Prof. Dr. Mehmet Ceyhan: ‘Families cannot afford meningitis vaccines because they are expensive’

Hazal Güven - 12punto.com.tr

Following the death of 8-year-old second-grade student İrem Aslan due to meningitis in Kocaeli last week, painful news has also arrived from Istanbul. The Turkish Medical Association (TTB) Family Medicine Branch announced that another 14-year-old child has lost their life due to meningitis. 

These deaths have brought meningitis vaccines back onto the agenda. Vaccines developed against meningitis, which is seen more frequently in children in Turkey, are not included in the National Immunization Schedule. In other words, the state does not cover these vaccines. The current pharmacy prices for the vaccines that should be used against meningitis range from 2,856 TL to 2,247 TL. Families are unable to obtain the vaccines due to the high prices. This increases the rate of fatal cases. 

Prof. Dr. Mehmet Ceyhan, Head of the Department of Pediatric Infectious Diseases at Hacettepe University (HÜ) Faculty of Medicine, who has been conducting research on the disease for many years, made striking assessments to 12punto. 

Ceyhan said, “Vaccination schedules actually show the level of development of countries. That is, the more vaccines a state can provide, the more developed that state is. If vaccination had been carried out, we would not have lost these children.” 

It has emerged that meningitis was behind the deaths of two children. What is the current situation regarding cases in Turkey? Can we speak of a serious increase in cases? 

“We do not know how much the cases have increased in Turkey at the moment. Because this disease does not follow a normal course; it follows a fluctuating course. We see an increase in cases every 10-20 years. The Ministry does not share data regarding this. When the number of people with low immunity in the community accumulates and reaches a certain point, the number of cases seen among them increases. This leads to an overall increase in cases. 

Another important piece of data is the pandemic period. After living under strict conditions with precautions, the state suddenly lifted all measures. This led to an increase in many diseases transmitted through the respiratory tract. Because people began to interact completely uncontrollably and even more than before. The bacterium we call meningococcus is also transmitted through the respiratory tract. Therefore, this is another reason for the increase.”

So, what is the situation with vaccination? 

“In general, there are three bacteria that cause meningitis. 95 percent of cases occur with these three bacteria. One of them is a bacterium we call Haemophilus influenzae Type B. It has been included in the National Immunization Program since 2006. The other is the bacterium we call pneumococcus. It has also been included in the National Immunization Program since 2008. The bacterium we call meningococcus remains. There are two effective vaccines for this. 58 countries vaccinate their citizens according to a plan, but Turkey does not have a national plan. Therefore, the vaccines for this bacterium are not in our national vaccination schedule. In other words, these are not vaccines that people go and get for free. However, they can get vaccinated if they purchase them from the pharmacy with their own means. Since these are also quite expensive vaccines, the rate of vaccinated children cannot increase very much.  

'IF VACCINATION HAD BEEN CARRIED OUT, WE WOULD NOT HAVE LOST THESE CHILDREN'

In our country, meningitis is seen more in young children. But this varies from country to country. For example, in the USA, starting from the 80s, it was seen more in college and university students. At one point, we saw it in mass cases among soldiers. That is, the disease is seen more frequently in places where crowding increases. That is why we recommend vaccination starting from infancy, as most of our cases are young children. But if an increase in cases occurs, we recommend a booster in the adolescent period as well.  

In 2013, we made a decision at the Ministry of Health Vaccine Advisory Board to include this vaccine in the national immunization program. However, the minister changed during that time, and the issue was shelved. Vaccination schedules actually show the level of development of countries. That is, the more vaccines a state can provide, the more developed that state is. If vaccination had been carried out, we would not have lost these children.”

What kind of disease are we talking about? 

“When the bacterium we call meningococcus causes meningitis, it leads to death in about 5-10 percent of cases. This is a picture we can still call good. Sometimes this disease causes blood infection. Then the mortality rate rises up to 30 percent. It is the most urgent situation a physician can encounter in their lifetime. In seconds, a perfectly healthy child's heart stops. Immediate intervention is required. For all these reasons, it is a bacterium that should be taken seriously. One feature of meningococcus is that it can change groups much faster than other bacteria. One year you see that the ‘W’ type is the most common type, then you see that the ‘B’ type is encountered more.”

Can permanent damage occur in someone who has had meningitis? 

“The most common thing we see is hearing loss. A significant portion of people with hearing loss in Turkey had meningitis when they were children. Reading and learning difficulties may arise. Epilepsy may occur. Some motor nerve diseases may develop. 

There are 12 types of the bacterium we call meningococcus. 5 of these lead to meningitis more often. A common vaccine that will protect against these five has just started to be used in the USA. It is not yet in Turkey. However, we currently have a vaccine that protects against 4 of them, and there is a separate vaccine for the B type. If people are going to get vaccinated, they need to get both. Of course, these are expensive vaccines. Families are struggling under today's economic conditions.”