Meningitis is back – and here is why | Devi Sridhar

With the tragedy of the deaths of two young people and 13 other confirmed cases, meningitis is once again making headlines in the UK, sparking public concern and concern about the risk. What is happening and why?

Meningitis has been a constant public health problem for decades. In the 1990s, around 2,500 laboratory-confirmed cases of meningococcal disease were recorded each year, largely caused by group C meningococcal bacteria – the disease is caused by a series of bacterial strains, each of which requires a different targeted vaccine to prepare the immune system. With the adoption of the MenC vaccine in 1999, cases of group C disease decreased by approximately 96%, to approximately 30 to 40 cases per year. Soon after, vaccination programs were expanded to ACWY groups, leading to a sharp decline in all of these groups as vaccines reduce infection transmission.

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

A key change is that another group of bacteria called MenB accounts for the majority of recent cases, particularly among young people. Previous vaccination campaigns have not covered this group. In 2015, the NHS introduced the MenB vaccine into the routine childhood immunization schedule, but this only covered children born after 2015. This does not cover children and young people over the age of 11 or 12.

Now that the Kent group has been identified as MenB (and not one of the other groups where adolescent vaccination coverage is above 70%), the main concern is that there is a high percentage of the population, including university students, without any vaccination protection against this group.

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

Early medical intervention is crucial to reduce the risk of long-term illness, including nerve damage and even death.

Once the strain was identified, health officials launched a targeted MenB vaccination program among university students in Kent, which will then roll outward. This is called ring vaccination in public health and has been used in other outbreaks to protect people who may be exposed and contain the spread of the disease. Evidence is mixed on whether the MenB vaccine reduces transmission, but it certainly provides protection against severe disease. As we know, not all vaccines provide perfect protection. During an outbreak like this, it is safer to get vaccinated than otherwise, but vaccines alone are unlikely to contain the disease.

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