Health

Should Your College Student Get a Meningitis Vaccination?
Due to the catastrophic potential of meningococcal meningitis, many are opting for immunization.

by Kate Wicker

Lynn Bozof's life changed forever on March 25, 1998, when her son Evan, a junior at Georgia Southwestern University, called complaining of a bad headache.

"He told me he wasn't feeling well and was going to skip his baseball game," Bozof recalls. "I knew he must have been sick because he loved baseball and was very dedicated, but I wasn't overly concerned since migraines run in the family."

But Evan's symptoms, a severe headache, nausea and vomiting, were unfortunately a precursor to something much more serious. Evan went to the emergency room that evening and, within 24 hours, he was in critical condition. Bozof and her husband soon learned their son had a rare and potentially fatal form of meningitis that most often attacks toddlers.

"We'd be surprised if he lives 24 hours." Bozof remembers hearing those haunting words before she and her husband left their home in Marietta to be at their son's bedside. At the hospital, the Bozofs were shocked by what they found. Evan was surrounded by a maze of medical tubes and wires. It took every ounce of his energy just to roll over. With terrifying celerity, their once fit, athletic son was reduced to a weak wisp of a body covered in purple splotches from the poison that was seeping into his blood.

"The bacteria released toxins in his blood. Soon his kidneys failed and his hands became black. I'll never forget his black, charred hands," Bozof says.

Evan's condition worsened. The aggressive disease was consuming his body, and just 26 days after he first complained of his headache, the 20-year-old honor student and starting baseball pitcher succumbed to the disease and died at the Columbia-Augusta Burn Center (now the Joseph Still Burn Center). In less than a month, Evan suffered damage to his lungs, kidneys and liver; amputation of his arms and legs due to gangrene; and multiple seizures that left him brain dead.

Evan died from meningococcal meningitis, a form of bacterial meningitis that affects the linings of the brain (known as the meninges) and the spinal cord. The disease is usually transmitted by respiratory secretions through coughing, kissing or sharing utensils or beverages. But because the bacteria can only live for a few minutes outside of the body, bacterial meningitis is not as contagious as illnesses like the common cold or the flu. Nor is it spread by casual contact or by simply breathing the air where a person with meningitis has been.

Although meningococcal meningitis affects only about 3,000 Americans each year, when the disease strikes, it is very aggressive and often deadly. The bacteria that cause meningitis make blood vessels dilate and leak, drastically reducing the flow of blood to vital organs and other extremities. Thus, even survivors of the disease often suffer from permanent disabilities such as limb amputation, brain damage and hearing loss. Its symptoms include fever, severe headaches, nausea and vomiting, a stiff neck (trying to lower the neck causes intense pain or may be impossible), lethargy, a rapidly spreading rash, low blood pressure and body aches.

It is important to keep in mind that not all forms of meningitis are life-threatening. Bacteria and viruses are not the only culprits behind meningitis; it can also be caused by another type of infection caused by a fungus or an irritant such as a chemical. When physicians suspect meningitis, they must quickly determine the root cause of the infection since the treatments differ.

Meningococcal meningitis and other types of bacterial meningitis are generally much more serious than the more common viral meningitis, according to Jack H. Austin Jr., M.D., chief of medicine at University Hospital and a private practice physician specializing in infectious diseases. "Many viral infections take more time to develop and the symptoms are usually less severe," he says. Viral (or aseptic) meningitis outbreaks often occur in pre-school or school-age children and result in flu-like symptoms such as a fever and mild headache. The disease is normally spread person-to-person from sneezing, coughing or from food and water contaminated by the virus. Symptoms typically last seven to 10 days and most sufferers recover completely.

But bacterial meningitis is another story altogether. "Bacterial meningitis, especially meningococcal meningitis, can develop over a few hours and, unless it is recognized quickly and treated rapidly, death is almost guaranteed," Austin says. Because of its aggressiveness, anyone experiencing symptoms of bacterial meningitis (especially meningococcal meningitis) should seek medical attention immediately.

"Meningitis is only definitively diagnosed by a spinal tap (also known as a lumbar puncture), although it can usually be strongly suspected just by the symptoms and a physical examination," Austin says. Besides performing a spinal tap, a doctor may take blood, urine, nasal and throat mucus samples to confirm a diagnosis.

