Could the Kent meningitis outbreak happen again?

This BBC Podcast is supported by ads outside the UK. Det är ett litet kompakt format. Me care, my wolf. Vielen Dank. 295 kronor i månaden. ¿Dónde están? Läs mer på volvokars.com Sälla, snälla, sluta, ni vars tråkig! Jag kommer inte köpa utåt åt er du! Det blir i alla fall inte värre än så här. Ibland är ett nej, det finaste du kan ge. Systembolaget. Anorlända av en anledning.

Hello there and welcome to the Inside Health Podcast with me, James Gallagher. Later, we're going to take a look at the health advice given by AI Chatboard. Our resident GP, Dr. Margaret McCarney, has concerns, but for now our attention is on the outbreak of meningitis in Kent. It's been described as unprecedented in its speed and has raised new questions about whether teenagers and young adults should be given the meningitis B vaccine.

We'll discuss those issues in a minute, but first we're joined by children's author Michael Rosen. His son Eddie died from meningitis at the age of eighteen. Michael, thank you for talking to us. Oh well thank you, James. Can you just start by telling me how you felt over the past week or so seeing the outbreak in Kent? I think it was a feeling of awful familiarity.

So usually we think of the word familiarity as something quite nice, um almost nostalgic. Um but because it reminded me of my own son, Eddie, dying that way through meningitis, there was a sense of uh Oh no, here we go again and a a sense of enormous sympathy for the parents and the friends and the lovers of those teenagers who had died or the ones who felt terribly threatened by it as well.

Can you tell us how quickly things changed with Eddie? It's one of those accounts that like fills every parent with horror. Well, very, very briefly I put Eddie to bed with what I thought was something fluy, and he was dead in the morning. It really was that quick. Can you describe for me the moment that you realised your son had died? I went into the bedroom and said, Right, I'm off to work Eddie and he was lying on his back.

And he didn't reply, and I think I knew before I touched him that he was dead. And I just remember freezing and I grabbed the phone, Dard nine nine nine, and the uh ambulance guys told me to pull him to the floor, and as I pulled him to the floor I realised that he was completely stiff. And his arm was in the air, and as I looked down at his armpit, I saw that it was it looked like bright red stretch marks in his armpit. And I thought, what's that?

How long did it take you to even comprehend that it could happen that quickly? Well, I lived in a street in which there were three GPs, uh, who were friends, and I don't quite know how it happened, but the house filled up in the space of about twenty minutes. It's a it was as if the whole street invaded the house. It was it was both very comforting and rather rather strange at the same time. And they explained to me what meningitis is, what happens

Do you ever escape a sense of was there something that I could have done? You put your son to bed with no other obvious symptoms, but I just don't know. Do you ever manage to escape that thought of Could I have done something differently? I think of there are so many ifs and buts, aren't there? There's not much you can do with ifs and buts. My mother was a very was a person who was very, very severe about having no regrets about things. She lost a child.

And uh I'm not at all like that, but I I do hear my mum sometimes saying in my ear, as it were, she died a long time ago, you know, there's nothing you can do about the past. Is there something particular about losing a son at that age, on the cusp of adulthood, the whole of your future Ahead of you. Uh he was someone with full of hope and intention.

He always announced to me that he wanted to be a comedy chef. He loved the idea that you could be on telly and cook things and crack jokes at the same time. That seemed to him to be very funny. Uh what I've had to teach myself is that a life is a life. A life isn't what you're going to do, a life is what you have, and I've had to teach myself that that's what he lived.

And it was great what he did in his own lifetime. And if you go into that space of all the would have's and could have's and should have's and might have, You're just left with a sense of desolation in in my case I find comfort in what he did. What do you think Eddie would be like? if you was with us today, do you ever have that thought?

I like to think, quite positively, that he'd have gone on writing plays and sketches and maybe he would have been a comedy chef. Maybe he'd he might have created this genre where, you know, you'd have been live at the Apollo. Um so I do sometimes think that in a in a in a reverie, it doesn't hurt. Michael, thank you so much for talking so openly.

Don't know about you, I found that quite moving listening to my call there. Well we're going to discuss meningitis in more detail now. I'm joined by Doctor Eliza Gale, a specialist in infectious disease and microbiology at the London School of Hygiene and Tropical Medicine. and by Dr. Simon Needle, a consultant in pediatric intensive care from St Mary's Hospital in London, who's treated children with meningitis for more than thirty years. Eliza and Simon, welcome to Inside Health. Thank you.

