TORONTO - A national advisory panel has recommended provincial and territorial governments not add a new meningitis vaccine to their childhood immunization programs, saying the additional strains of bacteria it protects against rarely cause disease in Canada.
The decision of the National Advisory Committee on Immunization to recommend against general use of Menactra is likely a relief to cash-strapped provinces and territories, which have added several costly vaccines to their programs in recent years and are currently grappling with whether to add another, against HPV or the human papillomavirus, which can cause cervical cancer.
But the recommendation likely won't win the panel, known as NACI, any fans among parents whose children have died or been permanently disabled by the rare strains of meningococcal bacteria covered by Menactra, which is made by Sanofi Pasteur.
Katie Grassie is one of them. Her son, Keaton, now 11, survived infection with the rare Y strain of meningococcus in 2005. He lost both legs and his spleen and suffered severe tissue damage to his arms as well -- the result of a bloodstream infection triggered by the bacterium.
"What do we say to the people that do contract Y?" she asked from her home in Keswick, Ont., on Wednesday.
"Sorry?"
The Y strain is also responsible for the death late last month of 15-year-old Brodie Campbell of Coquitlam, B.C.
Public health officials say that while cases like these are heartbreaking, public policy has to be based on risks and benefits, weighing also what other demands there are on the health system.
"Ideally I don't think one makes those decisions in the face of a particular disease or a particular tragedy," said Dr. Perry Kendall, chief medical officer of health for British Columbia.
"Because as a parent myself I am very sympathetic. Tragic deaths are really tragic. But they may not be the best basis for making rational economic allocative decisions."
Public health authorities would prefer to be able to protect against all preventable disease, Kendall said. But in a world of finite financial resources, decisions have to be made.
"So basically when you start getting into few cases and a lot of expense to prevent a case and even more to prevent a death, for example, then I think ethically you have to look at what the opportunity costs are of that money and what else you could be doing with that money."
NACI noted in its report that there are good vaccines offered by all provincial and territorial plans that protect against one of the most common causes of invasive meningococcal disease in this country, the C serogroup.
There are roughly 84 cases of invasive meningococcal disease caused by the C strain each year in Canada. There is currently no vaccine to protect against the B serotype, which causes the most disease -- about 93 cases a year -- in this country.
The Y strain causes on average of about 28 cases a year in Canada and the median age of people struck by the strain is 45 years old.
Menactra protects against four strains -- C, Y, A and W-135. According to the Public Health Agency of Canada, the A serogroup causes fewer than one case a year in this country and W-135 causes about nine.
The advisory committee only makes recommendations. Provinces and territories can decide to adopt the vaccine if they wish. But it is thought that with this blessing from NACI, most will stick with the existing vaccines for cost reasons.
Individual parents could still choose to have their children vaccinated with it. But it would be at their own cost.
NACI does recommend Menactra for people at high risk of contracting invasive meningococcal disease, including laboratory workers, people who have had their spleen removed or have received a solid organ transplant and those travelling to parts of the world where the A, Y and W135 strains are more common.
