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Volume CXXXII, Number 12 |
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Meningitis update
JEFF BENSON, M.D.
Dear Dr. Jeff: "I read a piece in The Boston Globe last November about the meningitis vaccine. It sounded like some states and colleges are requiring it. What about Bowdoin?" A.C.
Dear A.C.: Like most issues in medicine, this one is less than black and white. First, let's go over the facts as I understand them.
Meningococcal meningitis is an infection of the central nervous system (brain and spinal cord) caused by the bacterium Neisseria meningitides. It often begins as a vague, flu-like illness, but can progress extremely rapidly, with the development of headache, fever, stiff neck, and vomiting. A characteristic rash appears late, but usually just prior to collapse and coma. If treated promptly, meningococcal meningitis is highly curable. Untreated, it is likely to be fatal.
The natural reservoir of meningococcus is the back of our throats. In fact, Neisseria can be cultured from up to 15 percent of randomly selected healthy individuals. These "asymptomatic carriers" do not themselves develop meningitis. They may spread the bacteria by sneezing or coughing, however, and others may be more susceptible.
Carriage rates rise to 40 percent among close contacts of people with active meningitis, and the carrier state cannot be prevented by vaccination. Carriers can be treated with antibiotics, however, and at least temporarily cleared of Neisseria. That's the rationale for treating all close contacts of people with active meningitis.
Meningococcal meningitis is, fortunately, sporadic and rare. There are about 3,000 cases per year in this country. Between 100 and 125 of them occur on college campuses. The federal Centers for Disease Control describe the risk of disease among college students as "low," and the risk among college freshmen in residence as comparatively "modestly increased." The latter is estimated to be about 1 in 300,000. For purposes of comparison, that's about three times as likely as your lifetime risk of being struck by lightning.
There has not yet been a case of meningococcal meningitis in Maine. Dartmouth had a fatal case in 1999. Northeastern had a case two years ago (treated quickly and cured), and UMass Amherst had a case last November (also treated successfully and fully recovered).
For several years now, there has been a meningococcal vaccine available. It is about 90 percent protective against four of the five strains of Neisseria, which collectively cause about 70 percent of meningitis cases. So, if everyone in the country received the vaccine, about 63 percent, or almost 2 out of every 3, meningococcal meningitis cases could be prevented.
The vaccine has no significant side effects or risks. It is currently manufactured under patent by one company. It's expensive and is aggressively marketed to college health centers.
Many health care providers are enthusiastic supporters of the vaccine. For instance, Dartmouth's Director of Health Services has said, "[Meningitis] is a terrible disease that can kill people, and anything we can do to reduce it is a good thing." Several states, including Connecticut, have passed laws requiring the vaccine for incoming college students.
Vaccination of all first-year college students nationwide would be likely to prevent 37-69 cases of disease and 2-4 deaths each year, according to the CDC. The cost per case prevented would be about $3 million and the cost per death prevented about $48 million. That's many, many orders of magnitude more expensive than any other public health intervention.
On the other hand, the Health Center's cost for the vaccine is $63, so that's what it would cost you to be vaccinated here.
Statistics don't easily apply to individuals. However small your risk, if you do get sick, the rate is 100 percent.
One final caveat. We have antibiotics that can be easily and cheaply taken if you are exposed to meningocococcus. In the event of an actual case of Neisseria meningitis on campus, all close contacts would need to take antibiotics whether or not they had been vaccinated. The serotype of the infecting strain might take days to determine. Antibiotics are immediately effective against all five strains.
Quite possibly, knowing that you've reduced your risk by two-thirds may provide you and yours considerable peace of mind.
The final decision, of course, is up to you.
Be well!
Jeff Benson, M.D.
Dudley Coe Health Center
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