WHAT IS MENINGITIS?
Meningitis is an inflammation of the lining 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 Neisseria meningitidis. 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 require prophylactic therapy. Untreated meningococcal disease can be fatal.
HOW DOES MENINGOCOCCAL DISEASE OCCUR?
Meningococcal disease is transmitted through the air via droplets of respiratory secretions and through direct contact with an infected person by sharing items such as cigarettes or drinking glasses or through intimate contact such as kissing.
Approximately 10% of the general population carries meningococcal bacteria in the nose and throat in a 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 the upper respiratory tracts some protection from developing meningococcal disease.
Meningococcal bacteria cannot usually live for more than a few minutes outside the body. As a result, they are not easily transmitted by routine contact with an infected person in a classroom, dining room, rest room, etc.
HOW MANY CASES OF MENINGOCOCCAL DISEASE OCCUR EACH YEAR?
The annual incidence of meningococcal disease in the United States is about 1 case per 100,000 population. It is estimated that 100-125 cases of meningococcal disease occur annually on college campuses and that five to fifteen students die each year as a result. Recent evidence found that students residing on campus in dormitories appear to be at higher risk for meningococcal disease than college students overall.
WHO IS AT RISK?
Although anyone can come in contact with the bacteria that cause meningococcal disease, research indicates that certain social behaviors, such as exposure to passive and active smoking, bar patronization and excessive alcohol consumption, may put students at increased risk for the disease. Persons with compromised immunity, those in close contact with a known case, and travelers to endemic areas of the world are also at increased risk.
WHAT ARE THE SIGNS AND SYMPTOMS OF MENINGOCOCCAL DISEASE?
Meningococcal disease is potentially dangerous because it is relatively rare and can be mistaken for other conditions. Understanding the characteristic signs and symptoms of meningococcal disease is critical and possibly lifesaving. A person may have symptoms suggestive of a minor cold or flu for a few days before experiencing a rapid progression to severe meningococcal disease. Common early symptoms of meningococcal meningitis include fever, severe sudden headache accompanied by mental changes (e.g., fatigue, lethargy), and neck stiffness.
A rash, which may appear with severe meningococcal disease, may begin as a flat, red eruption, mainly on the arms and legs. It may then evolve into a rash of small spots that do not change with pressure. New spots can form rapidly, even while the patient is being examined.
MENINGOCOCCAL MENINGITIS VACCINE
Pre-exposure vaccination enhances immunity to four strains of meningococcus, Types A, C, Y and W-135. These strains comprise 65-70 percent of the invasive disease and therefore the risk for meningococcal disease is reduced. Development of immunity after immunization requires 7-10 days.
Although protection probably persists in schoolchildren and adults for at least 3 years, the exact timing for a booster has not been determined. As with any vaccine, vaccination may not protect 100% of all susceptible individuals.
Adverse reactions to meningococcal vaccine 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. The vaccine has been used since 1971 for routine mass vaccination of military recruits. This practice has led to a substantial decrease in disease outbreaks in the military.
WHO SHOULD BE VACCINATED PRE-EXPOSURE?
- Entering college students who elect to decrease their risk for meningococcal disease
- Students 30 years of age or under who request vaccination in order to decrease their risk of disease (and who are not pregnant). The highest priority should be for students 18 to 24 years of age. Students 25 years of age or older have a much lower risk of disease.
- 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 (primarily sub-Saharan Africa)
WHAT IS THE RECOMMENDATION OF THE HARTSHORN HEALTH SERVICE ON MENINGOCOCCAL VACCINE?
- The Hartshorn Health Service endorses the American College Health Association recommendation that college students consider vaccination to reduce their risk for meningococcal disease.
HOW CAN ONE REDUCE THE RISK OF CONTRACTING MENINGOCOCCAL DISEASE?
- Maximize your body's own immune system response. A lifestyle that includes a balanced diet, adequate sleep, appropriate exercise, and the avoidance of excessive stress is very important. Minimizing the risk for upper respiratory tract infections and avoiding inhalation of cigarette smoke may help to protect from invasive disease. Everyone should be sensitive to public health measures that decrease exposure to oral secretions, such as covering one's mouth when coughing or sneezing and washing hands after contact with oral secretions.
- Meningococcal Vaccinations are administered at Hartshorn Health Service. The immunizations department is open Monday through Friday 9:00am to 12:00noon and 1:00pm to 4:00pm. No appointment necessary. Call 491-6548 with any questions. The cost of the vaccine is $105.
PREVENTIVE TREATMENT FOR MENINGITIS
FOR CLOSE CONTACTS
What should I do if I have been in contact with a diagnosed case of meningococcal disease?
The use of preventive treatment (such as rifampin or ciprofloxacin) is recommended for close contacts exposed to a person diagnosed with meningococcal disease. Anyone who suspects possible exposure should consult a physician immediately. Beginning preventive treatment more than 2 weeks after exposure to the case would be too late to prevent secondary cases.
Who is considered a close contact?
- Close contacts are those who are likely to have been exposed to the nose and throat secretions of the sick person. Close contacts include, but are not limited to the following:
- Those living in the same house as the ill person,
- Those sharing sleeping arrangements with the ill person,
- Children sharing toys, such as in the same child care or nursery school, as the ill person,
- Those who shared cigarettes, food, drinks, or other things that contain saliva with the ill person,
- Those who have kissed the ill person,
- Those who have given mouth-to-mouth resuscitation to, intubated, or suctioned the nasopharyngeal secretions of the ill person.
Casual contact, such as being in the same classroom, workplace, or sitting at the same table with an infected person is not usually significant enough to cause concern.
More information about meningococcal disease can be found on the CDC's web site at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm