moments ago; and the health of all residents of the hall is being carefully vetted every day.

Students who have gone home are being advised to return to Cardiff for vaccination and health surveillance, but arrangements are being made for those who are unable to return, or who do not wish to return, to be vaccinated in their home area. However, the hon. Gentleman will see from the figures I gave earlier that it must now be the case that the vast majority of students will have been vaccinated by the end of the day. I hope that any who have gone home and not been vaccinated will contact the student health service in Cardiff to make the necessary arrangements.

The hon. Gentleman asked about the earlier incident. Most cases of this infection are sporadic, or one-off, incidents. The case on 14 October was treated as such, and the recognised preventive action was taken—the tracing of all close contacts in the home and at university hall, and the administration of antibiotics. The advice that I have received suggests that it is still unlikely that there would be any connection between the two incidents. The long interval between them would seem to suggest that the two were not related—the normal incubation period for the disease is approximately a week.

Clearly it will be important to look at the report to be compiled by the health authority on the basis of all the evidence. If anything in the report suggested that the guidelines for dealing with that infection should be changed, my right hon. Friend the Secretary of State for Health and I would consider taking action.

Sir Wyn Roberts (Conwy)

May I too extend my deepest sympathy to the parents of those students who have died? Is my right hon. Friend aware that there have been two cases of meningitis among students at York? Will he look into any possible connection between the students at the different institutions? Will he also bear in mind the difficulty of eradicating the disease and its recurrent nature? There can be considerable differences of time between one case and the next. Will he give me an assurance that, if the disease spreads outside the university in Cardiff, he will offer injections and vaccinations to other vulnerable groups in the Cardiff area?

Mr. Hague

I have heard about the cases in York. I have seen no evidence that they are linked, although anyone who may be affected will be asked by doctors where they have been and with whom they have been in close contact in the previous days or weeks. If there were any connection, I hope that it would be discovered. My right hon. Friend is correct to point out the seriousness of the disease and the difficulty of eradicating it, particularly as it comes in at least four different forms. However, it is important to stress that infection is normally transmitted only through close bodily contact.

Medical authorities shy away from administering antibiotics to very large numbers of people in response to each individual case, because the unnecessary giving of antibiotic prophylaxis is more likely to create antibiotic resistance. The medical authorities have to strike the right balance. Clearly, it has been judged necessary to administer the antibiotics in university hall in this case. If there are further outbreaks elsewhere, each will be judged on its merits.

Mr. Alex Carlile (Montgomery)

In echoing the sympathy that has already been expressed by several hon. Members, may I remind the Secretary of State that there are many anxious parents of Cardiff students, particularly throughout Wales, from where many students at the university come? Will he take steps to ensure that information about how to avoid the spread of this form of meningitis is made available to communities throughout Wales, particularly through general practitioners' surgeries, so that parents can pick up leaflets and discuss this worrying issue with their children?

Mr. Hague

Yes, I recognise that many people will be anxious. I hope that they have received and have heard again today my advice about students returning to Cardiff for vaccination and surveillance. A number of leaflets on meningitis have been produced, including one called "What is Meningitis?" and another called "Knowing about Meningitis and Septicaemia", both of which are available from the Welsh Office and from health authorities. They should also be available from GPs. In response to the recent outbreak, posters and leaflets on meningitis will be provided to all universities and sixth-form colleges in Wales this week.

Mr. Rod Richards (Clwyd, North-West)

My right hon. Friend has acknowledged that many students have now left Cardiff and gone home. He has outlined the measures that have been taken and are being taken to contact those students. Will he tell the House what mechanisms are being put in place to ensure that those students' local health authorities are aware that students from Cardiff have moved into their area of responsibility?

Mr. Hague

As I have made clear in answer to earlier questions, the vast majority of students will have been vaccinated by the end of today. I believe that many have been returning over the past 24 or 36 hours. The proportion of students who have not been vaccinated should be extremely small. I hope that they will return or will be vaccinated in their home areas—I have made it clear that that option is available. The GPs of all the students have been notified. That is one important channel of communication. I believe that all the necessary means of communication have been used, but I will certainly confirm that every possible means of communicating with those students has been used.

