University officials on two coasts are struggling to get control of dangerous meningitis outbreaks, by canceling social activities, giving preventive antibiotics to hundreds of students and arranging to provide a vaccine not licensed in the USA.
Four students at the University of California-Santa Barbara and eight students or visitors at Princeton University have developed bacterial meningitis this year. One of the Santa Barbara students had both feet amputated because of the infection, caused by the meningococcal bacteria.
The first meningitis case in Princeton occurred in March; the eighth was diagnosed Nov. 20. All four of the Santa Barbara cases became ill within weeks of each other in November, campus officials said. All of the students have been diagnosed with the same subtype of bacteria, called serogroup B. It's unlikely that the two outbreaks are related, however, because the bacteria have different genetic footprints, said Tom Clark, an epidemiologist with the Centers for Disease Control and Prevention leading the investigation. Large outbreaks are rare. About 98% of meningococcal meningitis cases are "sporadic," rather than part of a large outbreak.
Meningitis is an inflammation of the protective membranes around the brain and spinal cord, according to the CDC. Meningococcal bacteria also can cause bloodstream infections that lead to gangrene. Early symptoms of meningitis include fever, headache, body aches and feeling very tired or sleepy. Other symptoms can include a stiff neck, nausea, vomiting, confusion and sensitivity to light, according to the New Jersey Department of Health.
About 80% of young adults have been vaccinated against meningitis.
But these students have no protection against serogroup B, a strain of the bacteria not included in the vaccine, Clark said. The CDC worked with the Food and Drug Administration to get permission for Princeton officials to use an imported vaccine, licensed in Europe and Australia but not in the USA, that does protect against serogroup B. American drugmakers are currently working to develop their own vaccine against serogroup B, which is a more challenging strain to immunize against.
Meningococcal disease is rare - with just 500 cases last year, according to the CDC.
But it can be "catastrophic," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. About 10% to 15% of patients die, and another 10% to 15% are left with a permanent disability, such as deafness, brain damage or the loss of a limb, Clark said.
Santa Barbara campus officials have canceled fraternity parties and are warning students of the risks of attending other social functions. Although meningococcal bacteria don't spread as easily as the flu, the disease does spread in settings with "close personal contact," especially when people are smoking, drinking, sharing cups or kissing. Santa Barbara public health officials are also providing antibiotics to more than 500 "close contacts" of the sickened students to prevent them from becoming ill.
Vaccination can prevent people from becoming ill or spreading the infection to others, says William Schaffner, a professor at the Vanderbilt University School of Medicine. Although relatively few people infected with meningococcal bacteria become sick, many become "carriers" who can spread the disease to others.
"Without hesitation, I'd urge my child to go to the front of the line for the vaccine," Schaffner said.
Meningococcal bacteria can live in the throat for weeks or months, Schaffner said. So it's possible that the campus outbreaks could continue even after students return from winter breaks, which often last from mid-December to mid-January.
Students are unlikely to spread the bacteria to their families when they return home, however, because private homes are so much less crowded than dormitories, said Jim Turner, a University of Virginia professor who oversees the College Health Surveillance Network.
To reduce the risk of disease, students should receive the currently licensed meningitis vaccine, which protects against four of the five major strains of the infection, Turner said. Students also should get a flu shot, since influenza infections make people more vulnerable to meningococcal bacteria.
And they should practice basic hygiene, such as frequently washing their hands, coughing into their elbows and not sharing food or drinks with others. Because the meningococcal bacteria doesn't live long on surfaces, there's no need to do any special cleaning.