Meningitis Outbreak (Hansard, 13 February 1986)

§ Lord McNair
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)
My Lords, everything possible is being done to discover the cause of the outbreak. The Medical Officer for Environmental Health and his colleagues are investigating meticulously all patients reported to have meningitis, together with their contacts and environment. Advice and assistance are being provided by the Public Health Laboratory Service and the Communicable Disease Surveillance Centre in an effort to discover any evidence of a link between patients which might be responsible for these infections.

§ Lord McNair
My Lords, I thank the noble Baroness for that reply. Can she confirm that there is an anti-meningitis vaccine at present being manufactured? Does she know whether this is yet available? If it is available would the Ministry recommend its use in the Stroud district?

§ Baroness Trumpington
My Lords, there are vaccines available for groups A and C and they have been used with success abroad, for example on British servicemen in Nepal, where this disease is prevalent. Unfortunately it has not yet been possible to produce a vaccine for the group B organism, which occurs most frequently in this country.

§ Lord Auckland
My Lords, bearing in mind that this is a very vicious disease, can my noble friend the Minister say whether she has any figures of the national incidence of this complaint?

§ Baroness Trumpington
In this country, my Lords, since 1965 annual notifications of meningococcal meningitis rose from about 500 to 1,300 in 1974, and subsequently fell to about 400 in 1983 and 1984 in England and Wales. In 1985 they rose again to about 550. In the past few years about 60 per cent. of laboratory isolations have been group B.

§ Lord Ennals
My Lords, I welcome the part of the reply given by the noble Baroness which indicates that she and her department are making inquiries into what is a deeply disturbing problem. In 1983 in the Stroud district this type of meningitis was 17.5 times the national average. My second point, and I wonder whether I may press her on this, concerns the disturbing factor that 47 per cent. of cases have, it seems, not been reported. Does this not show an extraordinarily lax attitude on the part of the medical profession? Can the noble Baroness assure the House that she is considering that side as well as the very high incidence of meningitis in the Stroud district?

§ Baroness Trumpington
My Lords, I have already expressed the Government's full sympathy to the local committee from Stroud who came to see me on this matter. Of course they have everybody's sympathy as regards this extraordinary incidence of the disease. I agree with the noble Lord that there may have been some undernotification generally, but that is not likely to occur in areas where the disease causes concern. The Communicable Disease Surveillance Centre has it under constant surveillance, both in respect of notifications to the Office of Population Censuses and Surveys and in respect of laboratory isolations of the causal organism. All forms of acute meningitis are required to be notified under public health legislation.

Lord Winstanley
My Lords, does the noble Baroness agree that when the factors responsible for the high incidence of meningitis are identified in these areas of Stroud and Gloucestershire, the same conditions may exist elsewhere? Therefore there might be a need for central rather than merely local action. Does the noble Baroness further agree that the reply she has given to my noble friend underlines the statement she made to this House on the report on the Stanley Royd hospital, to the effect that there is an urgent need for a review of the operation of the public health function and of the role of the speciality of community medicine in general?

§ Baroness Trumpington
My Lords, to take the latter part of the noble Lord's question, no, I do not think this has anything to do with the Stanley Royd report or outbreaks of food poisoning by salmonella. This is quite a different kettle of fish. In relation to the national notification rate for meningitis, since 1970 there have been five similar outbreaks: in Anglesey, Plymouth, Devon as a whole, Bolton and Monmouthshire. I appreciate, as I have said before, the public concern and anxiety.

Lord Winstanley
My Lords, I am afraid that the noble Baroness misunderstood me. I know nothing of kettles or fish. I referred to her statement that an inquiry was to take place into the whole function of environmental health and to the role and specialty of 294 community medicine. She made an announcement that it was necessary then: does she not still think it is necessary?

§ Baroness Trumpington
My Lords, I am not absolutely sure what the noble Lord is getting at. If he is talking about research, an enormous amount of research is going on throughout the world because this country is not the only place to have the disease. All that information is freely shared. If that is what he is talking about, that is one thing. Apart from that I do not think that I have anything more to say.

§ Baroness Masham of Ilton
My Lords, could these strains of meningitis be carried by birds or animals? If so, has full co-operation taken place with veterinary surgeons? Are these infections resistant to antibiotic treatment?

§ Baroness Trumpington
My Lords, I am talking off the top of my head and I stand to be corrected, but the outbreaks of the disease are in places as various as Nepal, parts of Africa and parts of America, so I should not have thought that the bird suggestion was possible. But let me explain—I am sorry to detain your Lordships—bacteria are more easily treated with antibiotics than are viruses. If it is quickly identified, antibiotics are usually successful in treating the bacterial causes of meningitis in this country, where the meningococcal form is the one best known.

§ Lord Rea
My Lords, does the noble Baroness not agree that the meningitis epidemic in Stroud has revealed the gross inadequacy of the whole system of infectious disease notification in the country? Would she suggest that the department sets up an internal inquiry as to methods of improving infectious disease notification? At the moment, is she aware that it depends on—

Noble Lords
One question!

§ Lord Rea
Will she listen to my words and perhaps pass the message to her right honourable friend?

§ Baroness Trumpington
My Lords, I certainly shall pass on those words. The medical officer for environmental health and his colleagues are meticulously investigating all patients reported to have meningitis, together with their contacts and environment. Advice and assistance are being provided by the Public Health Laboratory Service and the Communicable Disease Surveillance Centre in an effort to discover any evidence of a link.