Mr. Dafydd Wigley (Caernarfon)

I have a direct interest in this matter, in that two of my children are at Cardiff university and constituents of mine have children in the university hall there.

Will the Secretary of State look into whether there should have been more rapid movement over vaccinations? The original programme was for Monday, but it was pulled forward to Sunday. Should it not have been possible, and was it not necessary, to carry out the programme on Friday, given that there had been three cases in the preceding five weeks? Also, is the right hon. Gentleman aware that seven new cases are suspected today? Can he say whether all those are from the same university hall and not from elsewhere?

Is the right hon. Gentleman also aware that chemists in Cardiff have run out of the antibiotics and are desperately looking for further supplies? In view of all those factors, is there not a need for an in-depth investigation into what has happened?

Mr. Hague

The hon. Gentleman has asked a number of questions. Several cases have been under surveillance in hospital since last night, but they are not all meningitis. Only one is suspected meningitis, and, as I explained, it is a viral form, which is different from the cases that I have been discussing in my statement, so it may be an unconnected case.

As to whether there should be a greater inquiry, as I have made clear, I will await the outcome of the health authority's report, which has to be based on all the medical evidence, not all of which is immediately available—much of it has to be analysed in laboratories. That report will be forthcoming in a few weeks, and we will then be able to find out whether any further inquiry is needed.

As to whether the vaccination programme was carried out early enough, once a link is established between cases, the most critical thing is to administer the antibiotics quickly to the population who may be affected. That has been done. It has meant the use of a very large quantity of drugs. Of course, we will ensure that the necessary drugs are available to the students, but the programme of administering antibiotics and vaccinating has been carried out extremely quickly by the authorities, as we would expect. From what I have seen, I have no cause to criticise them.

Mr. Alan W. Williams (Carmarthen)

How effective is the vaccination, and for what period does it provide protection? I understand that there was another case of meningitis in that hostel a year ago. Surely there must be a link between these cases. Will the right hon. Gentleman's investigation pursue in detail what that link is?

Mr. Hague

The vaccination is effective in dealing with this type of meningitis—group C, which is what the six cases are believed to be. Vaccination is not effective against group B meningitis. The hon. Gentleman must be careful when talking about different meningitis cases, because the disease has different characteristics depending on the form that it takes. There are four types of meningitis—A, B, C and Y.

Vaccination and antibiotics are effective against this form, if they are administered early enough. They are effective for sufficiently long to deal with the incubation period of the disease, although I am not sure exactly how long doctors would advise that such a vaccination would last. I can let the hon. Gentleman know about that. He should bear in mind the fact that there are normally 2,000 cases of meningitis in the UK in any given year; so it is difficult to draw connections between cases, and there are more cases than he might have suspected.

Mr. Paul Flynn (Newport, West)

Has the Secretary of State seen the answer that I received on 19 November from his colleague at the Department of Health to a request about whether any link has been established between the over-use of antibiotics and the incidence of meningitis? In that answer, the Minister said that recent research had shown a possible link between the high use of a particular form of antibiotic in Gloucester and an outbreak of meningitis there.

Given that certain strains of tuberculosis are resistant to antibiotics and that the hospital bug disease—methicillin-resistant staphylococcus aureus or MRSA—is also possibly caused by the over-use of antibiotics—MRSA cases in Wales have increased from 400 last year to 2,000—can we not be wise before the event? We should recognise that we vastly over-prescribe and over-use antibiotics, and that they are creating new virulent, incurable forms of ancient diseases.

Mr. Hague

The answer from my colleague at the Department of Health to which the hon. Gentleman referred spoke of a possible link, but by no means a proven one at this stage. The balance of medical opinion is very much in favour of administering antibiotics in the eventuality that we are now dealing with. That is why they have been administered to many hundreds of students.