Simon, can I start with you? Um when somebody is in hospital, what is the moment that you go this is meningitis? How do you know? I think you have to distinguish meningitis and meningiococcal septicemia. So meningitis is the classical presentation of children or adults with a stiff neck and difficulty looking at light and a severe headache and vomiting and fever. So that can be quite straightforward actually to diagnose in an older child or a young adult.

The meningiococcusemia is can be more difficult to diagnose, particularly in the early stages when you just have this fluid type illness. But when the rash this rash that doesn't go away when you press it or under a glass comes out, it can be then very straightforward to diagnose and that's the moment you know that uh it's most likely that someone's got miniaturecoccal septicemia. It's terrifyingly quick, isn't it? Or it can be. We heard from Michael how he put his son to bed that night.

And he had died by morning. Yeah, this is a disease that can progress in minutes to hours with kind of overwhelming organ failure and then subsequent death very quickly. Do you have that pressure on the hospital ward that you you know the clock is ticking?

Absolutely. You know that uh patients can deteriorate very rapidly and it's important just to keep on top of everything and looking at the these patients can can change very quickly, so they have to be examined, reassessed, you know, every really every few minutes. And how many cases do you see now in comparison to twenty, thirty years ago?'Cause we've seen the gradual introduction of different vaccines over time. So in fact now it's

for us to see a child or young adult with meningococcal infection. I think there are around three hundred to four hundred cases a year reported across the whole of the UK. I mean we haven't seen a case of meningococcal septicemia for a couple of years on our unit. Eliza, just looking at what's happened in Kent over the last few weeks, lots of words have been thrown around things like unprecedented.

What is it for you that marks this outbreak as different to the cases that we get pretty much one a day up and down the country? So normally the cases that we see we don't see any link between them. So we know that around ten percent of the population are carrying this bacteria in their throat at any given time and that can be as high as mid thirty percent if we're talking about young adults.

And most of those people never develop an invasive infection and when invasive infections occur it's sort of a bad luck event that happens at random points in time in random places around the country. So to see so many cases clustered together over such a short period of time is really unprecedented. So I think that is fair the language.

Now I think one of the things that's really important is actually understanding why because that helps us understand whether this was some kind of like unique one-off event or if something about meningitis has changed going into the future. What is your assessment of what happened in Canterbury?

Um so I think most likely we're not going to find one single explaining um solution. So that obviously that would be the neat answer in some ways, although potentially very worrying I guess if we attribute it just to a new type of meningitis.

So if we think about the bacteria, um it may well be that this is an aggressive version of this strain. So it's a strain that we're familiar with and we know has been circulating in the UK for several years and it's never done this before, so in some ways that's quite reassuring. Even within a strain there are uh variants, so bugs turn on and off uh their disease causing properties, so it may be that this one was particularly aggressive at the time that th that it was spread.

There's also going to be host factors they'll be looking at. So I know there's been a lot of talk around whether vaping increases your risk, either sharing vaping or through the act of kind of the inhaling um the product in the vape, which also is possible. Um the fact that there were so many

non immune adults, young adults gathered in a small space, so lots of vulnerable people, um, who were not immune because both because they weren't vaccinated but also probably have lower immunity than young adults have had at this stage of life historically. Rydyn ni'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl.

Rydyn ni'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n ymwneud â phobl sy'n mynd. One of the things that I've struggled with with my reporting over the past week in terms of understanding this outbreak is trying to find out what's unique about it that that could separate it out from everything else. And when you say things like, Well, maybe this is a generation of children that

didn't get exposed during covet lockdowns or maybe it's vaping. I'm just hearing things that would apply up and down the country. And and the reason I asked right at the beginning uh as to kind of like how important it is to understand the reasons why. If if it is some kind of like universal factor, should we expect more outbreaks like Kent in the future?

So yes, that is the million dollar question. Um, and in medicine we often talk about Swiss cheese, so when the holes all align and it may be that there isn't one single causing factor, but lots of these have have come together all at the same time um in a very unlucky combination of events. But as you say, all the individual circumstances don't seem particularly exceptional.

Which is why I think there will be a rush to understand this particular bacteria and whether there's something new about this exact type that's been found in this outbreak.

