Incoming college freshmen are more likely to get meningitis than are other college students, conclude several studies. And according to one doctor, the time to get vaccinated is at least one month before students move into dormitories.
\It takes two to four weeks for the vaccine to have full effects,"" said Dr. Tom Saari, a physician and UW-Madison pediatrics professor.
College students are slightly less likely to get meningococcal disease'the most common cause of meningitis'than are others in their age group. However, several recent studies published in the Journals of the American Medical Association say incoming freshmen living in dormitories are five times more likely to get the disease than are other college students. One of the studies also noted a slightly higher chance of getting meningitis in the North, Northeastern and Southwestern states.
The American College Health Association advises colleges to inform incoming college freshmen of the available vaccine for meningococcal disease and provide easy access to it. Dr. Saari explains that since meningococcal disease is rare, physicians have previously advised patients against the vaccine, but he agrees with ACHA that concerned students should talk with their physicians about the vaccine.
""Just because you've got the vaccine doesn't mean you won't get sick,"" Dr. Saari said.
He said the vaccine against the most common cause of bacterial meningitis might actually hinder students by giving them a false sense of security. Dr. Saari said that if vaccinated students get meningitis-like symptoms, they may not take them as seriously as they should.
Dr. Saari says that like most physicians, he does not push the vaccine and does not think all incoming freshmen should be vaccinated, as military recruits are. But, if a parent or patient wants the vaccine, he gives it to them, or, since many hospitals are in short supply of the vaccine, he directs them to University Health Services.
Craig Roberts, an epidemiologist at University Health Services, says the vaccine offers about 60 percent protection from meningococcal disease for three or four years and costs $68.
According to Roberts, meningitis is one of the more serious diseases students get, but is as rare as cancer or newly diagnosed HIV in UW-Madison students.
""The concern is often out of proportion to the actual risk of getting it,"" Roberts said.
Wisconsin students saw six cases of meningitis in late April and May, and they are worried about getting the disease.
""It is sort of unusual that these cases have happened in the span of a [couple] weeks,"" Roberts said.
But, he added, only about one in 100,000 people get meningitis each year, and since most sufferers are younger than 20, this translates to one or two cases of UW-Madison students per year. In some years, three or four students will get meningitis and some years none will, he added, in contrast to the several hundred students that are seen at UHS for mononucleosis or influenza.
The Centers for Disease Control explains that meningitis is not a disease but a symptom'like a sore throat or running nose'of a viral or bacterial invasion of the fluid surrounding the brain or spinal cord.
According to the CDC, viral meningitis is the least severe and most common, with the body's immune system the only necessary treatment. ""Most cases of meningitis run a short, uneventful course,"" reports the UHS Web site , http://www.uhs.wisc.edu/ex/selfcare/resource/meningitis.php, for the disease that causes abdominal discomfort, chest pain or rash.
While many bacteria can cause meningitis, the CDC asserts that Streptococcus pneumoniae and Neisseria meningitidis are today's leading causes. N. meningitis, also called meningococci, is most prominent in the Western world. Symptoms of bacterial meningitis include high fever, severe headache, neck or back stiffness and rash.
Initially, patients may confuse the symptoms for signs of the flu, Roberts said, but can tell the difference in the speed in which symptoms hit.
""People get very sick very fast,"" he said.
Symptoms may appear in a few hours or one to two days, the CDC claims, and patients who suspect meningitis should seek immediate medical attention. The sooner they get seen and get treated, the more likely they are to survive.
According to Roberts, meningitis is a medical emergency. Since a person's chance of survival depends on early detection and treatment, physicians will prescribe penicillin or another antibiotic before conclusive test results are available. To test for the disease, doctors perform a spinal tap, in which a needle is injected into the lower back to remove spinal fluid, which is viewed under a microscope for signs of bacterial infection. The fluid is also cultured to identify the responsible strain.
""If you actually get the disease, 10 percent die and 10 percent have permanent damage,"" Roberts said.
A 2000 study by the American Association of Pediatrics said this permanent damage can include hearing loss or limb loss or neurological problems.
Roberts said the disease usually progresses to a point of no return when antibiotics can no longer save a patient, but the time frame for reaching that point varies from person to person.
Fewer patients may reach that point with a vaccine already available in Britain and Canada.
Scientists project that a new, more comprehensive and possibly life-long vaccine will be ready within two years. According to Dr. Saari, this vaccine is designed to include infants'currently excluded from receiving vaccines until age two'and has a better chance of protecting patients well into their college years. U.S. residents will have to wait until the Federal Drug Administration approves the vaccine, which may take a few years.
According to the UHS Web site, about 10 percent of people carry N. Meningitidis harmlessly in the nose and throat without getting meningitis. People are most vulnerable to meningococcal disease when their immune systems are least developed, which is why younger adults and children are at the highest risk.
As people age, they are exposed to an increasing amount of bacteria, making antibodies'an immune response'to each strain encountered. In this way, if the same bacteria invade a person, the body's immune response will quickly eliminate the bacteria through antibody identification and its following immune responses.
Though meningococci can cause serious disease, they are one of the least robust bacteria humans encounter.
Meningococci can only survive outside of the body for a couple of minutes without dehydrating and dying. Kissing and sharing soda are common routes of transmission as are other exposures to saliva and nasal fluids. Meningococci can survive in aerosol droplets, the breath one sees on cold winter mornings. This mode of transmission is usually problematic in overcrowded living conditions such as in military barracks. People exposed to a meningitis patient in these ways are considered close contacts and are routinely given antibiotics.
Keith Cartwright, editor of ""Meningococcal Disease,"" explains what scientists know about meningitis and raises unanswered questions.
""For doctors and epidemiologists, it is a paradoxical and mystifying infection. After almost 200 years of observation and research, we know much about the transmission of the organism from person to person,"" Cartwright said. ""Yet we are unable to explain why one particular individual, on acquiring meningococcus, develops invasive disease whereas several hundred others acquiring the same strain do not.\