As I said in an earlier reply, health authorities are generally extremely careful not to respond to sporadic incidences of meningitis by mass prescribing of antibiotics, because those drugs may, over time, create antibiotic resistance. We are very much aware of that problem. The hon. Gentleman has referred to a possible link in some cases, but at this stage I do not think that it is possible to draw general conclusions from that.

Mr. Rhodri Morgan (Cardiff, West)

First, on behalf of the Opposition, may I endorse the Secretary of State's messages of condolence and sympathy to the entire student body at the University of Wales in Cardiff, and above all to the family and friends of the students who have died? I also offer our support to the medical teams that are engaged in combating this virulent and inherently unpredictable disease.

Now that the Secretary of State has confirmed that there was a meningitis case at the same hall of residence five weeks ago—happily, that student has recovered—will he comment on the widely expressed concern that, if a programme of administering antibiotics and vaccination had been carried out then as has been carried out now, the latest outbreak, which has had unfortunately fatal consequences, might not have occurred?

Are there adequate guidelines on how to contain an outbreak of meningococcal meningitis when it occurs at a hall of residence? Such guidelines already exist for outbreaks within families, when people are isolated, given vaccinations and treated with antibiotics.

Is it significant that the outbreak has occurred at the tower block at the university hall of residence at Pen-y-lan, and that none of the cases has come from the self-catering block in the same complex? The tower block may have some significance because of its communal eating facilities and communal toilet and shower facilities, which thereby permitted a greater spread of the germs through coughing, sneezing and so forth.

Would the right hon. Gentleman therefore confirm that perhaps more could have been done to persuade students more promptly, particularly those resident in the tower block at Pen-y-lan, to remain in Cardiff over the weekend to receive antibiotics and vaccinations, and be subject to medical surveillance? That would prevent any contagion from spreading to other parts of the country by students who are unknowingly incubating the disease while visiting family and friends.

Following the tragic death of the law student on Thursday, why did the university authorities take the trouble to e-mail the full-time law tutors to warn them, but did not e-mail the postgraduate law tutors who had the same amount of contact with that student?

Given that the five students so far confirmed as suffering from the disease are said not to be in the same social circle, does the Secretary of State agree that we urgently need to solve the mystery of how the bug spread? Will the right hon. Gentleman therefore give the House two guarantees?

First, will the right hon. Gentleman take responsibility for pulling together the combined expertise of the Bro Taf health authority, the University Hospital of Wales trust, the Glan Hafren trust of Newport, which treated the other student five weeks ago, the Meningitis Trust, the university medical authorities and the Public Health Laboratory Service, in order to isolate the origin of the outbreak and combat it? Secondly, if new guidelines are to be set on how to handle meningitis in communal living quarters, such as university halls of residence, they should be introduced and acted on without delay.

Mr. Hague

I am grateful to the hon. Gentleman for his opening remarks: the House is united in sending its condolences to the relatives and friends of those affected.

The hon. Gentleman asked again about the first case on 14 October. It is important to understand that that student became ill at home, and all the normal courses of action were followed—antibiotics were administered to the family and others who might have been in close contact with the student, including those at university hall. Subject to what is found later, the balance of evidence suggests that, owing to the incubation period, that case is unlikely to be connected, but we do not know that, and have to retain an open mind. The third case involved someone who did not live in university hall.

It was last Friday before the medical people involved formed the view that there was a link between cases. Information was quickly given to students following that analysis and before any definitive confirmation had been obtained. Information was given out at least twice, and bulletin boards were set up in the university last Friday afternoon. From what I have seen so far, I do not want to criticise the authorities for the action they took to inform people.

The hon. Gentleman asked whether the incident would have implications for guidelines we give in future. It may do—we seek all the time to improve our knowledge of the disease and the means of dealing with it. The report that eventually emerges from the health authority may give rise to new guidelines, or to our having to consider new guidelines.

Dealing with the incident will remain the responsibility of the health authority. I can guarantee to the hon. Gentleman that my chief medical officer is, and will remain, in close touch with everyone involved, and I and my colleagues in government will be anxious to see the evidence of the case as it emerges.