| What Jailan Smith can teach us Missed by new vaccine, toddler struggles to recover from preventable form of meningitis 04/09/2001 By Sherry Jacobson / The Dallas Morning News It started with a slight fever, a bit of crankiness and a refusal to play outdoors with another toddler, which was highly unusual for Jailan Smith. The rambunctious 18-month-old boy liked nothing better than to be outside, picking up stones and throwing them as far as his chubby arms could manage.
"He acted like he didn't feel good," recalls Pauline Fulsom Smith of the Sunday afternoon in February when her son got sick. "So I put him in the car and took him home. I took his temperature and it was 100. But he started to play again and I thought he was all right."
Every detail of Jailan's illness has come back to haunt Mrs. Smith. She spends her weekends at Children's Medical Center of Dallas, watching over her unconscious son, who suffered a rare bout of bacterial meningitis almost six weeks ago.
His father, Keith Smith, maintains a vigil the rest of the week, as doctors struggle to understand how badly the boy's brain has been damaged and chart a course for his uncertain recovery.
"I watched my baby closely," Mrs. Smith stresses. "He was lying in my arms. I was checking him for fever. I knew he didn't feel good. But I never knew it could get this bad."
Hers is more than a mother's lament about a seriously ill child. What happened to Jailan Smith goes beyond the sad fact that young children are vulnerable to bacterial meningitis, an infection of the fluid surrounding the brain that can strike quickly and unexpectedly.
Health officials say Jailan's illness is tragic proof that some babies – even those with attentive parents – aren't getting a new vaccine, called Prevnar, that prevents the type of meningitis that nearly cost the boy his life. Jailan was born too late to get the shots as an infant and was never given a catch-up dose.
"He's been through absolute hell," says Dr. Brett Giroir, Jailan's doctor and an infectious-disease specialist at Children's. "He's had severe meningitis with brain swelling. It caused his kidneys to fail. He was in shock.
"And this all could have been prevented with one little shot," he says. "As a physician, I understand there are a lot of diseases we can't control. But the absolutely most heart-breaking and senseless cases are the ones you can prevent. This kind of meningitis is one."
The U.S. Food and Drug Administration approved Prevnar a year ago in hopes of preventing an estimated 1,400 cases of meningitis caused by pneumococcal bacteria annually in children under age 5. About 200 U.S. children die each year from this type of infection, which also is responsible for more than 7 million ear infections annually.
Several national medical associations, including the American Academy of Pediatrics, have urged that children under age 2 receive the four-dose vaccination, starting at age 6 weeks. In clinical trials involving 38,000 children in California, the vaccine all but wiped out the risk of meningitis, pneumonia and other serious side effects of the bacterial infection.
"Unfortunately, we continue to see cases of pneumococcal meningitis in children who have not received this vaccine," says Dr. Ben Schwartz of the National Immunization Program at the U.S. Centers for Disease Control and Prevention. "This is a bad disease, and it should not be occurring anymore."
In Dallas County, 15 cases of bacterial meningitis have been reported to the health department so far this year. That number, averaging five cases per month, represents a 50 percent reduction in the incidence of bacterial meningitis compared with last year, says Dr. Assefa Tulu, county epidemiologist. In 2000, there were 120 cases, averaging 10 per month.
However, the county's reporting system makes no distinction between meningitis caused by pneumococcal bacteria as opposed to other types of bacteria, Dr. Tulu said, so "it is too soon to tell if the new vaccine will have a major effect."
Unfortunately for Jailan Smith, his parents say they never heard of Prevnar before he became critically ill. It wasn't until the day after Jailan was rushed 90 miles by ambulance to Children's that his father says he learned that a vaccine could have prevented his son's illness.
"I was reading a magazine in the hospital waiting room, and I saw this full-page ad about the vaccine," Mr. Smith recalls. "I'm asking myself over and over, 'Why didn't my son get this vaccine?'"
It could have been a problem of timing.
Jailan was born Aug. 2, 1999, six months before Prevnar received its government approval. The vaccination schedule calls for babies to be immunized with four doses of Prevnar, starting at age 6 weeks and ending at 15 months. Older babies get fewer doses but still should catch up on the vaccine before they are 2 years old, medical experts agree. For certain high-risk groups, including African-American children, Prevnar shots are recommended up to age 6 and in certain cases up to age 9.
"Unfortunately, the catch-up doses [for the older babies] seem to be less complete than the vaccination of infants," says Dr. Schwartz, a pediatrician and infectious-disease specialist. This year he has seen several meningitis cases in Atlanta hospitals. "They were between 1 and 2 years old, and what they had in common is that they hadn't been immunized."
Mrs. Smith says she does not blame her family doctor for not immunizing Jailan in the past year. "Maybe Jailan was supposed to get the shot on his next visit," she says. "It doesn't make sense to me to blame anybody for what's happened. I just want to focus on my son and helping him get better."
Nor does she think she could have done anything more for Jailan when he first got sick, she says, recalling how she stayed home with him for the first two days. When his fever reached 103 degrees, she took him to the emergency room at Parkview Hospital in Mexia.
The physician on duty treated Jailan for an ear infection, she recalls. It was the first ear infection the boy had ever had, and Mrs. Smith says she was unsure how quickly he would respond to the antibiotics he was given.
"He was very sleepy," she recalls of the hours after the hospital visit. "We put in The Lion King, which is his favorite movie. I noticed his head flopped to the side and I'd sit him back up."
Mrs. Smith says she watched her son closely throughout the day, worrying that he had a headache because he clutched his head with his hands at one point. But Jailan wasn't crying or complaining excessively, so she waited for the medicine to take effect, calling the hospital twice to be reassured that he would feel better soon.
But finally, because he was so unresponsive, she knew something was terribly wrong. She wrapped him in a blanket and took him back to the hospital. It was just 34 hours after the first visit.
As doctors hastily tested the toddler for meningitis that afternoon and readied him for the ambulance trip to Dallas, "he wouldn't cry," Mrs. Smith recalls. "There were no sounds."
Almost six weeks later, doctors have slowly weaned Jailan from life support and are waiting to see whether he needs a shunt in his head to drain excess fluid from his brain. They expect it will take intense therapy for six months to a year to understand the extent to which he will recover normal brain function. Studies have shown that about 25 percent of the children who survive this type of meningitis have long-term neurological problems, including seizures and retardation.
But Jailan's family remains optimistic. Although he has not regained consciousness, they see small signs and movements that indicate to them that he is improving.
"He was wiggling in the bed until his big brother said his name," Mrs. Smith recalls of a recent hospital visit by her 12-year-old son, LaPaul. "Jailan stopped moving and opened one eye and looked at LaPaul. We're sure he heard him. They are best friends."
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