What to Give a College Student Returning for Christmas
by Dr. Randall M. Suzuka
1999

How About a Meningitis Vaccine?

On October 20,1999 the Advisory Committee on Immunization Practices (ACIP) modified its guidelines for the use of meningococcal vaccine. College freshmen living in dormitories appear to be at a modestly increased risk of getting meningococcal meningitis. The incidence of meningococcal meningitis is this group is six times higher than in college students living off campus (3.4-5.4/100,000 Vs 0.9/100,000). The incidence of disease in students living off campus is similar to that of the general population.

What is meningococcal meningitis?

Meningococcal disease is caused by a bacterium Neisseria meningitidis. Meningitis is an inflammation of the membranes surrounding the brain or spinal cord. Around 13% of the people who get it will die. Of the patients who recover 10% will have permanent hearing loss, mental retardation, loss of limbs, or other serious problems.

Neisseria meningitidis can also cause pneumonia, septic arthritis and sepsis (infection in the blood). Other bacteria such as Streptococcus pneumoniae can also cause meningitis.

How common is it?

Each year 3,000 Americans will get meningococcal disease and 300 will die from it. It is estimated that 100 – 125 cases occur annually on college campuses and 5 – 15 students die as a result of it.

What are the symptoms?

The early symptoms include fever, severe headache, stiff neck, rash, nausea, vomiting, and lethargy (excessive drowsiness). Yes, college students are often lethargic and yes, these symptoms are similar to those of the flu, but because the disease can progress rapidly (within 12 hours) any student with 2 or more of these symptoms should seek medical attention immediately.

Should my college student be vaccinated? Who should be vaccinated?

The CDC stopped short of suggesting that all students be vaccinated. They recommended that those who provide care to college freshmen, particularly those who live in or plan to live in dormitories or residence halls, provide information about meningococcal disease and the benefits of vaccination to the students and their parents. Consider yourselves informed.

They also recommended 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 can choose to be vaccinated.

I will be writing to HMSA to see if they will cover the vaccine. I believe that it costs between $60 and $70 for the shot.

The CDC has recommended the vaccine be considered in the following groups:

• Entering college students, particularly those living in dormitories or residence halls.
• 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 (Absent spleen from surgery or sickle cell disease, antibody or terminal complement deficiency, HIV, prednisone use, etc.)
• Students and others traveling to areas of the world with endemic meningococcal disease.

Meningitis has occurred in epidemics in sub-Sahara Africa (Senegal in the west to Ethiopia in the east), Saudi Arabia, Kenya, Tanzania, Burundi, and Mongolia.

How good is this vaccine anyway?

The current vaccine immunizes against serogroups A, C, Y, and W-135. In 1998-199, serogroups C and Y caused about 70% of cases among college students. The vaccine is essentially 100% effective in healthy young adults against serogroups A and C. It takes 7-10 days after the vaccination for it to start to work. The vaccine seems to be effective for 3-5 years.

What are the side effects of the vaccine?

Besides cost? The main side effect is pain and redness at the injection site. Estimates on this side effect range from infrequent to 40% of recipients. Transient fever may develop in around 2% of young children.

What if I hear of an outbreak at my kid's school?

If there is an outbreak make sure your child gets chemoprophylaxis (antibiotics to prevent disease). There are currently three approved regimens-

• Rifampin 600 mg every 12 hours for 2 days.
• Ciprofloxacin 500 mg as a single dose.
• Ceftriaxone 250 mg injection.

Where can I get more information?

Check with your doctor. You can also check out the CDC website at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_college.htm   and http://www.acha.org/special-prj/men/faq.htm.

Editor: Dr Randall M. Suzuka is a graduate of the John Burns School of Medicine. He can be contacted at 637-5087 or by email.