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MENINGITIS: BIG DREAD ON CAMPUS
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The following article is reprinted from the October 12,
1999, "Washington Post" ("Health," p. D12). It is reprinted here with permission of the author,
MENINGITIS: BIG DREAD ON CAMPUS
Rise in Potentially Fatal Illness in Students Prompts Call for Wider Use of Vaccine
by Kathleen Phalen
Special to "The Washington Post"
Life on Virginia Military Institute's (VMI) freshman "rat line" is rough, regimented and leaves little room for
gim-riders, the tag given to those who spend too much time on the sick list. So when Cadet John Fuller started
feeling sick and couldn't hold his head in a rat's traditional chin-down pose, he
started to worry.
"It was a Wednesday night; in 15 minutes I went from feeling fine to feeling
horrible," said the 19-year-old student from Anderson, Ind., now in his second
year at the military college in Lexington, Va. "I was unbelievably cold. It felt
like it was 30 degrees below--I thought I was getting the flu."
Fuller went to the school's infirmary, he learned he didn't have a fever, he got
some Tylenol and went to bed. The next morning, while dressing, he couldn't push his
chin to his neck. "I think that was the most noticeable thing, because I knew we were required to hold that
position," he said. "By the time I got to class, I had red dots on my arms."
Barely 24 hours later, Fuller was in the intensive care unit at the University of
Virginia hospital in Charlottesville. He had meningococcemia, a form of
meningitis caused by the bacterium Neisseria meningitidis.
"It moved super-fast," said Fuller about his brush last February with this sometimes fatal disease. "I
was sweating and the headache, the pain, was so unbelievable--I was conscious the whole time, but it
felt like I was drunk. I was talking, but I wasn't coherent."
Fuller joins the rising ranks of college students infected with meningococcal
disease. It often strikes those living in close conditions, such as college dorms
and military barracks.
There have been recent cases in the Washington area. Two weeks ago a 20-year-old student at the University
of Maryland was hospitalized with bacterial meningitis but is now recovering. The same day the student was
hospitalized, a Manassas Park Middle School teacher, Jane Dimitrious, 47, died of bacterial meningitis.
The disease has two common forms: meningococcal meningitis, an inflammation of the membranes
surrounding the brain and spinal cord, or meningococcemia, when the bacteria move into the
bloodstream. There is also a type of meningitis caused by a virus, but it is usually less severe
than the bacterial form.
The bacterium causing meningitis is common and people often harbor it in their nasal passages and
throats without effect. But when it gets into the bloodstream and moves to the brain, it causes problems.
The bacteria can be spread by simply sneezing or coughing. Kissing and sharing utensils, drinking
glasses or cigarettes can also contribute to its onset. Yet despite that, the bacterium is not
especially contagious, and very close contact is usually necessary to spread the disease.
Of the more than 3,000 annual cases of bacterial meningitis in the United States, about 20 to 25
percent of those contracting meningococcemia will die, said Bradley Perkins, chief of the meningitis
and special pathogens branch of the U.S. Centers for Disease Control and Prevention (CDC). Perkins
adds that many of these deaths could be prevented with a highly effective vaccine.
The vaccine was developed by the U.S. military and since 1971 has been given to all recruits. The number
of cases in the military has fallen 90 percent since then, according to James Turner, director of the
department of student health at the University of Virginia in Charlottesville and chairman of the
American College Health Association's (ACHA) task force on vaccine-preventable diseases.
Particularly alarming to health officials is an increase in cases among college
freshmen and sophomores living in dormitories, a group the CDC reports are more
than five times more likely to develop meningitis than college students in general. More than 600 cases of
meningitis were reported in 1996 among people age 15 to 24, twice as many as a decade ago.
"Freshmen come into crowded conditions and are often exposed to bacteria they have not previously seen. And
then their lifestyles--binge drinking, smoking, spending time in bars, lack of sleep--compromise their immune
systems," said Turner. Three years ago, Turner began recommending that U-Va. students be vaccinated after
seeing five cases in a 20-month period at the university. The university hasn't had any cases since
The vaccine protects against four common strains of the bacteria, but not others. Maggi Bridwell, director
of the University of Maryland's health center, said, "We are not pushing the vaccine because it doesn't
cover all strains and it only lasts about five years." Still, after the most recent case at College Park,
Bridwell said university and Prince George's County Health Department officials gave out about 600 doses
of the vaccine to students who were concerned about getting the disease.
The ACHA, which represents about half of the nation's college health service
centers, made a formal recommendation in 1997 that all college students consider
vaccination. And the CDC's Advisory Committee on Immunization Practices (ACIP) will consider issuing a
similar recommendation on Oct. 20.
"It's likely to happen that ACIP will endorse (an optional recommendation) that college students living
in dormitories get the vaccine," said Perkins, part of the ACIP study group. "This is a serious threat. We have
seen over the last decade a gradual increase in rates in this age group and an increased
frequency in outbreaks among college students. It is preventable. Now is the
right time to move aggressively."
Fuller was lucky. A rapid infusion of potent antibiotics stopped the progression
of the bacteria. Nonetheless there are those receiving similar treatment who
don't make it or are severely impaired. Others mistake the symptoms--high fever, headache, stiff neck, nausea, vomiting, confusion
and sleepiness--for the flu and never seek treatment. A cadet at VMI died in 1996 from
meningococcemia. Reporting to the campus hospital with flu-like symptoms, Cadet Scott
Hickey of Staunton, Va., died 12 hours later. The onset was similar to Fuller's.
"There's a pretty fixed proportion that will die," said CDC's Perkins. "There
appears to be a group who are going to die no matter what--we are recognizing through improved
studies that there are groups of people at risk for bad outcomes, and we think it has to do with the genetics of
their inflammatory response." The vaccine, however, could help them.
There are no words to describe how Lynn Bozof felt when she discovered there was a vaccine that could have saved
her son, Evan. "We were in disbelief," said Bozof, of Marietta, Ga. Evan, a 20-year-old honor student at
Georgia Southwestern University, called his mom on a Wednesday afternoon to say he had a horrible headache.
"Migraines run in our family, so we weren't that alarmed," she recalls. "I checked on him around 5 and
he had a blinding headache and couldn't keep anything down. I told him to have a friend take him to the
Evan was hospitalized and slipped into a coma and because the disease ravages the circulatory system,
his legs and arms became gangrenous. He, too, had meningococcemia and died 26 days later. His family
is working with Georgia officials to educate students and parents about the disease and the
"We just can't sit back, we want parents to know. We will never be able to fill
this hole in our hearts," she said. "The vaccine only costs about $65--how often do we
blow $65? My child's life is worth more than $65."
EDITOR'S NOTE: CDC issued a press release titled "ACIP Modifies Recommendations for Meningitis Vaccination"
following the Advisory Committee on Immunization Practices meeting in October 1999. To read this
press release, go to: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_college.htm
MORE INFORMATION ON MENINGOCOCCAL DISEASE AND VACCINE
Many organizations including CDC, ACHA, and the American Academy of Pediatrics have posted information on their
websites about meningococcal disease and vaccine. To access these pages, visit the Immunization Action
Coalition's (IAC) "Meningococcal Disease and Vaccine" web page at: http://www.immunize.org/genr.d/menin.htm
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