Vol. 419 No. 6
60 Mr. G. Mitchell asked the Minister for Health if he has investigated recent cases of meningitis in children in this country; if he has satisfied himself as to whether these are in any way related to bovine TB; and if he will make a statement on the matter.
Reported cases of meningitis in this country can be broken broadly into two main categories. These categories are (a) acute viral meningitis and (b) bacterial meningitis. Acute viral meningitis is not normally regarded as a serious illness. Bacterial meningitis is, on the other hand, a more dangerous condition.
The Department of Health monitor the incidence of infectious diseases including meningitis in two ways: (I) through the weekly reporting of cases by general practitioners to the local director of community care/medical officer of health who, in turn, reports the cases to my Department, and (II) reports on individual cases of bacterial meningitis are submitted by the local director of community care/medical officer of health to my Department. This reporting mechanism enables the Department of Health and the health boards to monitor the presence of meningitis throughout the country.
The reports showed the general pattern of infection for meningitis to be one of sporadic cases occurring in various parts of the country but late last year and earlier this year an increase in the number of cases of bacterial meningitis was apparent and a number of fatalities were recorded in the Southern and Eastern Health Board areas. Medical staff from my Department maintained close contact with these boards throughout these outbreaks during which the deputy chief medical officer of my Department wrote to each director of community care/medical officer of health in the country asking them to liase with general practitioners to ensure that there was a high awareness among GPs of the disease and that appropriate control and management measures could be undertaken.
The appearance of a case of bacterial meningitis indicates to the local health service the presence of infection in the area. The local health board through its director of community care/medical officer of health then liaises with GPs to create a more clinical awareness of the presence of infection in the area. This is important because in the more pernicious types of infection the prognosis will depend on early diagnosis and appropriate antibiotic therapy. Prophylactic therapy is also initiated for the family and immediate contacts of cases and a detailed report is made to my Department by the local director of community care/medical officer of health of each case that is notified to him by GPs in his area.
My Department are not aware of any association between bovine TB in Ireland and recent cases of meningitis. I should say that no cases of tuberculous meningitis have been reported in recent years.
Is the Minister aware that there is a connection between bovine tuberculosis and meningitis?
I am.
Is he further aware that the incidence of bovine tuberculosis has not been brought under control, as promised, and that in some regions it is at severe levels? Would he carry out an investigation in those regions where it has been documented that bovine tuberculosis exists at high levels as compared to others to see if there is a connection in those areas between bovine tuberculosis and meningitis? It has been related to me that there is the possibility that one is connected with the other.
Bovine tuberculosis is related to meningitis but not to bacterial meningitis and specifically haemophilus influenzae meningitis. It can be and was associated with tuberculous meningitis which is totally different. Bacterial meningitis which we are discussing at the moment — there were sporadic cases in Cork in particular and in Dublin — is caused by haemophilus influenzae. I should say to the Deputy that the Department of Health in Britain have decided to introduce a vaccine for children under the age of four. We are planning to introduce a haemophilus influenzae vaccination programme in this country for the winter or early spring seasons. This vaccine has been approved in Britain and they consider it safe. Given the increase in the number of sporadic cases in Britain they are introducing it. We are examining it to see if it should be introduced here.
Is the Minister giving the House an absolute assurance that there is no connection between any recent cases of meningitis and bovine tuberculosis? Has he had the matter investigated and is he giving the House an assurance that there is no relationship?
I am not an epidemiologist but rather a medical doctor.
You are the Minister for Health.
There is no correlation between bovine tuberculosis and haemophilus influenzae meningitis which is caused by a different bacteria. Bovine tuberculosis is caused by tubercle bacillus, which has no connection with the haemophilus influenzae bacillus.
The Minister is not giving us an assurance.
I should tell the Deputy that there is nothing sacred or authoritative in medicine and it can change tomorrow.
It is like politics.
I am sure the Deputy would not like me to arrive in the House with egg on my face.
I wish to assure the House that I would not like to see that happen.
This appears to be a constituency matter.
I detect some indulgence, Deputy in relation to constituency relationships which is not given to every other Deputy who asks questions.
The Minister has done me a severe disservice by putting on the record the fact that we are very close friends. I would like to ask him if he has had this matter investigated as it has been related to me by authorities outside this country that there may be a connection? If the Minister has not had the areas where there are the highest levels of bovine TB reconciled with the incidence of meningitis in those areas, will he now do so and let me have a report?
I am assured by the experts in the field of health that there is no correlation between haemophilus influenzae meningitis or bacterial meningitis and tuberculus meningitis. I could not make a categorical statement in that regard but I have been assured that that is so. However, as the Deputy is a close friend of mine, despite what he said to the contrary and because we work closely and in great harmony in the constituency——
Will the Minister keep that quiet?
I will make all the evidence available to the Deputy so that he may reassure his constituents.
The Chair has decided that, in everybody's interest, including that of the Chair, we should proceed to the next business.
The Minister for Health should carry a health warning.
