Outbreak of meningitis under censorship was one of the first challenges of the PNI

The organization of the National Immunization Program (PNI) was taking its first steps after its creation in 1973, when Brazil faced one of its most serious public health crises of the 20th century, the meningococcal meningitis epidemic, with 67 thousand cases between 1971 and 1976, with 40,000 in the state of São Paulo alone.

A serious and vaccine-preventable disease, bacterial meningitis can cause generalized infections, meningococcemia, which are highly lethal and leave permanent sequelae such as limb amputations.

Now a member of the Permanent Immunization Advisory Committee of the State of São Paulo, Guido Levi was already a doctor at the time and remembers that the disease caused scenes that were difficult to forget.

“It was a terrible time. Emílio Ribas Hospital, which was the main isolation hospital in São Paulo, had children hospitalized in the courtyard. A hospital that normally had 180, 200 beds occupied, ended up having more than a thousand children. As they could no longer fit in the wards, they remained in the parking lot, in the courtyard. Fortunately, this has been controlled. Today, we have control of this disease with vaccination.”

The situation was worsened by the censorship of the military dictatorship, which tried to suppress the seriousness of the epidemic and only began to act when there was no longer any way to control it.

“At a certain point it was no longer possible to hide it, because the thing was explosive. But he tried to hide it. This has historically occurred with many diseases, since ancient times. Today, fortunately, the population is informed about the existence of the vaccine and the number of cases has dropped significantly”,

says Levi.

Criminal authoritarianism

Researcher at Casa de Oswaldo Cruz and president of the Brazilian Center for Health Studies (Cebes), historian Carlos Fidelis Ponte classifies as authoritarian, criminal and stupid the attempt to censor a disease that needed to be contained by preventive measures by the military dictatorship. .

“It was a time when people talked about a great Brazil, a powerful Brazil, a developed Brazil of the future. And Geisel still had strength, he wasn’t in the same crisis as Figueiredo. So, they sought to censor the existence of an epidemic in São Paulo. That was the dumbest thing ever, because when you censor, you censor even for the state machine. The machine that is supposed to fight also doesn’t know it exists. And the population is not prepared. This gives the disease a free field, increasing the number of cases and the range of action. It was an authoritarian, stupid and criminal attempt, because it caused the disease to spread more quickly and affect a greater number of people.”

At that time, Brazil did not produce a vaccine against the disease, and, when it was no longer possible to hide the epidemic, it was necessary to hastily purchase not a number of doses to contain the expansion of cases in São Paulo, but a quantity that could face an outbreak already of national proportions.

“Brazil needed to import a quantity of vaccines that were not produced in the world. The French needed to build a new factory to meet Brazilian demand.”

Economist Vinícius da Fonseca, at the time at the Planning Secretariat (Seplan), managed to include in this negotiation with the Pasteur Institute, in France, the transfer of technology for the vaccine against meningococcus. It was from this that, in 1976, the Institute of Technology in Immunobiologicals (Bio-Manguinhos/Fiocruz) was created, with Fonseca as president of Fiocruz, to incorporate and nationalize existing technologies in the world in favor of the PNI and, in the future, the System Unified Health System (SUS). In 2023, the National Immunization Program completes 50 years.

“He is the first to use the State’s purchasing power to generate employment, scientific development and reduce dependence. This inaugurated a political strategy that fueled Bio-Manguinhos for years and still does today”,

highlights the historian.

National production began to reach Brazilians in 1977, the year in which cases normalized, partly due to vaccination and partly due to the large number of people infected by the bacteria. Today, meningococcal meningitis is considered a disease controlled by vaccination.

For children and teenagers

Available at the PNI, the meningococcal C conjugate vaccine must be administered in two doses, at 3 and 5 months of age, and also requires a booster dose at 12 months. The Unified Health System also offers the ACWY meningococcal vaccine to adolescents aged 11 to 14 years.

Brazil has had a significant drop in the number of cases of the disease since adopting the vaccine in the SUS in 2010. The drop in coverage in recent years, however, brings a warning, because the disease has not stopped circulating.

Meningitis is a disease caused by inflammation of the meninges, membranes that surround the brain and spinal cord, which occurs through infection caused mainly by viruses or bacteria.

In total, SUS offers seven vaccines against meningitis, which is considered an endemic disease in the country. This means that cases are expected throughout the year, with occasional outbreaks and epidemics occurring. According to the Ministry of Health, bacterial meningitis is more common in autumn and winter, and viral meningitis is more common in spring and summer.

Aggressive bacteria

The meningococcus C bacteria is considered aggressive and can lead to death in less than 24 hours, even when diagnosed and treated. In these more acute cases, the infection can enter the blood and become widespread, causing what is called meningococcemia.

The director of the Brazilian Society of Immunizations, Isabela Ballalai, explains that meningococcal meningitis is among the most serious, as it is a disease that causes the death of 20% of patients and leaves one in five with important consequences, such as amputations. of arms and legs and irreversible neurological damage.

“Bacterial meningitis is the most serious, and the two bacteria that cause the most are meningococcus and pneumococcus. Meningococcal is the most common in the country, but, one year after the worst phase of the pandemic, we are seeing an increase in pneumococcal,” warned. “It is a very serious disease, which, when it does not kill you, can leave sequelae for the rest of your life.”

Isabela Ballalai emphasizes that vaccinating babies against meningitis cannot be left until later, because immunization is scheduled for the first year of life precisely because it is the moment of greatest vulnerability.

“Meningococcal disease occurs at any age, but the incidence in children under 2 years of age is much higher than in adults. And, proportionally, there are more cases in children under 1 year old”, she warns. “People don’t stop getting vaccinated because they received fake news, they stop getting vaccinated because they did not realize the risk of the disease. They end up delaying, and this leads to low coverage.”

Prevention

Vaccination against meningitis should begin at birth, with the BCG vaccine, which protects against severe forms of tuberculosis, which includes tuberculous meningitis.

The pentavalent vaccine, prescribed for 2, 4 and 6 months of age, prevents meningitis caused by Haemophilus influenzae serotype B, as well as diphtheria, tetanus, pertussis and hepatitis B.

At 2 months of age, babies must also take the first dose of 10-valent pneumococcal, which also requires a dose at 4 months of age and a booster dose when completing the first year of life. This vaccine protects against pneumococcal meningitis and pneumonia.

The meningococcal C conjugate vaccine, which protects against meningococcal serotype C, should be administered at 3, 5 and 12 months of age. In this case, prevention is against meningococcal meningitis.

Meningococcal ACWY, against the same type of meningitis, protects against serotypes A, C, W and Y, and is recommended for adolescents aged 11 to 14 years. Vaccination with ACWY in the country is in an even worse situation than that of meningococcal C, with coverage of just 57% in 2022, according to the Ministry of Health.

The 23-valent pneumococcal vaccine is not part of the children’s calendar and is recommended by the Ministry of Health for the entire indigenous population over 5 years of age and for the population over 60 years of age sheltered in shelter institutions.

The 13-valent pneumococcal vaccine is only applied in Reference Centers for Special Immunobiologicals (CRIEs), and its use is recommended for individuals at least 5 years of age living with HIV, cancer patients, solid organ transplant recipients and bone marrow transplant recipients. bone.

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