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June 2005

Recently the Centers for Disease Control and the American College Health Association released updated recommendations for the prevention of Meningococcal Disease. This is an issue all college students and their families should be informed on.

Overview of Meningococcal Disease

Meningococcal disease, caused by bacteria called Neisseria meningitidis, is the leading cause of bacterial meningitis in older children and young adults in the United States. It strikes 1,400 to 3,000 Americans each year and is responsible for approximately 150 to 300 deaths.

Adolescents and young adults account for nearly 30 percent of all cases of meningitis in the United States. In addition, approximately 100 to 125 cases of meningococcal disease occur on college campuses each year, and five to 15 students will die as a result. Evidence shows approximately 70 to 80 percent of cases in the college age group are caused by serogroup C, Y, or W-135, which are potentially vaccine-preventable.

Vaccination Recommendations for College Students

On May 26, 2005, the Centers for Disease Control and Prevention (CDC) released new recommendations that all incoming college freshmen living in dormitories be vaccinated against meningococcal disease. The CDC also recommended vaccination for all adolescents at high school entry and during pre-adolescent health care visits (11 to 12 years old). Other adolescents and college students under 25 years of age may choose to receive meningococcal vaccination to reduce their risk for the disease.

Also, as of June 2000, the state of Maryland passed a law that requires an individual enrolled in an institution of higher education in Maryland who reside in on-campus housing receive vaccination against meningococcal disease or sign a waiver indicating the choice to decline being vaccinated.

Meningococcal Disease Caused by Five Strains/Serogroups

Five predominant strains or serogroups of N. meningitidis account for most cases of meningococcal disease. These are A, B, C, Y, and W-135. The currently available vaccine protects against four of the five strains (A, C, Y, and W-135), and evidence shows approximately 70 to 80 percent of cases in the college age group are caused by serogroup C, Y or W-135, which are potentially vaccine-preventable. No vaccine is available for widespread vaccination against serogroup B

Transmission and Symptoms of the Disease

Meningococcal disease is contagious and progresses very rapidly. The bacteria are spread person-to-person through the air by respiratory droplets (e.g., coughing, sneezing). The bacteria also can be transmitted through direct contact with an infected person, such as oral contact with shared items like cigarettes or drinking glasses, and through kissing.

Many people in a population can be a carrier of meningococcal bacteria (up to 11 percent) in the nose and back of the throat, and usually nothing happens to a person other than acquiring natural antibodies.

Symptoms of meningococcal disease often resemble those of the flu or other minor febrile illness, making it sometimes difficult to diagnose, and may include high fever, severe headache, stiff neck, rash, nausea, vomiting, fatigue, and confusion. Students who notice these symptoms – in themselves, friends, or others – especially if the symptoms are unusually sudden or severe, should contact their college health center or local hospital.

If not treated early, meningitis can lead to death or permanent disabilities. One in five of those who survive will suffer from long-term side effects, such as brain damage, hearing loss, seizures, or limb amputation.

Persons at Risk for the Disease, Including College Students

Meningococcal disease can affect people at any age. Infants are at the highest risk for getting the disease. Disease rates fall through later childhood but begin to rise again in early adolescence, peaking between the ages of 15 and 20 years.

Due to lifestyle factors, such as crowded living situations, bar patronage, active or passive smoking, irregular sleep patterns, and sharing of personal items, college students living in residence halls are more likely to acquire meningococcal disease than the general college population.

Prior to 1971, military recruits experienced high rates of meningococcal disease, particularly serotype C disease. The United States military now routinely vaccinates new recruits. Since the initiation of routine vaccination of recruits, there has been an 87 percent reduction in sporadic cases and a virtual elimination of outbreaks of invasive meningococcal disease in the military.

In addition to increased risk because of crowded living situations, proximity to a person diagnosed with disease (e.g., being a household contact) also increases one’s risk of disease. Other factors also increase risk, such as a compromised immune system (which might be caused by HIV/AIDS or taking certain chemotherapy or immuno-suppressants) or having no spleen. Even something as simple as a respiratory tract infection may increase the risk of getting the disease. Certain genetic risk factors also may increase susceptibility to infection.

Vaccination to Prevent Meningococcal Disease

Meningococcal vaccination is recommended for all first-year students living in residence halls to protect against four of the five most common strains (or types) of N. meningitidis (A, C, Y, and W-135). In persons 15 to 24 years of age, 70 to 80 percent of cases are caused by potentially vaccine-preventable strains. All other college students younger than 25 who wish to reduce their risk of infection may choose to be vaccinated.

Because disease rates begin to climb earlier in adolescence and peak between the ages of 15 and 20 years, the vaccine also is recommended for adolescents at high school entry and young adolescents at the pre-adolescent health care visit (11 and 12 year-olds).

For more information click on MENINGOCOCCAL VACCINES

Brady Health Center does have the meningitis vaccine available (including the newly licensed Menactra). The new vaccine is believed to have several advantages over the existing polysaccharide vaccine (Menomune) including reduction in the bacterial carriage in the nose and throat and longer duration of immunity. Call the health center at 301-687-4310 for further information.

Adapted from: Centers for Disease Control and Prevention, Press Release, May 26,2005
American College Health Association ( 6/05


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