OUR VIEW: Outbreak shows need for a change

No severe illnesses or deaths were reported in connection with a viral meningitis outbreak centered in Terrebonne and Lafourche, of which we informed readers last week.

While this type of meningitis is not life-threatening in most cases, deaths can occur, primarily among infants or adults who compromised immune systems. Nonetheless the matter is serious. Serious enough to warrant a visit to Terrebonne Parish by Dr. Raoult Ratard, who heads up Louisiana infectious disease program as state epidemiologist.

Angi Falgout, director of the Bayouland YMCA, should be commended for her own prompt investigation of the outbreak after learning from relatives of children attending the organization’s day camp that they had taken ill. She sent a letter home with children attending the program advising them of her findings, that there were to her knowledge seven cases connected to the camp, which were confirmed for her by Ratard.

The outbreak has also resulted in some criticism of Falgout, for not giving notice to people who are adult patrons of the YMCA. In retrospect perhaps it should have been incumbent upon the Y to post information, perhaps of a nature that would have emphasized prevention through hand-washing and other recommended precautions.

Nonetheless, Falgout’s praise for open treatment of the matter through the notifications to parents should not be diminished. The emergency was one that her organization had not experienced before to anyone’s knowledge, and Falgout did not have a script to follow.

Of greater concern to us are two issues that a review of the emergency has brought up.

A spokesman for the Louisiana Department of Health and Hospitals confirmed Monday that his agency was not notified initially by a local hospital of meningitis cases, within the required period.

Viral meningitis is classified in Louisiana’s sanitary code as a “Class B” disease reportable within one business day.

A flurry of phone calls between state officials, at least one hospital in the Houma area – identified as Terrebonne General Medical Center – and other entities confirmed the outbreak officially, setting in motion the protocols that the state has designed as a first line of defense. Other cases might have occurred prior to the YMCA notifications but might well have gone unreported as well, either from TGMC or other hospitals. A call to TGMC last week resulted in a denial by officials there that there was any knowledge of a meningitis case, despite the claim from the YMCA parents that their children had been there.

The meningitis outbreak is a frightening event, made more so by the disclosure that the score of local cases authorities ended up tallying was a microcosm of the projected true exposures. As many as 2,300 to 2,500 people have locally carryied the virus without knowing it, according to Dr. Ratard’s estimate. That could have included parents of vulnerable infants or caretakers of frail adults.

But one of the biggest problems we have observed lies with the DHH itself, and it is one we have encountered before. DHH officials say they generally refrain from identifying specific locales – especially in less populated rural areas – when discussing rare or infectious diseases. It is too easy, they maintain, to inadvertently identify a sick individual by doing so.

They will identify a DHH region. Region III includes seven parishes, Assumption, Lafourche, St. Charles, St. James, St. John, St. Mary and Terrebonne. But the practice, in our view, is not sound. DHH should re-examine its policy. While we understand the concern, we also know that identifying by mere region removes relevance and immediacy for how local people acknowledge threats, and is an accomplice to local denial. It makes an audit of which local hospital failed to follow reporting procedures difficult if not impossible.

We were able to report the truth as we could determine it after prior reporting with made any attempt to conceal the outbreak’s local nature – no matter how noble the intent – an exercise in folly. DHH should immediately take what steps might be needed to give more specific information.