College students preparing to settle into dorm life this fall probably don’t have getting a meningitis vaccination on their “to do” list, yet health officials say they might want to consider it.
Bacterial meningitis strikes about 3,000 Americans each year, including about 125 college students, and kills about 300 people annually. Research has shown that freshmen living in dormitories are at six times the risk of contracting bacterial meningitis than college students overall, according to the Centers for Disease Control and Prevention (CDC).
Bacteria that causes meningitis lives in the nose and throat of between 5 percent and 20 percent of the population. Normally, people don’t get sick from it, according to James Turner, M.D., chairman of the Vaccine Preventable Task Force of the American College Health Association (ACHA). However, he says the mix of a crowded living environment, such as a dormitory, where bacteria can easily pass back and forth, plus certain college lifestyle factors can be a dangerous combination.
“Most of the time nothing happens. You can become a carrier and not get sick,” Turner says. “But there are features of college life that put students at greater risk for getting the disease – being tired, being exposed to tobacco smoke and alcohol, and having other respiratory infections, such as colds, flu and strep throat.”
May feel like the flu
Meningitis is a potentially deadly inflammation of the membranes surrounding the brain and spinal cord. The disease is usually caused by a viral or bacterial infection. Viral meningitis is relatively mild with fever and headache, but bacterial meningitis, if left untreated, can be fatal.
Initially, bacterial meningitis may feel like the flu. Symptoms include fever and headache and a stiff neck, particularly in adults. The disease progresses quickly, and as many as 10 percent of patients die within days. Those who survive often lose limbs and suffer hearing loss, and brain and kidney damage.
“It’s rare, but it’s a horrific disease,” says Turner, who is also director of the Department of Student Health at the University of Virginia.
Alerting college freshmen
The incidence of bacterial meningitis is low, yet on the rise on college campuses. During the late ’80s, there was an average of one or two outbreaks of meningococcal meningitis (one strain of bacterial meningitis) on college campuses every year. In the mid- to late-90s, the incidence jumped to two to four outbreaks every year, according to Turner. An outbreak is defined as three or more cases of the same strain.
Colleges do not require that students receive the meningococcal vaccine. The CDC’s Advisory Committee on Immunization even stops short of recommending that all college students get the vaccine. However, the panel does recommend that students’ health care providers, colleges and universities provide information about meningitis and the vaccine to college freshmen, particularly those who live in dorms or residence halls. The panel further recommends that immunization be provided or made easily available to students.
“We’re not recommending that everyone go out and get this (vaccine),” says Cary Engleberg, M.D., professor and chief of the Infectious Diseases Division of the University of Michigan Health System. “Each student needs to think about it for himself and understand the facts.”
The ACHA, an advocacy organization for college and university health, estimates that as many as 200 colleges and universities have included the CDC’s recommendation on their college entrance health forms and/or are conducting awareness campaigns to educate parents and college students about meningitis and the vaccine.
Good but not great vaccine
The vaccine isn’t universally recommended by the CDC for purely economic reasons, according to Turner. “The cost of immunizing students is more than the cost of the (rare) disease and deaths,” he says. However, he adds, the economic formula doesn’t take into account the consequence of the disability that meningitis can cause or the liability costs to colleges and universities.
The average cost of the vaccine is about $70, and although not all health insurers cover it, more are agreeing to do so, according to Turner.
“Seventy dollars may be a lot of money to some people,” he says, “But when you think of the cost of going to college, it’s a trivial expense to eliminate a rare, but deadly, infection.”
One of the vaccine’s shortcomings is that it does not protect against all of the meningococcal strains. It is, however, about 90 percent to 95 percent effective in protecting against 80 percent of the meningococcal strains.
“It’s not a great vaccine, but it’s a good one,” Engleberg says.
The vaccine, which confers immunity for three to five years, is safe, and adverse reactions are typically mild, such as redness and discomfort at the site of injection lasting up to two days. The vaccine takes about two weeks to become active.
“The vaccine doesn’t help with an outbreak. If you’re not vaccinated and your roommate comes down with meningococcal meningitis, then it makes no sense to get the vaccine,” Engleberg says. Instead, antibiotics, which act immediately, are given to quell an outbreak.
Making sure shots up to date
Engleberg recommends that while college students consider the meningococcal vaccine, they should also review their vaccination status for normally required vaccines and make sure they are up to date.
“If they have incomplete immunization to Hepatitis B, that might be considered. They should have had a second immunization against measles-mumps and rubella before they enter college,” he says. “These are things that should be considered seriously.”