By Karen Hsu, The Boston Globe
In January, Boston University senior Julia Kenna went to BU
Health Services because she thought she had a migraine.
A campus doctor told her to pick up some aspirin and go home and
rest. Two hours later, Kenna was incapacitated from bouts of
vomiting and a raging headache. She managed to dial 911 for an
ambulance.
``I felt so stupid calling 911. But I knew something was really
wrong,'' said Kenna, who graduated from BU in May and is now
working as a temp in Brooklyn, N.Y.
After being taken to St. Elizabeth's Medical Center in Boston,
she quickly became disoriented. Doctors suspected bacterial
meningitis because Kenna had the infection's hallmarks: headache,
vomiting, disorientation, high fever and a stiff neck. They
confirmed their suspicions by taking a sample of spinal fluid.
``What's scary about this bacteria is that it can kill people
more rapidly than any other infection that we know,'' said Dr.
Michael Worthington, chief of infectious disease at St.
Elizabeth's, who treated Kenna with intravenous antibiotics.
``People can be well, then in shock and dead six hours later.'' If
Kenna had waited until that evening, Worthington said, she may have
died.
Meningococcal meningitis, an inflammation of the lining of the
spinal cord and brain, is caused by the Neisseria meningitidis
bacterium, which normally lives harmlessly in people's mouths and
throats but can enter the spinal fluid, though doctors are baffled
as to how it happens. The bacteria is generally transmitted through
saliva; by kissing or sharing toothbrushes, lipsticks, drinking
glasses and eating utensils.
While meningococcal disease is still considered very rare, its
incidence among 15- to 24-year-olds has doubled over the last five
years to more than 600 cases annually, prompting some colleges to
recommend a vaccine to their students. Each year, about 125
students on college campuses get the disease, and about five to 15
students die from it.
Last Tuesday, the University of Connecticut confirmed its first
case of meningococcal disease in six years. The student was
hospitalized, and 30 others in her dorm were given antibiotics as a
preventive measure.
Overall, however, college students are not at higher risk than
others for developing meningococcal disease, but freshmen living in
dormitories may have a three- to six-times greater risk of getting
the infection than all college students, according to preliminary
studies by the Centers for Disease Control and Prevention.
Many public health experts believe bacterial meningitis is too
rare for widespread vaccination, except for soldiers in cramped
barracks or for those who travel to high-risk areas such as
sub-Sahara Africa, where the last major outbreak of meningococcal
disease, in 1996, killed more than 25,000 people.
Although the CDC currently does not recommend that all college
students get the vaccination, some schools are offering it, at $60
to $75 per shot.
Parents have been hungry for information about the vaccine since
highly publicized deaths on college campuses within the last year.
Last June, Dartmouth College had two confirmed cases of
meningococcal disease; one woman died and another student
recovered. Dartmouth later offered free vaccines to summer
students. Recently, letters recommending the vaccine, now $60, went
out to parents.
Last year, Brown University Health Services and other Rhode
Island colleges also offered free vaccines paid for by the Rhode
Island Department of Health to students; this was after three Rhode
Island children died from the disease within a few weeks of each
other. This year, Brown will still offer the vaccine, but it will
only be free for Rhode Island residents.
The meningococcal diseases -- which include meningitis and an
even deadlier less-common infection of the blood known as
meningococcemia -- strike about 2,800 Americans each year, most of
them children less than five years old. And unlike viral
meningitis, which is not life threatening and accounts for 90
percent of cases of the disease seen in the US, bacterial
meningitis is fatal about 10 percent of the time.
The vaccine Menomune, manufactured by Pasteur Merieux Connaught,
covers four strains of meningococcal disease, but not strain B,
which makes up a third of US cases. The vaccine has been available
since 1981.
Some health officials say that all students should consider
being immunized, especially freshman. After Georgia college athlete
Evan Bozof died of meningitis last year, his mother persuaded the
University of Georgia Board of Regents to require schools to
suggest the vaccine to new students.
And last December, the family of Alanna Haywood, a Williams
College student, won a $1 million lawsuit after she died of
meningococcal disease; the family accused health care workers of
being negligent. Haywood spent a night at the school infirmary
before being sent to North Adams Regional Hospital, where she died
two hours later.
Many, however, say that because the disease is so rare,
widespread immunization doesn't make sense. Those who oppose
routine shots point out that the vaccine is expensive, does not
protect against the B strain, only works for three to five years,
and may be only 85 percent effective in the strains it does protect
against.
``The vaccine is not a foolproof way to provide protection
against meningitis,'' said Dr. David Rosenthal, director of Harvard
University Health Services and a professor of medicine at Harvard
Medical School.
Indeed, a vaccine would not have helped Kenna, who acquired the
B strain of the bacteria.
Freshman in college may be more susceptible to the disease
because of their new found freedoms, many of which, to the chagrin
of parents, involve close contact with others.
``It's not surprising because it's the time when people do more
social drinking, are experiencing sexual relationships, sharing
cups, cigarettes, lipsticks,'' said Dr. Bela Matyas, director of
the Massachusetts Department of Health's epidemiology program.
But parents should be more concerned about regular rowdy college
behavior than meningitis, said Dr. Thomas Nary, director of health
services at Boston College. ``The risk of meningitis to any student
is very, very low,'' Nary said. ``Unfortunately I don't have a
vaccine for drunken driving and risky behavior.''
Boston College does not recommend the vaccine, but if parents
ask for it, they will make it available. Some parents say that at
least being presented with a vaccine option is critical. In Evan
Bozof's case, it could have saved his life, says his mother Lynn,
because he died from the C strain, which the vaccine can prevent.
Meanwhile, a CDC advisory committee will convene next month to
consider whether recent studies warrant a change in the agency's
vaccine recommendations.
Matyas of the state health department encourages parents and
students to get information about the disease, but says that
whether or not to be vaccinated should be made on a case by case
basis.
