Meningococcal meningitis - College controversy Health tips for college students

College students are widely believed to be at increased risk for a number of health problems,including sexually transmitted diseases (STDs), eating disorders and binge drinking. But mostpeople don't realize that colleges and universities have become sites for outbreaks of potentiallylife-threatening meningococcal infections. Meningococcal infections can cause meningitis, aninflammation of the membranes, or meninges, surrounding the brain and spinal cord(meningococcal meningitis), and also can invade the bloodstream (meningococcemia).

Dormitory dangers

While meningococcal infections are most prevalent among children under age 5, they arebecoming increasingly common among college-age students. According to the Centers forDisease Control and Prevention (CDC), cases of invasive meningococcal disease among 15 to 24year-olds jumped from 310 cases in 1991 to 602 cases in 1997. Among this age group, collegestudents living in dormitories appear to be at greatest risk, possibly because such crowdedenvironments promote the spread of infectious disease. According to a study presented at the July1, 1999, meeting of the American College Health Association (ACHA), the rate ofmeningococcal disease among freshmen living in dormitories was more than six times higher thanamong college students overall. The germ that causes the infection is carried in the nose andthroat of many individuals. Many people are naturally immune but can still spread the germ. Itspreads in droplets from the nose or mouth, such as from sneezing or coughing in a person's face,by kissing, sharing eating utensils and sharing a toothbrush. Some studies have linked increasedrisk to drinking alcohol and smoking, which may suppress immunity. Sharing a drinking glass ora cigarette at a party also can increase your risk.

A medical emergency:

Robert M. Jacobson, M.D., is a pediatrician at Mayo Clinic, Rochester, Minn. "The earlysymptoms of meningococcal disease are often mistaken for the flu," Dr. Jacobson says. "Thesesymptoms can progress so quickly that it's often hard for a person to obtain medical care beforebecoming very ill." According to Dr. Jacobson, the warning signs of meningococcal disease aresimilar to those of a number of other serious conditions. If you experience any of the followingsymptoms, seek medical care immediately:

High fever that prevents you from eating or sleeping

Headache accompanied by a fever

Inability to drink adequate fluids

Stiff neck

Meningococcal infections are medical emergencies. The longer you have the disease withouttreatment, the greater your risk of permanent neurologic damage, such as hearing loss, braindamage and loss of vision. Non-neurologic complications can include kidney failure and evendeath. Meningococcal infections may progress very quickly. Within hours of theonset of symptoms, the disease can lead to shock, and it may be rapidly fatal. Meningococcaldisease causes about 300 deaths in the United States each year. Among the 14 million people whoattend college each year, an estimated 125 to 175 cases occur, and 15 to 20 students die fromcomplications of meningococcal infections. Among those who survive, up to 15 percentexperience serious complications.

Two case studies:

Shortly after Melanie Benn of San Diego, Calif., came home from college for the holidays severalyears ago, she began to complain of flu-like symptoms. When her symptoms worsened over aperiod of hours, her mother took her to the emergency room. Melanie went into shock almostimmediately. She was diagnosed with a meningococcal infection in her bloodstream(meningococcemia), which resulted in kidney failure and gangrene in her limbs. Melanie's armsand legs had to be amputated.

Another college student, Evan Bozof, from Marietta, Ga., was in his junior year when he calledhis mother and said he had a terrible headache. After his symptoms worsened, his mother urgedhim to go to the emergency room. By the time he received urgent care, just hours later, it wastoo late. He was diagnosed with meningococcemia, and suffered gangrene, lung and liver damage and seizures before dying of brain damage.

The mothers of Melanie and Evan now work with the ACHA to promote awareness of thevaccine that may have prevented their children from contracting meningococcal disease. However,many experts feel that the vaccine is warranted only during meningococcal disease epidemics.

The vaccine

Meningococcal disease is caused by the bacteria Neisseria meningitidis. There are five strains ofN. meningitidis, known as A, B, C, Y and W-135. A vaccine is available that offers someprotection against serogroups A, C, Y and W-135. The vaccine currently offers no protectionagainst serogroup B, and it's effective for only 3 to 5 years. The ACHA recommends that allcollege students (unless pregnant), especially those ages 18 to 24, consider getting the vaccine asa preventive measure. But this recommendation is controversial. "The ACHA is making arecommendation that many experts have yet to support," Dr. Jacobson says. "Mayo Clinic, CDCand the American Academy of Pediatrics all are currently recommending that the vaccine be usedonly during an epidemic." According to Dr. Jacobson, there are a number of reasons for reservingthe vaccine for outbreaks. "The vaccine doesn't offer lifelong immunity," he says. "So a personwho receives the vaccine early in their college career still may be in college when their immunityhas worn off but an epidemic on campus occurs. So preventive vaccination still may leave them atrisk." In addition, the serogroups responsible for about half of the meningococcal epidemics arenot responsive to the vaccine, according to Dr. Jacobson. "Serogroup B causes a significantamount of on-campus meningococcal infection outbreaks," he says. "And the vaccine offers noprotection against that organism." The cost of the vaccine, about $65, may also be a deterrent."We must seriously consider the cost of a recommendation involving 14 million people a year at$65 per person," says Dr. Jacobson. "The best precautions against meningococcal disease may beto give your immune system a boost by leading a healthy lifestyle, and seeking immediate medicalcare if you develop symptoms."