Second Meningitis Death
In RI - Fears Build
Germ Is Spread Through Saliva
Providence Journal-Bulletin Staff Writers
From Vaughn L Clavin II

Concern about meningitis reached a crescendo in Rhode Island yesterday, as the major health insurers agreed to cover the cost of vaccinating all children and news of a 5-year-old's death prompted worried parents to jam pediatricians' phone lines and flock to walk-in clinics in quest of vaccine.
The state Health Department, in a departure from federal policy, recommended that anyone aged 2 to 22 be vaccinated against meningitis, but stressed that there was no emergency. Such a mass vaccination is expected to cost health insurers a total of $7 million; it will prevent 8 to 10 cases of meningococcal infection and perhaps one death.
Because the vaccine has many limitations, however, meningococcal infections will continue to occur in Rhode Island even if all 221,000 children are vaccinated. Some 15 to 20 out of every 100 children vaccinated will have no protection, and the vaccine does not work at all in babies under 2.
``The hearts of all Rhode Islanders go out to the families that lost loved ones,'' Governor Almond said at a news conference last night inside the T.F. Green Airport terminal. A 9-year-old from Woonsocket died on Feb. 12, and a 5-year-old from North Providence on Monday night. Almond said the state plans to kick in $1.5 million toward the vaccination effort but expects to recover most of it from the insurers.
The state will also work with communities to establish clinics, as soon as possible in North Providence and the northern part of the state. North Providence Mayor A. Ralph Mollis said last night that he plans to institute an inoculation program in his town.
Dr. David Chronley, a South Kingstown pediatrician who was among four doctors at Almond's news conference, urged parents to be patient while the vaccine is being shipped and distributed, and not to tie up doctors' phone lines with inquiries.
With help from the federal Centers for Disease Control, health officials will monitor the efficacy of the vaccination program. One question to be decided is whether the vaccine, which wears off in three years, should be administered again in such an organized way in 2001.
THE HEALTH DEPARTMENT began negotiating with health insurers on Monday, hours before Steve Tella, son of Robert and Cheryl Tella of 88 Merchant St., North Providence, was rushed to Hasbro Children's Hospital with symptoms of meningococcal infection. He died within an hour. The Health Department expects test results today that will disclose whether the child did have meningococcal disease -- an infection with meningococci, bacteria that cause meningitis and the blood infection called meningococcemia.
Neither Steve Tella nor his sibling attend North Providence public schools. The boy, who attended preschool at Friends' House in Warwick, had not been at the school for the past week. Several people who had close contact with the boy were given antibiotics, a standard procedure. Meningococcal infections are spread through saliva -- by kissing, sharing drinks and such -- but the bug does not live long outside the body.
``It is important for people to realize that although we had a death last night, that does not represent a change in what's going on in our state,'' Health Director Patricia A. Nolan said at Almond's news conference. ``It's not an emergency to get immunized.'' Parents should remain ``vigilant,'' she said, and report headaches, stiff necks, vomiting, fevers and other flu-like symptoms to a doctor.
The Health Department's recommendation for widespread immunization was developed in response to an unusual increase in meningitis cases in Rhode Island, and the latest death did not affect decision-making, said Dr. Utpala Bandy, the Health Department's director of disease control.
It did affect public mood, however. Phone lines were busy at the Health Department all day. Eight to 10 nurses were moved from other duties to answer questions from the public about meningitis.
Pediatricians' offices were similarly stressed; one mother with a sick child said she had to redial 22 times to reach the child's doctor.
And both the Fogarty Unit of Landmark Medical Center in North Smithfield and Kent Hospital in Warwick got so many calls they had to set up hot lines to handle questions.
Many doctors' offices and clinics had little or no vaccine on hand, and told patients to come back later.
At Coastal/Waterman Pediatrics, parents seeking vaccines were asked to sign up for a clinic that would be held as soon as the vaccine arrived; 305 registered within four hours yesterday, said medical secretary Anna Mansolillo. They will be called as soon as the drug arrives.
A spokesman for Pasteur Merieux Connaught, the vaccine's manufacturer, said the drug was in ample supply. Doctors placing orders can receive the vials via United Parcel Service within 48 hours. The vaccine comes in powder form which doctors reconstitute. The powder lasts three years; once reconstituted the vaccine lasts five days.
