'You want to inform people': Public health policy expert speaks to meningitis notification protocols

A public health expert says officials will often warn of suspected cases of infectious disease, balancing patient privacy with the need for health interventions.

Dr. Anna Banerji of the University of Toronto’s Dalla Lana School of Public Health was answering questions from CTV Atlantic after concerns have been raised over how Dalhousie University and Nova Scotia Public Health handled a meningitis outbreak at an on-campus student residence.

The father of an 18-year-old student, Maria Gaynor, says she died of meningitis days after the first case of the disease hospitalized a student living on a different floor of Shirreff Hall.

Banerji was not involved in the Dalhousie cases and has no specific knowledge of the chain of events but says, in general, health officials make public announcements of disease outbreaks to mitigate risk.

“You want to inform people to look for signs and symptoms, and if there’s something you can do about it, an intervention, that’s the main reason why you have these things, saying that there’s possibly something going on,” she says.

In an interview with CTV Atlantic Tuesday, Gaynor’s father said his daughter started to feel unwell on Sunday, Dec. 11; unaware Nova Scotia Public Health was investigating a suspected case of meningitis that hospitalized another student the week before.

Mike Gaynor said Maria thought she had the flu. But when he didn’t hear from her Monday evening or the following day, he became worried. He said Maria died in her dorm room, and he didn’t learn about the other meningitis case until he spoke to the medical examiner that Wednesday.

A memo from Dalhousie University’s director of residence life and assistant vice-provost of student affairs to student residences dated Monday, Dec. 12, did not mention meningitis or include any information on prevention or symptoms.

“Over the weekend, public health notified the university that one case of an infectious disease was identified within our residence community,” it said.

"Only those contacted by public health are required to take action,” it stated, adding the medical diagnosis of “individuals affected will not be provided,” due to privacy.

Dalhousie University continues to refer CTV's questions about the memo to Nova Scotia Public Health -- which has declined CTV’s repeated requests for an interview.

Instead, N.S. Health senior communications advisor Krista Keough provided a written statement Tuesday, reading in part:

“Our heartfelt thoughts are with the family and friends of those who have been affected by this situation ... it is natural to search for reasons why events turned out the way they did and to advocate for any changes to prevent similar tragedies.”

“Our initial focus was on identifying the immediate contacts from the first case -- this does take time and is the most crucial group of people to identify and reach directly.

“We have to balance providing as much information as needed at the right time to protect those at risk, with protecting privacy and confidentiality of those involved.

“Certain steps, like providing early advice and intervention to high-risk contacts, can be taken based on initial results. Other steps, like sharing specific diagnoses or offering vaccines, need to wait for more definitive results.”

Last Friday, regional medical officer of health Dr. Cristin Muecke told CTV lab results verifying the meningitis B strain in both Shirreff Hall cases had only come back that day from the National Microbiology Laboratory.

Banerji says officials don’t have to wait for lab results to issue a warning.

“If (a patient is) coming in with symptoms of meningitis, even if you haven’t cultured the bacteria or confirmed the typing, you could say ‘suspected case’ if it’s clinically consistent with that diagnosis,” says Banerji.

When it comes to patient privacy concerns, Banerji says that depends on the circumstances.

“A big city in Toronto, if you say, a 15-year-old child with symptoms of meningitis ended up in the hospital, that’s one thing,” she says. “Versus a village in the Arctic where there’s only ten 15-year-olds and one of them ends up in the hospital….You have to be careful because you don’t want to give enough information to actually identify that child.”

Gaynor believes students should have been warned of the potentially fatal disease much earlier.

“If anything could have been communicated with that word, meningitis, suspected, possible, confirmed, I don’t care, but if that word had been mentioned, we don't know, but maybe things could have turned out differently, just maybe.”

Meningitis B is a strain of bacterial meningococcal disease that spreads through direct secretions from the nose or mouth through activities like kissing or sharing food, drink, utensils, water bottles, or toothbrushes.

Symptoms of meningitis B can progress quickly and include worsening fever, headache, stiff neck, light sensitivity, rash, and changes in alertness. Health professionals recommend seeking immediate medical attention if ill with symptoms.

Nova Scotia’s public vaccination program for school-age children doesn’t cover the B strain of meningitis. A vaccine for meningitis B is available at a cost from doctors and pharmacists and may be covered by some private health programs.