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.

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.

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.

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 or drinking glasses or through intimate contact such as kissing.

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.

Who is at risk?

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.

How often do outbreaks occur in 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.

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.

What is ACHA's recommendation on meningococcal disease?

ACHA Vaccine-Preventable Diseases Task Force has agreed to adopt the new ACIP recommendation, which recommends that undergraduate college students, particularly freshmen who live in or plan to live in dormitories or resident halls, consider getting the vaccine to reduce their risk for meningococcal disease.

Does the CDC recommend vaccination for college students?

As of October 20, 1999, the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC) recommends that individuals who provide medical care to college freshmen, particularly those who live in or plan to live in dormitories or residence halls, should provide information about meningococcal disease and the benefits of vaccination with these students and their parents. ACIP further recommends that immunization should be provided or made easily available to those who wish to reduce their risk for meningococcal disease. Other undergraduate students wishing to reduce their risk for meningococcal disease can also choose to be vaccinated.

Additionally, the ACIP recommends that colleges and universities provide information about meningococcal disease and the vaccine to freshman, particularly those who plan to live in dormitories and resident halls, and encourages public health agencies to serve as a resource for information about meningococcal disease and vaccination, including how to obtain the vaccine.

Why should college students consider vaccination with the meningococcal vaccine?

Data from the U.S. Centers for Disease Control and Prevention (CDC) demonstrate increasing incidence of outbreaks on college campuses. Data further suggests that sub-populations of college students are at increased risk for meningococcal disease. Pre-exposure vaccination enhances immunity to four strains of meningococcus that cause 65 to 70 percent of invasive disease and therefore reduces a student’s risk for disease. Development of immunity post-vaccination requires 7-10 days.

Who be vaccinated pre-exposure?

• Entering college students, particularly those living in dormitories or resident halls, who elect to decrease their risk for meningococcal disease.

• Undergraduate students 25 years of age or under who request vaccination in order to decrease their risk for disease and are not pregnant.

• Students with medical conditions that compromise immunity (e.g., HIV, absent spleen, antibody deficiency).

• Students traveling to areas of the world with endemic meningococcal disease.

Are colleges and universities following ACHA's recommendation?

Since the release ACHA's recommendation in 1997, it is estimated that as many as 200 colleges and universities have included the ACHA recommendation on their college entrance health forms and/or are conducting awareness campaigns to educate parents and college students about this disease.

How effective is the vaccine?

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 vaccine has shown to be 85 to 100 percent effective in serogroups A and C in older children and adults.

Is the vaccine safe? Are there adverse side effects to the vaccine?

The vaccine is very safe and adverse reactions are mild and infrequent, consisting primarily of redness and pain at the site of injection lasting up to two days.

What is the duration of protection?

The duration of the meningococcal vaccine’s efficacy is approximately three to five years.

What is ACHA doing to assess the risk of meningococcal disease among college students?

ACHA is currently partnering with the CDC on a surveillence study to identify potential subgroups of college students that may be at increased risk for meningococcal disease. Results of this study will be published in the near future.

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 consider getting the vaccine.