From Our 2013 Archives
Meningitis Outbreaks: FAQ
By Kathleen Doheny
Reviewed by Michael W. Smith, MD
Dec. 5, 2013 -- An outbreak of a less common form of meningitis on two U.S. college campuses has prompted public health officials to take action to prevent the disease from spreading.
As of Dec. 4, the CDC confirmed eight cases of meningitis at Princeton University and four more cases, with one other possible, at the University of California, Santa Barbara.
While most students have recovered or are recovering, one student had both feet amputated and is still hospitalized. Students in close contact with them are being given preventive antibiotics. The disease can lead not only to amputations but also paralysis, hearing loss, brain damage, and death.
Because the vaccine used in the U.S. does not protect against this specific strain, the CDC took the extraordinary step of asking the FDA to import a different vaccine approved in Europe and Australia to help prevent more infections.
Here is what else parents and students need to know to stay healthy and minimize risk.
Q: What is meningitis, also known as meningococcal meningitis?
''Meningococcal meningitis is several diseases caused by different strains" of bacteria, says William Schaffner, MD, an infectious disease specialist at Vanderbilt University. Bacteria infect the protective covering of the brain and spinal cord, called the meninges. The bacteria can also infect the bloodstream.
A strain labeled B caused both campus outbreaks, Schaffner says. He reports consultant work for Sanofi Pasteur and Merck.
Q:Are the outbreaks related?
No, says Amanda Cohn, MD, an epidemiologist at the Meningitis and Vaccine Preventable Diseases Branch of the CDC.
While both are strain B, they are different types of B, she says.
Q: How is the disease spread?
The disease is spread when people exchange saliva during close contact, such as kissing and living in close quarters. That's why the risk is high for university students.
Q: What does the current U.S. meningitis vaccine protect against?
It protects against several different strains, including A, C, Y, and W-135, says Schaffner. This vaccine, known as meningococcal vaccine or MCV4, is given at age 11 or 12 with a booster dose at age 16.
Q: How is this B strain different, and why does the U.S. have no vaccine for it?
The bacteria in the B strain include a protein that resembles some proteins that we have in our bodies, Schaffner says. That's why it's been difficult to create a vaccine that fights it.
The vaccine Bexsero, approved in Europe and Australia, can attack B strains. Under a special arrangement, the FDA agreed to import supplies of Bexsero to offer to Princeton students.
Immunizations are set to start at Princeton Monday, Dec. 9, according to the university web site.
Q: How common are B strains?
They account for about a third of the 500 cases of meningitis typically seen in the U.S. in the last few years, Cohn says.
Meningitis involving the other strains has decreased, she says, as more and more students have become protected with the vaccine.
Q: What can the healthy students do to stay that way?
''Students should be vigilant," Cohn says, by paying attention to possible symptoms.
A fever along with a bad headache or a rash, typically on the arms and legs, are reasons to seek medical help right away, she says. Stiff neck, confusion, and nausea and vomiting are other possible symptoms, according to the CDC.
Practice good hygiene, Cohn says. Cough into your arm instead of your hands. "There is data that suggests that healthy habits do protect kids from getting meningococcal disease," Cohn says.
Q: Will the CDC ask the FDA to approve Bexsero for universal use?
"That is really the role of the FDA and pharmaceutical companies," Cohn says.
SOURCES: William Schaffner, MD, professor of medicine and infectious disease specialist, Vanderbilt University School of Medicine, Nashville.Amanda Cohn, MD, medical epidemiologist, CDC's Meningitis and Vaccine Preventable Diseases Branch, Atlanta.CDC: "Meningococcal Disease."
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