Concern has been raised by health authorities and parents who have been alarmed since yesterday by the death of a 20-year-old student in Patra from meningitis. The rapid progression of meningococcal disease and its potential to quickly lead to the unfortunate young man’s collapse and eventual death is shocking. And they bring back into the debate the value of vaccination for serogroup B – especially for some groups such as students – with which most cases of meningitis are found in our country.

Patra has been at the centre of meningococcal disease since last year. A 20-year-old female student became severely ill and underwent lower limb amputation. This was preceded by a student whose parents found him in poor condition due to the disease early last January. Another student had also fallen ill in the Patras area last year, meaning that a total of three cases had been recorded. The National Organization of Public Health (EODY) closely monitored the University of Patras students and contacts of the above-mentioned young people and administered chemoprophylaxis as a precautionary measure to those who were identified as close contacts of the cases.

Public health experts are adamant that there is no epidemiological link betweenthe current fatal case and last year’s. As they say, based on guidelines, a possible association is being considered for a time interval between cases of up to three months. Nevertheless, the record of serious cases in this city is of concern to the medical and scientific community.

As ygeiamou.gr the Professor of Pathology – Infectious Diseases at the Hospital of Rio, Markos Maragos, notes, the risk of contracting meningococcal disease is increased near the “peak” of seasonal influenza, i.e. the months of February – March. And last year’s season, the cluster in Patras was about the same time period. The first severe case was recorded in the first 10 days of the year.

Especially regarding the 20-year-old who died yesterday, according to reports, the student went to the University Hospital of Rio in the early hours of Tuesday and after a few hours he expired. The deterioration was rapid, with doctors intubating him and admitting him to the ICU. They had seen on clinical examination the bleeding rashes, which mobilised them as well as the high fever reported by the unfortunate young man’s twin sister describing his symptoms in the previous hours.

Tests to identify the meningococcal serogroup are ongoing. It is most likely, however, thought to be meningitis B. Mr. Maragos, who has handled all the severe cases of meningitis in Patras himself, notes in ygeiamou.gr that because the population is vaccinated for the other common types of meningitis, meningitis B predominates.

Up to 10% of cases lose their lives

Meningococcal meningitis and septicaemia, caused by meningococcus – there are 12 serogroups including B – is a disease that can affect any age group. Most cases occur in infants and young children under four years of age, but a large number of cases (about 1 in 3) occur in adolescents and young adults aged 10-24 years. The incidence of meningococcal disease is low, but because of the high mortality rate, early diagnosis and treatment are critical.

Characteristically, it can cause death within only a few hours. About 5-10% of cases can result in death, while in 15-25% it can cause permanent brain damage, deafness, kidney failure or limb amputation.

A total of 37 cases were recorded in the country last year, five of which occurred in January. This year in January to date eight cases have been recorded, five of which have been identified as serogroup B and results are awaited for three. In the years 2014-2023, a total of 131 cases of invasive meningococcal disease (MMD) of serogroup B in infants and children aged up to 18 years were reported in Greece. The majority involved infants under the age of one year and children aged 1-4 years, with the highest incidence observed in infants under the age of one year. During the decade 2014-2023, there were a total of 9 deaths from serogroup B STDs in infants and children up to 18 years of age, according to official data.

Shocking development

The course that meningococcal disease can take in a matter of hours is shocking. According to pediatricians, a big question mark is why an organism can collapse so rapidly after being infected by the infectious agent of meningococcal B. It seems that in some cases there is increased susceptibility, but it is not possible for parents and doctors to know this in advance.

Also, the signs are not clear to alarm children, young people, such as students, and parents, as the symptoms are similar to flu. “Bells” are high fever and hemorrhagic rash, symptoms that should mobilize patients and parents when it comes to minors. A proportion of 30% of cases do not give the typical picture of meningitis.

“Any infection and any illness that goes beyond what the parent has seen when their child is sick should mobilize the parent. When pediatricians hear ‘I brought you the child because this time it’s something different’, they know how to move,” notes Professor Emeritus of Pediatrics at the University of Athens and President of the National Vaccination Committee, Maria Theodoridou.

Especially in the early stages of meningitis it is difficult for the doctor to make a correct diagnosis.

• The most common symptoms of the disease are:
• high fever
• headache
• difficulty bending the neck
• Other symptoms may include:
• nausea
• vomiting
• centered eyes
• photophobia
• sleepiness or intense restlessness and irritability
• rash

The free vaccination

The best way to prevent meningococcal meningitis is vaccination. Until recently, the vaccine for meningitis B was not covered in our country. As a result, most children and young adults are unvaccinated.

Epidemiological data showing that the highest incidence of invasive meningococcal disease is in infants combined with the return of cases to pre-pandemic levels – still low, of course – were among the reasons that led the National Vaccination Committee five months ago to include the meningitis B vaccine in the National Vaccination Program for infants under one year of age. The need to immunize closed populations, such as college students in dormitories, is of concern to the scientific members of the National Immunization Committee.

According to official guidelines, vaccination should be carried out starting at two months of age and administered in 3 doses in a 2+1 schedule at 2, 4, and 12 months of age respectively. It should be noted that early initiation is of great importance because the maximum incidence of the disease in Greece is recorded in infancy and even in the first six months of life.

It is worth noting that for those ages not reimbursed, the vaccine costs about 100 euros per dose and three doses are required. If a family has two and three children, it is easy to understand that this is a very significant amount to pay, which is why most families have not had it even though pediatricians recommend it. As an example, in the last two years there have been around 333,000 meningitis B vaccines for children and adolescents, with families paying around €27 million to buy them.