Meningitis: Managing Meningococcal Disease in College Populations

Contents:

About Meningitis
Is Meningitis Vaccine Recommended for College Students?
Getting the Meningococcal Vaccine at Tang
Services at Tang Center
Additional Resources
Related Topics

About Meningitis
Meningitis is an inflammation of the linings of the brain and spinal cord caused by either viruses or bacteria.

Viral meningitis is more common than bacterial meningitis and usually occurs in late spring and summer. Signs and symptoms of viral meningitis may include stiff neck, headache, nausea, vomiting, and rash. Most cases of viral meningitis run a short, uneventful course. Since the causative agent is a virus, antibiotics are not effective. Persons who have had contact with an individual with viral meningitis do not require any treatment.
Bacterial meningitis occurs rarely and sporadically throughout the year, although outbreaks tend to occur in late winter and early spring. Bacterial meningitis in college-aged students is most likely caused by Streptococcus pneumoniae or Neisseria meningitidis. Bacteria meningitis caused by Neisseria meningitidis is also known as meningococcal meningitis. Because meningococcal meningitis can cause grave illness and rapidly progress to death, it requires early diagnosis and treatment. In contrast to viral meningitis, persons who have had intimate contact with a case of meningococcal meningitis require prophylactic (preventive) therapy.
Meningococcal meningitis bacteria
Approximately 10% of the general population carry meningococcal bacteria in the nose and throat in an asymptomatic harmless state. This carrier state may last for days or months before spontaneously disappearing, and it seems to give persons who harbor the bacteria in their upper respiratory tract some protection from developing meningococcal disease.
During meningococcal disease outbreaks in a community, the percentage of people carrying the bacterium in that community may approach 95%, yet the percentage of people who develop meningococcal disease is less than 1%. This low occurrence of disease following exposure suggests that a person's own immune system, in addition to bacterial factors, plays a key role in disease development.

Meningococcal bacteria usually cannot live for more than a few minutes outside the body. As a result, they are not easily transmitted in water supplies, swimming pools, or by casual contact with an infected person in a classroom, dining room, bar, rest room, etc.

Roommates, friends, spouses, and children who have had intimate contact with the oral secretions of a person diagnosed with meningococcal disease are at risk for contracting the disease and should see a clinician to receive prophylactic medication immediately. Examples of such contact include kissing, sharing eating utensils, and being exposed to droplet contamination from the nose or throat.

How many cases of meningococcal meningitis are seen in the United States?

Invasive meningococcal disease is relatively rare in the United States.
2,000-3,000 cases are reported each year.
The incidence rate is approximately 1 case per 100,000 people in the United States.

Meningococcal meningitis in US college students

A surveillance study of college students by the Centers for Disease Control and Prevention (CDC) was conducted in 1998-1999. Data from this study revealed:

96 cases of meningococcal meningitis occurred in college students during academic year 1998-99.
An overall rate of 0.7 cases of meningococcal meningitis per 100,000 people for all undergraduates.
A rate of 1.4 cases per 100,000 people for 18-23 year-old non-students.
For college freshman living in dormitories the rate is 5.1 cases per 100,000 people

Can meningococcal disease be mistaken for other health problems?

Meningococcal disease is potentially dangerous because it is relatively rare and can be mistaken for other conditions. The possibility of having meningitis may not be considered by someone who feels ill, and early signs and symptoms may be ignored.

What are the signs and symptoms of meningococcal disease?

Understanding the characteristic signs and symptoms of meningococcal disease is critical and possibly lifesaving.

Common early symptoms of meningococcal meningitis include fever, severe sudden headache accompanied by mental changes (e.g. malaise, lethargy), and neck stiffness. Any person with the above symptoms should seek immediate medical attention.

In addition, a rash may begin as a flat, red eruption, mainly on the arms and legs. It may then evolve into a rash of small dots that do not change with pressure (petechiae).

Treatment of meningococcal meningitis infection

Meningococcal disease can be rapidly progressive. With early diagnosis and treatment, however, the likelihood of full recovery is increased.