Now, both of you, I want to ask you about um the meningitis B vaccine, which was introduced in twenty fifteen but only for babies and toddlers, not for teenagers. So there is like a a gap in immunity for the people currently going through

university and A levels at the moment. Um, before we discuss it, I want to hear from Professor of Pediatrics at the University of Bristol, Adam Finn, who has also sat in the past on the Joint Committee on Vaccination and Immunisation, which makes these big decisions about which vaccinations should be rolled out in the UK.

Who you give it to is determined really by who are the most likely people to get invasive Men B disease. And the straightforward answer to that is very young children. It's a rare disease, even in early childhood. But it's common enough to justify the cost and effort of immunising all of those young children to save the relatively small number who would otherwise

get seriously ill or even die of Menbe disease. There is a second peak of incidence in the second decade of life, in adolescence and early adulthood. But it's much smaller than in early childhood. And so the number of cases you could prevent by immunizing all of those. Secondary school children is so small that the cost of doing it would really be much higher than. is the standard threshold in the UK for buying healthcare intervention, whether it's drugs or vaccines.

If there is a change in the epidemiology and we start to see more cases and outbreaks, as we recently saw in Canterbury, that of course might change the balance, of course, benefit and lead to a change in policy. But we have to wait and see if that happens. Simon, how do you feel about this? Should teenagers be offered a meningitis B vaccine in your opinion? I mean obviously if you're the child or young adult who gets infected with Men B and unfortunately dies of a vaccine preventable disease.

then, you know, no amount of of cost effectiveness is will justify that decision. So I think it very much depends on what happens in the future with the epidemiology of meningococcal b disease. I imagine the decision that the J C V I took ten, eleven years ago is still relevant because the number of cases are still low. But uh whether that justifies not giving people who are at risk the vaccine is a i is a difficult question to answer.

It's almost painful, isn't it, the contrast between the devastation that meningitis causes. And against something which is basically some call mathematics. Yeah. Uh you know, if there's one vaccine preventable death. then it's almost impossible to justify, I think. Eliza, what do you think? I mean, I agree, it's it's very hard to talk about personal tragedy and, you know, families that have, you know, undergone these horrendous events.

a bring it round to health economics and cost. That's the reality of the health care system that we operate in. Rydyn ni'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny'n gwneud hynny.

I think they will struggle with the current epidemiology to come to a different conclusion, but obviously the politics and the public awareness may... yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n

Simon, do you think we need to worry about meningitis in the future more than we have recently? Because i it feels like something that has really you know, a and is borne out by the figures, that that we are not in the same place as we were in the nineteen nineties. For example, but have we almost not paid it enough attention?

I think there's an element of complacency. You know, I think both from the general public and the medical profession because the general public feel that they've received all these meningitis vaccines, you know, and they're protected against meningitis because I mean, there are several vaccines in the routine schedule that will protect you from bacterial meningitis on the whole. But obviously men B is lacking in that in that routine immunisation for older children and young adults.

And also we don't know how long the immunity from infant men be vaccination lasts. That's the other aspect of this. Eliza, how do you calibrate what's happened in the last week?'Cause I've had people emailing me or or getting in touch all week concerned about they've got children at universities at different parts of the country, they don't know whether they should go on holiday to Kent, just Like, it has alarmed a lot of people. What would you say?

Um I think we need to be very diligent in our communication around this and say that as things stand there's absolutely no reason for people to be more concerned mewn gwirionedd yn ymwneud â'r ymwneud â'r ymwneud â'r ymwneud â'r ymwneud â'r ymwneud â'r ymwneud â'r ymwneud â'r This remains an extremely rare, if devastating, condition, I think we can be reassuring that the risk to at an individual level is very, very small. Eliza Gill, Simon Nadal, thank you so much for coming in. Thank you. Yeah.

Snälla, snälla, sluta! Jag kommer inte köpa utåt er! Det blir i alla fall inte värre än så här. Ibland är ett nej, det finaste du kan ge. annorlunda av en anledning. اشتركوا في القناة I ett litet kompaktformat. 295 kronor i månaden. He is Läs mer på volvocars.com

You're listening to Inside Health with me, James Gallagher. Now, would you trust health advice from an artificial intelligence chatbot? I'm feeling a little bit grotty at the moment, so I told one that I was bunged up with cold, so what should I do? and it gave me fairly obvious advice around rest, fluids, and paracetamol, but are there

Any dangers to using this technology, or is it essentially the same as just doing an internet search with a list of symptoms? Well, we'll find out in a minute, but first I want you to meet Abby, who uses ChatGPT a lot. Hi, I'm Abby and I'm here with my Spaniolotta. Abbey, sut rydych chi wedi'i defnyddio ChatGPT? I would say about a year now. Because I've struggled with health anxiety, I used to look a lot on Google and Google has a way of showing the scariest problem first.

