The recent outbreak of meningitis on two college campuses has parents nervous. I often get asked, “If my child got vaccinated are they okay?” The answer unfortunately is not always – this outbreak was a type of meningitis not covered by the vaccine we have in the U.S. But let’s start with the basics first.
What is meningitis?
Meningitis is a serious, sometimes life-threatening infection of the protective membranes surrounding the brain and spinal cord. It is one of those very serious diagnoses that if suspected in the ER, we act on quickly – usually with a spinal tap to look at and test the fluid around those membranes and immediate IV antibiotic treatment. Many different types of germs can cause it. One of the most serious bacterial meningitis infections is due to a bacteria called Neisseria meningitides, also called meningococcal meningitis.
According to the Centers for Disease Control (CDC), in 2009 there were about 2,000-3,000 cases in the U.S., resulting in about 110 deaths. It is an aggressive infection that can be fatal within 24 hours. Other serious forms of a meningococcal infection occur when the bacteria gets into the blood stream and causes sepsis, often with gangrene of extremities. Survivors can have permanent brain damage, deafness and kidney failure and require limb amputations.
How is it spread?
This very contagious disease is spread through close contact with shared secretions, as with coughing, kissing or sharing eating utensils and drinking glasses. That is why it so easily spreads on college campuses, especially in dormitories. College students are also thought to be more at risk not only from their cramped living quarters, but also their lifestyle while away at school. While college students are more at risk, adults are also susceptible to the infection and should be aware of the symptoms and warning signs of its onset.
Why wasn’t this outbreak prevented by the U.S. vaccine
There are 12 known serotypes or strains of meningococcal bacteria, but A, B, C, Y and W cause most of the infections. In the U.S. we have an approved vaccine by the brand name Menactra that covers 4 out of the 5 serotypes (groups A, C, Y, W-135), which are the most common cause of meningococcal disease in the U.S. The outbreak we have been reading about is the less common serotype B. However because the CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that all college freshmen get vaccinated before matriculation, this serotype B is the one now emerging in the recent college outbreaks. This is the serotype that caused disease at Princeton and University of California Santa Barbara. There is a vaccine for serotype B made by Novartis called Bexsero. It is approved and is being used in Europe and Australia, where this serotype has always been more common.
I spoke with Dr. Thomas Clark, epidemiology lead for CDC’s Meningitis and Vaccine Preventable Diseases Branch and his colleague Dr. Amanda Cohn. They have been leading and coordinating the effort between the universities, the state health departments, the FDA as well as the pharmaceutical company Novartis to bring it this vaccine into the U.S. to help further contain this outbreak.
Dr. Clark was at Princeton this past week assessing a vaccination program for those students who might still be at risk. This well-orchestrated public health system response was instrumental in part for no reported deaths in these recent outbreaks so far. While there is work on the development of a vaccine in the U.S. that actually covers all five serotypes, early detection and treatment is the key message that all coordinating agencies want to get out.
So what, if anything, can parents do?
It is important to educate our children in college (and ourselves!) about how to prevent communicable disease in general, by getting plenty rest, eating well and discourage any sharing of food or drinks. However, it is even more important to know the warning signs and symptoms to recognize meningitis early:
- High fever
- Stiff neck
- Sensitivity to light called photophobia.
These are indications to get to an emergency room right away. By the time you see the symptoms of septicemia (a bloodstream infection), such as cold hands and feet with rapid breathing, severe muscle aches and pains and a purple rash, the risk of death is very high.