Meningitis

1. What is meningococcal meningitis?
Meningococcal disease is a rare but potentially fatal bacterial infection. The disease is expressed as either meningococcal meningitis, an inflammation of the membranes surrounding the brain and spinal cord or meningococcemia, the presence of bacteria in the blood.

2. What causes meningococcal meningitis?
Meningococcal disease is caused by the bacterium Neisseria meningitidis, a leading cause of meningitis and septicemia (or blood poisoning) in the United States. Meningitis is one of the most common manifestations of the disease, although it has been known to cause septic arthritis, pneumonia, brain inflammation and other syndromes.

3. How many people die from meningococcal meningitis each year?
Meningococcal disease strikes about 3,000 Americans each year and is responsible for approximately 300 deaths annually. It is estimated that 100 to 125 cases of meningococcal disease occur annually on college campuses and five to 15 students die as a result.

4. How is meningococcal meningitis spread?
Meningococcal disease is transmitted through the air via droplets of respiratory secretions and direct contact with an infected person. Direct contact, for these purposes, is defined as oral contact with shared items such as cigarettes, water bottles, musical instruments or drinking glasses or through intimate contact such as kissing.

5. What are the symptoms?
The early symptoms usually associated with meningococcal disease include fever, severe headache, stiff neck, rash, nausea, vomiting, and lethargy, and may resemble the flu. Because the disease progresses rapidly, often in as little as 12 hours, students are urged to seek medical care immediately if they experience two or more of these symptoms concurrently.

6. Who is at risk?

Although meningococcal disease rates are highest in infants, rates begin to rise again in early adolescence and peak between the ages of 15 and 24. During the 1990s, one study reported substantially increased incidence among 15- to 24-year-olds. In addition to the increased incidence, the fatality rate was over 22 percent in this age group, over five times that seen in younger persons. Up to 83 percent of the cases reported in this study were caused by the potentially vaccine-preventable serogroups that are included in Menactra vaccine.

Recent evidence found students residing on campus in dormitories appear to be at higher risk for meningococcal disease than college students overall. Further research recently released by the CDC shows freshmen living in dormitories have a six times higher risk of meningococcal disease than college students overall.

Although anyone can come in contact with the bacteria that causes meningococcal disease, data also indicates certain social behaviors, such as exposure to passive and active smoking, bar patronage, and excessive alcohol consumption, may put students at increased risk for the disease. Patients with respiratory infections, compromised immunity, those in close contact to a known case, and travelers to endemic areas of the world are also at increased risk. Cases and outbreaks usually occur in the late winter and early spring when school is in session.

7. How often do outbreaks occur on college campuses?
From 1980 to 1993, there were 21 outbreaks, three of which occurred in colleges. From 1994 to 1996, there have been 26 outbreaks, four of which occurred in colleges. Between 1986 and 1993, an outbreak was defined as five cases of the same serotype in 100,000 people with at least three occurring within three months. From 1994 to present, 10 cases of the same serotype in 100,000 people with at least three occurring within three months constitute an outbreak.

8. Is one type of serogroup of meningococcal meningitis more common in college students?
Recent evidence shows the epidemiology of meningococcal disease is changing with a majority of cases (65 percent) in the college age group caused by either serotype C, Y, or W-135, which are all vaccine-preventable.

9. What is ACHA's recommendation on meningococcal vaccination?
The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC) has recommended that children 11-12 and teens entering high school, as well as college freshman living in dormitories receive the newly licensed meningococcal vaccine.

10. Does the CDC recommend vaccination for college students?
Yes. As of February 10, 2005, the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC) recommends that individuals ages 11, 12, 15 and graduating high school seniors entering college obtain a meningitis vaccination with the Menactra vaccine.

11. Which students should be vaccinated for pre-exposure?

	College freshmen living in dorms and any college student who wants to reduce his or her risk for meningococcal disease.
	Children 11 to 12 years old, teens entering high school and any adolescent who wishes to reduce his or her risk for meningococcal disease.
	Students traveling to areas of the world with endemic meningococcal disease.

12. Is the vaccine effective?
The meningococcal vaccine has been shown to provide protection against the most common strains of the disease, including serogroups A, C, Y and W-135. The vaccination has been shown to be 80-90 percent effective by not only building up immunity for the individual, but also reducing the lilkihood that individuals could be carriers of the disease and spread it without being sick themselves.

13. Is the vaccine safe? Are there adverse side effects to the vaccine?
The bacterial meningitis vaccine is safe, effective and generally well-tolerated. The vaccine has been shown to provide protection against the most common strains of the disease, including serogroups A, C, Y and W-135. An individual will not contract bacterial meningitis from the vaccine. The vaccination is given in one injection.

In clinical trials, the most commonly reported solicited adverse reaction in adolescents, ages 11 – 18 years, and adults, ages 18 –55 years, were local pain, headache and fatigue. The majority of local and systemic reactions following Menactra vaccination were reported as mild in intensity. However, there is a potential risk for a severe allergic reaction which may include difficulty in breathing or swallowing, hives/itching , reddening of skin, especially around ears, swelling of eyes, face or inside of nose, unusual tiredness or weakness (sudden or severe)

Because the vaccine uses the diphtheria toxoid as the protein carrier that allows for longer lasting protection, individuals who have had a reaction to the diphtheria shot should not receive Menactra. Another vaccine is available, Memomune, which provides protection for 3-5 years without the diphtheria toxiod.

14. What is the duration of protection?
After an initial dose of Menactra, re-vaccination is recommended for certain persons who remain at high risk. Intervals between doses are 3 years for children between ages 2 to 6 and 5 years for persons age 7 years and older. High risk persons include persons with functional or anatomic asplenia, or persistent complement component deficiency; persons with prolonged exposure (i.e., some lab personnel, travelers, or residents in areas where disease is common); and persons previously vaccinated with Menomune.

15. What can a college do to protect students if an outbreak occurs?
If a suspected or diagnosed case of meningococcal meningitis is reported (on campus or in neighboring communities), the following intervention measures should be considered:

	Intensify surveillance and increase awareness among college health services, community physicians and hospitals.
	Notify college administration and health care personnel as well as public health departments.
	Begin education on the college campus and in surrounding areas about transmission. Pursue early diagnosis and treatment of cases and contacts.
	Consider mass immunization of students to prevent additional cases if an outbreak occurs, that is, 10 cases per 100,000 and three or more cases of the same serogroup within three months.

Because meningococcal meningitis is one of the most feared diagnoses in the United States, sporadic cases and outbreaks almost invariably spread panic through college communities. In order to proactively guard against an outbreak (or endemic disease), ACIP recommends that undergraduate college students, particularly freshmen who live in or plan to live in dormitories or resident halls, should receive the vaccination.

Information reprinted, in part, with permission from the American College Health Association.

Human & Financial Costs of Bacterial Meningitis
1,400 to 2,800 cases annually

10% to 14% of those who contract meningococcal disease will die as a result

11% to 19% of those who survive sustain a permanent disability such as hearing loss, mental retardation or limb amputation

$13,431 to treat a single case, on average

Source: Centers for Disease Control and Prevention, National Foundation for Infectious Diseases

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