So if I had kind of stomach pain or, I don't know, a headache, as soon as you put that into Google or if you go on a sort of patient symptom checker, it's always gonna give you the scariest thing first. So basically every time you're dying.

Yeah. And also you just really can't give it like a tailored approach. Like it's hard to kind of say if you have stomach pain how severe your stomach pain is when you're putting it on symptom checker it's coming up as severe and then it's telling you that your appendix is birth. Can you think of a time that's really worked for you? Yeah. I actually had a UTI, um, a urinary tract infection about a month ago. I'd put it into Chatch PTO as saying I could these are the symptoms that I've got.

Compared to my past experience, this feels pretty minor. Um, but you know, they kept asking me questions, and then by the end of it, they were like, You need to go visit your pharmacist. And I did and I got the antibiotics and I was absolutely fine. And that was like a really easy way for me to be able to access advice without feeling like I was taking a NHS time, I struggle a lot with knowing when you need to visit a doctor, and I'm finding Chat GPT is that in between. Has it ever gone wrong?

Okay. I um so I went on a hike in I think it was January and I slipped and fully decked it, smacked my back on a rock. Very embarrassing. Then I went on ChatGPT and I said, look, I've I've had this fall. It's given me like a insane pressure across my back, it's spreading into my stomach. And ChatGPT told me that I'd punctured an organ. Oh wow.

And that I needed to go to A and E straight away. And I did. And I sat there for about three hours and I was in the kind of urgent Press the ambulance for you. Yeah. Yeah. Um I kinda sat there for three hours and then Paints was Easing and I was like I just don't need to be here. I know I haven't punctured enough. Yeah. I was like I think that I'd be like Sweating, probably very, very ill, um, and it very clearly got it wrong that time. Is it easier than going to the GP?

Sorry, my little dog's in my pocket. Yeah. I think Chat GPT is very validating. It will say like thank you so much for telling me. You're being so brave. I'm really glad you told me this and we can chat through it. I think I've had experiences with doctors and I've definitely felt dismissed. Before and kind of not taken seriously. Being made to feel more confident about what you're discussing is a massive part of being able to open up about your symptoms. How much do you trust it?

I wouldn't trust that anything that it's saying to me is like absolutely right. I think it helps me just navigate the decision between self monitoring and approaching a doctor. Abbey, rwy'n mynd i'n mynd i'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi'n mynd i chi? Thank you. I think take everything with a pinch of salt and also try and be as honest

with it as you can, but protecting your kind of privacy at the same time and remembering that it will get things wrong. It's it's a machine. So knowing that maybe especially if you're kind of consulting it multiple times, you need to go and see your doctor. Most important question, is it helping to save on otters' veterinary bills as well? Oh my partner literally said he was like you need to tell them that you're doing it for the dog as well.

Yeah. Thank you very much, Avi, and thank you to Otta for being a very good boy. Girl Oh no. She's wearing pubs.

Uh, Abby was great to chat to you, and I'm joined by equally fine company now, uh Resident GP, Dr. Margaret McCartney. Margaret, welcome back. Thank you for having me, James. You've just listened to Abby. What did you make of the way she's using AI? Yes, so Abby's obviously a very reflective and thoughtful um person who's really considered, I think quite carefully, the pros and cons of using a chatbot like this. It sounds as though she's thinking very carefully about the way that she's using it.

Apart from the one time she was burned very heavily. Yeah, but even then she kind of recognised that, didn't she? She was thinking about it at the same time and it also sounds as though she's using it with a grain of salt at all times. And and in some ways it makes me feel a bit sad as well because

In general practice, I've always tried very hard to have a personal relationship with the people that I'm trying to look after. And there was just something really poignant in the way that she was describing needing that kind of almost like a handhold, someone to support her, give her some personal support. And I think with so many pressures in general practice, that's increasingly something that's really hard for us to offer.