"Viral meningitis is treated with supportive care consisting of analgesics for pain control, bed rest, hydration (intravenously or orally) and the "tincture of time,'" Austin says. "Bacterial meningitis is treated immediately with intravenous antibiotics." Early treatment of bacterial meningitis with appropriate antibiotics can increase the chance of full recovery. Antibiotics may also be given to any other close contacts of the infected individual to prevent them from getting meningitis.

Most bacterial meningitis cases involve very young children in the U.S., but for reasons still unclear, its occurrence among adolescents and college students is on the rise. In fact, several Georgia colleges have recently reported cases of meningococcal meningitis and an Augusta State University student died of the illness last February.

College students face a higher risk of contracting the more deadly bacterial strain for various reasons. "The bacteria love to attack persons living in close quarters," Austin explains. "Since college students are frequently living in crowded dormitories, they are particularly susceptible to the Neisseria organism, the bacteria that cause meningococcal meningitis."

Other risk factors inextricably linked to college life include smoking, drinking alcohol and irregular sleep patterns. These factors have all been shown to depress the immune system, making people more susceptible to infection.

How Evan contracted the disease is unknown, and thankfully no other cases were reported at his college after he became sick. Although Bozof says watching her son suffer unspeakable complications from meningococcal meningitis was heartbreaking, what was even more devastating was learning Evan's death probably could have been prevented. "After he died, we discovered there's a vaccine available to protect against meningococcal meningitis. Immediately, I began asking myself why didn't we know about it? And what can we do to prevent this from happening to other families?"

According to Austin, the vaccine for meningococcal meningitis has only recently become more widespread. Yet bacterial meningitis caused by the H. influenza organism has almost been eradicated, thanks to a routine vaccination in pediatricians' offices.

Research shows that up to 80 percent of meningococcal meningitis cases in adolescent and young adults could be prevented with vaccines. Moreover, the American Academy of Pediatrics recommends that college freshman, particularly those living in dormitory housing, and their parents consider having the student vaccinated.

So why don't more people know about the vaccination?

For starters, not all public health officials are always quick to recommend immunization because bacterial meningitis is rare. In addition, the vaccine is not without flaws. It only lasts three to five years and it is not 100 percent effective.

But Bozof feels if parents understood the severity of the disease, they would have their children vaccinated anyway and take their chances at averting tragedy. "You hear a lot about the basic symptoms, but there's still not enough information available about what the disease can do to a person's body and that there is a safe and effective vaccination available to prevent it," she says. "I think most parents who knew what this disease could do to a person would choose to have their child vaccinated."

To this end, Bozof, along with her husband and other parents who have been touched by bacterial meningitis, founded the National Meningitis Association. The organization is committed to raising awareness about the heightened risk of bacterial meningitis among college students and adolescents and to encourage parents, students and legislators to help fight the disease by promoting vaccination programs.

Bozof and her husband's personal lobbying efforts paid off when Georgia introduced a bill last spring encouraging meningococcal meningitis vaccination among college students at both private and public institutions. The law, which goes into effect January 1, 2004, requires that Georgia students 18 years of age or older and living in campus housing be vaccinated against meningococcal meningitis or sign a waiver acknowledging they have been warned of the risks and have refused vaccination.

"This bill is definitely a victory in protecting young adults against meningococcal meningitis," Bozof says.

The shot has few side effects and costs between $60 and $70. Austin recommends that all students, ages 18-23, especially those who go off to college and live in dormitories, be vaccinated. Vaccines are available at the Richmond County Health Department as well as some local pediatricians' offices.

Apart from vaccinations, there is no known way to protect against meningitis. Fortunately, the risk of bacterial meningitis is relatively low. "Just because someone is exposed to a person with meningitis and even if they acquire the germ, it doesn't mean they will get meningitis," Austin points out.

Despite its low occurrence, Bozof insists the threat of meningococcal meningitis doesn't warrant a lackadaisical response. "Had we known about this vaccine, Evan would definitely have been immunized. He would be alive today," she says. "But if others are informed about the disease and the vaccine that can protect against it, then at least Evan's death won't be in vain."