As a parent, you have done everything you can do to protect your college student’s health (or, at least, to keep the odds of good health in their favor). Immunizations are up-to-date, responsible partying has been discussed, appeals to prevent pregnancy have been made, the use of the on-campus student health center has been reinforced, and away they go to a college campus in another zip code.
Then you read this in the newspaper:
A meningitis outbreak has been declared at Princeton University after a seventh case of the disease was reported at the Ivy League school since March, according to New Jersey Department of Health.
A male university student living in campus housing was diagnosed and hospitalized Sunday morning after developing symptoms of the disease on Saturday, according to the health department.
If your child goes to Princeton, you panic. If your child goes elsewhere, you wonder whether she is immunized against meningococcus. You check your records or call my office or go online to the patient portal to check. Sure enough, you see that your child has received two meningococcal vaccines called Menactra (one at 11 years old and a booster at 16). You sit back and relax, reassured that you did the right thing when you kept her immunizations updated at those office visits.
And then you read on:
Five of those six students have since recovered from a type B strain of the bacteria. One student diagnosed in October with the same B strain is still recovering, according to the health department.
State law requires that all students living on campus receive a meningitis vaccination which protects students from most strains of the bacteria, except for type B which does not have a vaccine licensed in the U.S.
You read that last part (my emphasis) again. Now you panic!
Menactra, a quadrivalent vaccine, protects against the four most common strains of Neisseria Meningitidis — serogroups A, C, W-135, and Y. Wikipedia has an interesting entry regarding the development of a vaccine to prevent serogroup B:
Vaccines against serotype B meningococcal disease have proved difficult to produce, and require a different approach from vaccines against other serotypes. Whereas effective polysaccharide vaccines have been produced against types A, C, W, and Y, the capsular polysaccharide on the type B bacterium is too similar to human neural antigens to be a useful target.
A vaccine for serogroup B was developed in Cuba in response to a large outbreak of meningitis B during the 1980s. The VA-MENGOC-BC vaccine proved safe and effective in randomized double-blind studies, but it was granted a license only for research purposes in the United States as political differences limited cooperation between the two countries
Meningococcal meningitis is not a common disease due to any serotype, and Group B meningococcus has been rare in the United States, up until now. Princeton University is now considering importing Bexsero — a vaccine that targets the Group B strain — to voluntarily administer to students. The vaccine is used in Europe and Australia, but it has not been approved for use in the U.S. by the F.D.A.
Like most contagious respiratory bacterial (and viral) infections, meningococcus is spread via tiny respiratory droplets that are coughed or sneezed from an infected person’s mouth and nose onto the mucus membranes of another person. These droplets can also be touched and auto-innoculated onto one’s mucus membranes (usually the eyes or mouth), or passed from one to another by sharing saliva (sharing spoons or cigarettes or kisses).
Pediatricians are well aware of the typical course bacterial meningitis takes, and meningococcal meningitis is especially frightening. Stories abound of (mostly young) people being healthy one minute, extremely sick in 60 minutes, and dead within a matter of a few short hours. An infection of the lining of the brain and spinal cord, meningococcal meningitis causes symptoms that start with fever, headache, and neck pain and stiffness. As pressure around the brain rapidly increases, nausea and vomiting, sensitivity to light, and confusion soon develops. The infection disseminates into the bloodstream (bacteremia) causing widespread symptoms, including a rash that pediatricians would recognize as ominous. Rapid identification of the illness and treatment are essential for surviving meningococcal meningitis: these young people get really sick, really fast. (A person with meningitis will not be sitting up on an exam table, calmly telling you about his symptoms. Rather, he will look dreadfully ill.) According to the National Meningitis Association, 11% of infected Americans will die. Of the survivors, about 20% will have permanent sequela, including brain damage, kidney damage, hearing loss, and amputation of limbs.
So the take-home message about meningococcal meningitis is that it’s bad but, thankfully, it’s rare. The meningitis vaccine your teenager receives (twice) protects them against the vast majority of these infections.
Finally, you might want to have another talk with your collegian about what to do if he or she gets sick away from home. Having a plan of action should give the both of you some peace of mind.