WOONSOCKET'S EFFORT to vaccinate all schoolchildren as well as the Health Department's move to encourage vaccinations are unique in the country. Although meningococcal illnesses are increasing nationwide, no other state or community has taken such steps. The vaccine is not recommended for mass use because it is believed to be effective only in stanching outbreaks.
But Bandy said that because of Rhode Island's small size, high public anxiety, and the strong feelings by political leaders that more had to be done, the Health Department decided to take action.
``This is not an emergency,'' Bandy said, recommending that parents have their children vaccinated sometime within the next six to nine months. Bandy, who previously said she wouldn't vaccinate her own children, has changed her mind and plans to do it, but not in any hurry.
Bandy said that parents should watch feverish children ``like a hawk.'' When one of her own children goes to bed with a fever, Bandy said, she sleeps on the child's floor with a flashlight and checks for the telltale meningitis rash every half-hour. ``I'm paranoid about this,'' she said. ``I'm a pediatrician and a mother.''
Bandy, who recently presented the state's data to a group of Brown University infectious disease experts, said that the doctors in the group could not remember ever seeing such a high rate of meningococcal disease. Even so, the numbers are low: 12 cases in 1995, 23 in 1996, 24 in 1997, and 12 so far this year.
``I know it's a horrible disease and people are panicking,'' said Dr. Rana Hajjeh, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention. ``But the data we have so far [from Rhode Island] is not that outstanding. It's a really small number.''
``When you look at the overall attack rate, it is still very low,'' agreed Dr. Georges Peter, chief of pediatric infectious diseases at Rhode Island Hospital. ``There are going to be children who unfortunately die in car accidents; people are still going to continue to drive cars. Parents should be reassured that this is not an emergency, and the chances are overwhelmingly in favor of not developing the disease.''
Asked about the $7 million cost of widespread vaccinations, Peter said: ``Any investment that prevents death is a good one . . . If you talk to the parents of the kids that died, they will tell you that amount of money is a good investment.
``There's a lot of public anxiety,'' Peter added. ``The more the Health Department does to demonstrate that they're doing everything possible, the more reassured the public will be.''
ANXIETY SURELY ran high at a meeting of the House Health Education and Welfare Committee, which heard more than three hours of emotional testimony on legislation that would require all Rhode Island children to be vaccinated for meningitis before enrolling in any school.
No vote was taken yesterday on the legislation, sponsored by Reps. Rene Menard and John Barr, both Lincoln Democrats. ``This legislation is born of heartbreak,'' said Barr.
``Kids are dying as we're not taking preventative steps,'' said Barr. ``The state mandates bus monitors on school buses to protect our kids. The state should mandate vaccinations for meningitis.''
Menard, an emergency medical technician, told of having a child die in his arms.
Gail DeGuilio of Cumberland, whose daughter survived meningitis and is now doing well, told the committee a harrowing story of a night at Hasbro Children's Hospital when she was not sure that her very sick 14-year-old was going to live. Her fevered and confused daughter teetered near death in the intensive care unit of the hospital for hours as doctors performed a spinal tap and gave her massive doses of antibiotics.
``That night will live with me until I die,'' said DeGuilio. ``It was an unbelievable thing.''
But Nolan, the state health director, told committee members that the scientific and medical evidence is not definitive on vaccination. ``There is no good science to tell us whether increasing use of vaccine will help us or not.''
Meningitis is a ``very unpredictable'' disease that cannot be wiped out with mass vaccinations, Nolan said.
While there was widespread support on the committee for the legislation, the measure was held so that Barr and Menard could draft some amendments to cover younger children who attend day care and nursery schools.
In Lincoln yesterday, town and school leaders clamored to address residents' concerns about meningitis .
School Committee Chairwoman Linda Resnevic called an emergency School Committee Meeting for 6:30 p.m. tomorrow at the school administration building.
Supt. Robert A. DeRobbio said the committee will decide on an action plan in response to calls from parents for a meningitis inoculation program. On Monday, the state rejected DeRobbio's request for vaccination clinics.

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