Meningococcal disease is a rare but potentially fatal bacterial infection. The disease is expressed as either meningococcal meningitis, an inflammation of the membranes surrounding the brain and spinal cord or meningococcemia, the presence of bacteria in the blood.

Meningococcal disease is caused by the bacterium Neisseria meningitidis, a leading cause of meningitis and septicemia (or blood poisoning) in the United States. Meningitis is one of the most common manifestations of the disease, although it has been known to cause septic arthritis, pneumonia, brain inflammation and other syndromes.

Meningococcal disease strikes about 2,200 Americans each year and is responsible for approximately 300 deaths annually. It is estimated that 100 to 125 cases of meningococcal disease occur annually on college campuses and five to 15 students die as a result.

Meningococcal disease is transmitted through the air via droplets of respiratory secretions and direct contact with an infected person. Direct contact, for these purposes, is defined as oral contact with shared items such as cigarettes or drinking glasses, or through intimate contact such as kissing.

The early symptoms usually associated with meningococcal disease include fever, severe headache, stiff neck, rash, nausea, vomiting, and lethargy, and may resemble the flu. Because the disease progresses rapidly, often in as little as 12 hours, students are urged to seek medical care immediately if they experience two or more of these symptoms concurrently.

Evidence found students residing on campus in dormitories appear to be at higher risk for meningococcal disease than college students overall. Further research released by the CDC shows freshmen living in dormitories have a six times higher risk of meningococcal disease than college students overall.

Close contacts of cases of meningococcal disease should receive appropriate antibiotic chemoprophylaxis, whether or not they have been vaccinated. CDC provides guidelines on defining close contacts and appropriate antibiotics and dosing schedules.

Although anyone can come in contact with the bacteria that causes meningococcal disease, data also indicates certain social behaviors, such as exposure to passive and active smoking, bar patronage, and excessive alcohol consumption, may put students at increased risk for the disease. Patients with respiratory infections, compromised immunity, and travelers to endemic areas of the world are also at increased risk. Cases and outbreaks usually occur in the late winter and early spring when school is in session.

From 1980 to 1993, there were 21 outbreaks, three of which occurred in colleges. From 1994 to 1996, there were 26 outbreaks, four of which occurred in colleges. Between 1986 and 1993, an outbreak was defined as five cases of the same serotype in 100,000 people with at least three

occurring within three months. From 1994 to present, 10 cases of the same serotype in 100,000 people with at least three occurring within three months constitute an outbreak.

Evidence shows the epidemiology of meningococcal disease is changing, with a majority of cases (65 percent) in the college age group caused by either serotype C, Y, or W-135, which are all vaccine-preventable.

ACHA’s Vaccine-Preventable Diseases Task Force adopted the CDC recommendation, which recommends that undergraduate college students, particularly freshmen who live in or plan to live in dormitories or residence halls, consider getting the vaccine to reduce their risk for meningococcal disease.

As of October 20, 1999, the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC) recommends that individuals who provide medical care to college freshmen, particularly those who live in or plan to live in dormitories or residence halls, should provide information about meningococcal disease and the benefits of vaccination to these students and their parents. ACIP further recommends 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 for meningococcal disease can also choose to be vaccinated.

Additionally, the ACIP recommends that colleges and universities provide information about meningococcal disease and the vaccine to freshman, particularly those who plan to live in dormitories and residence halls, and encourages public health agencies to serve as a resource for information about meningococcal disease and vaccination, including how to obtain the vaccine.

Data from the U.S. Centers for Disease Control and Prevention (CDC) demonstrate increasing incidence of outbreaks on college campuses. Data further suggests that sub-populations of college students are at increased risk for meningococcal disease. Pre-exposure vaccination enhances immunity to four strains of meningococcus that cause 65 to 70 percent of invasive disease and therefore reduces a student’s risk for disease. Development of immunity post-vaccination requires 7-10 days.

• Entering college students, particularly those living in dormitories or residence halls, who elect to decrease their risk for meningococcal disease.
• 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 (e.g., HIV, absent spleen, antibody deficiency).
• Students traveling to areas of the world with endemic meningococcal disease.

Since the release of ACHA’s recommendation in 1997, more and more colleges and universities have included the ACHA recommendation on their college entrance health forms and/or are conducting awareness campaigns to educate parents and college students about this disease.

In addition, more than 25 states have passed or are actively pursuing legislation that requires entering college students either be informed of or vaccinated against meningococcal disease. For a current list of state legislation, please visit nmaus.org.

The meningococcal vaccine has been shown to provide protection against the most common strains of the disease, including serogroups A, C, Y and W-135. The vaccine has shown to be 85 to 100 percent effective in serogroups A and C in older children and adults.

The vaccine is very safe and adverse reactions are mild and infrequent, consisting primarily of redness and pain at the site of injection lasting up to two days.

The duration of the meningococcal vaccine’s efficacy is approximately three to five years.

If a suspected or diagnosed case of meningococcal disease is reported (on campus or in neighboring communities), the following intervention measures should be considered:

• Intensify surveillance and increase awareness among college health services, community physicians, and hospitals.
• Notify college administration and health care personnel as well as public health departments.
• Begin education on the college campus and in surrounding areas about transmission. Pursue early diagnosis and treatment of cases and contacts. Contacts of cases of meningococcal disease should receive appropriate antibiotic chemoprophylaxis whether or not they are vaccinated for meningococcal disease. CDC provides guidelines on defining close contacts and appropriate antibiotics and dosage schedules. Consider mass immunization of students to prevent additional cases if an outbreak occurs, that is, 10 cases per 100,000 and three or more cases of the same serogroup within three months.

Because meningococcal disease is one of the most feared diagnoses in the United States, sporadic cases and outbreaks almost invariably spread panic through college communities. In order to proactively guard against an outbreak (or endemic disease), ACIP recommends that undergraduate college students, particularly freshmen who live in or plan to live in dormitories or residence halls, should consider getting the vaccine.

For those persons needing assistance in locating a provider for the vaccine, please consult with your medical practitioner, local or state health department, or call: 1- 800-VACCINE.

In the event of an actual meningitis outbreak, ACHA has developed a response kit to guide college health officials in appropriately and expeditiously responding to sporadic cases and outbreaks. For more information about the kit, email ACHA.

American College Health Association

P.O Box 28937

Baltimore, MD 21240-8937

(410) 859-1500

fax: (410) 859-1510