Prompt medical attention, early recognition, performance of a lumbar puncture (spinal tap), hospitalization and prompt initiation of intravenous antibiotic therapy are crucial.

Treatment of persons potentially exposed to meningococcal disease

Anyone who suspects intimate exposure to meningococcal meningitis should consult a clinician to determine if prophylactic (preventive) antibiotics are indicated. The use of prophylactic antibiotics, such as ciprofloxacin or rifampin, is recommended only for those who have had intimate exposure to a person diagnosed with meningococcal disease.

Vaccination

As an adjunct to appropriate antibiotic prophylaxis, immunization against the meningococcus bacterium may be recommended for people with casual contact when an outbreak of meningococcal disease has occurred in a defined community (e.g., residential hall).

It is important to note that meningococcal vaccines should not be used in place of antibiotic prophylaxis for those with intimate exposure to an infected person: the protection from immunization is generated too slowly in this situation.

Meningococcal meningitis vaccines

Immunization against the bacterium Neisseria meningitidis (N. meningitidis) may be recommended for persons over 2 years of age if they are members of a population that is experiencing an outbreak of meningococcal disease caused by a serogroup that is included in the current vaccines, e.g. students at a university where an outbreak is occurring.

Numerous studies have demonstrated the immunogenicity and clinical effectiveness of meningococcal vaccines. Although protection probably persists in schoolchildren and adults for at least 3 years following vaccination, the need for and exact timing of a booster has not been determined. As with any vaccine, vaccination may not offer 100% protection, yet is estimated to be about 85-90% effective for select serogroups of N. meningitidis. In addition, the currently available vaccines do not afford protection against all types of bacterial meningitis.

The vaccines currently available offer protection against 4 serogroups of N. meningitidis which account for about 50% of cases of N. meningitidis induced meningitis.
The vaccines do not offer protection against N. meningitidis serogroup B which accounts for 30-40% of this type of meningitis.
There is no vaccine available offering protection against serogroup B.

Adverse reactions to meningococcal vaccines are mild and infrequent, consisting primarily of redness and pain at the injection site that may last 1 to 2 days. Rarely, fever of short duration may occur.

Are the meningococcal meningitis vaccines recommended for college students?

The meningococcal vaccines are recommended by the Centers for Disease Control (CDC) for students 11-18 years of age, incoming college freshmen living in dormitories and those 19-55 at increased risk for meningococcal disease. For more information, see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a3.htm?s_cid=mm5631a3_e

The American College Health Association supports the CDC recommendation.

We recommend that all college students read the information about meningococcal meningitis and the potential benefits of vaccination. The vaccines are available to those wishing to reduce their risk of meningococcal disease.

The ACIP also recommends meningococcal vaccines for certain high risk persons:

Select immune system deficiencies
People who have had their spleen removed
Certain research and laboratory personnel
Travelers to the African meningitis belt and other selected high risk areas

Getting the Meningococcal Vaccine at Tang

The new meningococcal conjugate vaccine, Menactra, is available at the Tang Center. Please call (510) 643-7177 to make an appointment.

Services at the Tang Center

For Students

Immunization/Travel Clinic: (510) 643-7177
Advice Nurse: (510) 643-7197
Self-Care Resource Center: (510) 642-7202

For Faculty and Staff:

Please refer questions to your health plan or primary care provider.
Immunization/Travel Clinic: (510) 643-7177 (Fee-for-service)

Additional Resources

Centers for Disease Control website on Meningitis
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm
Local Emergency Departments
Alta Bates Hospital
2450 Ashby Avenue
Berkeley, CA (510) 204-4444
Summit Medical Center
350 Hawthorne Ave & Webster
Oakland, CA (510) 655-4000

Related Topics

Disclaimer: The information provided here is not intended to diagnose, treat or provide a second opinion on any health problem or disease. It is meant to support, not replace, the relationship that exists between an individual and his/her clinician.

Last reviewed: September 2005

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