Do you see there being any difference between using an AI model to get answers about your health? compared with what, you know, has become very familiar for over a decade, probably two now, of just searching the internet. Yeah, I think this is a bit different because it seems like you're having a personal relationship.

with a chatbot. Whereas with a Google search you kind of go into a website, you go out, there's lots of things on that website that might tell you whether it's more reliable or less reliable. You will have signals, you know, is it approved by the NHS? Does it look as though they've got Whereas in Chat GPT I would argue that it's much more difficult to do that. There's inconsistent advice that's been given out. You won't get always the same answers quite twice if you make small tweets.

to the information that you're putting in and so forth. But I suppose biggest of all is it seems as though you're getting this supportive advice that's being made for you. And I think that probably changes the way that we interpret what's being told back to us. Do you think we believe it more? Don't know. Um I suppose the research is still to be done on that. I mean certainly, James, I have to confess

that I have experimented with ChatGPT. I asked it if I should buy a new bicycle. And not only did it tell me that I definitely should buy yet another bicycle, but also that I should probably remortgage, you know, that was completely justified to do it. So you know, that flattery thing, you know, telling you what you want to hear in some respects. Some researchers have been attempting to grapple with whether the advice is actually helping people. What are the conclusions so far?

Yeah, and there has been a fair bit of research which is admirable considering this technology is is so recent. And I think um what we are finding is that it's not very good in a lot of high risk situations, which I suppose is the most worrying thing. There was a paper published in a nature journal back in February, really looking to see whether triage recommendations were correct. So that is when they made little vignettes.

yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw And basically it overdiagnosed and it also underdiagnosed. So it sent people to ANE who didn't need to go there, but it also didn't send people to ANE who needed to go there. So the worst of all possible worlds. What do you think about all the concerns around the source material that these chatbots have learned?

in order to be able to give medical advice because we know that a lot of medical research is skewed towards white rather than racially diverse groups, often men rather than women, et cetera, et cetera. Yeah, and you're absolutely right. So if you feed it on the stuff that's already out there, it will retain the same biases. But wouldn't it be an opportunity to say, actually, we want to do a new thing and we want to try and get our information that we're building these chatbots with?

that you've trained so well that it actually might improve on cognitive biases that we all have and actually might help to take those kind of human biases away. But if we just continue just feeding it the stuff that's already out there, we should not be surprised when it retains all the same problems that we currently have.

What would your advice be, Margaret, if I was, you know, had a bit of a headache and, you know, ignoring the perfect opportunity for a consultation with your good self, went and AI'd it as soon as we uh got off air. Yeah, it's a really interesting one. Because it just depends on so many things. Like I wouldn't use it to to diagnose or to to treat me. I I think that there's a much bigger role for use of AI.

when we're talking about things that are really clearly evidence based. So once you've got a diagnosis, thinking about options for treatment. and, you know, investigations or otherwise that you might need or not. But the problem with diagnoses is if you get that wrong, everything you do after that will also be wrong. I just don't think that we have the evidence just now to say that these tools are reliable enough to safely use at the moment.

But I hope they improve. I'm not against it. I would love it if it worked. What are your tipping points from when this goes to something that you have concerns about to something that you would go Yeah, I'm I'm okay with people going off and using this?

Randomised controlled trials, James. I would like to see really high quality evidence published so we can see what's happening. So I think we really have to have a high standard of proof here that this is better than the current offerings in order to recommend it. Well, thank you to Margaret and to Abby. We invited OpenAI, which is the company behind ChatGPT, to comment.

and they sent a statement saying that they take seriously the need to make their responses as reliable and safe as possible because people were turning to ChatGPT for health information, but they say that it's not there to replace professional medical advice. Thank you for listening to Inside Health with me, James Gallagher. The producer was Jerry Holt, technical production by Donald McDonald.

The show was made by the BBC's Audio Science Unit in collaboration with the Open University. Next time, we're looking at medicines to treat hot flushes in menopausal women, so I'll see you for that. But in the meantime, can you detect health fact from fiction? Well find out with the Open University's new interactive quiz. Go to bbc.co.uk slash insidehealth and follow the links to the Open University. Volvo. I ett litet kompakt format. मेकर मैं वोल्व 55 kronor i månaden. Läs mer på volvocars.com

I femtio år har vi på AG-produkter varit på väg. Steg för steg inom förändring och utveckling, men det som betyder något är inte hur långt vi har vandrat, utan vad vi lärt oss under resans gång. Till exempel om man skapar arbetsplatser där människor m bra. Och så får du mer än bara inredning. Du får 50 års erfarenhet. Välkommen till Lagipproduktion!