July 1999
PHILADELPHIA - Rates of meningococcal disease appear to be elevated in specific subgroups of college students, such as freshmen and other students who reside in dormitories, according to new data from nationwide surveillance.
"Overall, we can say that rates of meningococcal disease do not appear to be elevated in college students; however, they do appear to be elevated in specific subgroups such as freshmen and students living in dormitories," said Michael Bruce, MD, MPH, Meningitis and Special Pathogens Branch, Centers for Disease Control and Prevention (CDC).
The overall incidence of meningococcal disease in 18- to 22-year-olds is 1 to 1.5 per 100,000 population. In college students as a whole, the rates are lower at 0.6 per 100,000.
In specific subgroups such as freshman and freshmen in dormitories, the rates are higher, said Bruce. The rate in freshman is 1.4 per 100,000 population, and the rate in freshman living in dormitories is higher at 3.8 per 100,000 population, according to recent data presented here at the American College Health Association (ACHA) Annual Meeting.
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These at-risk populations need to be identified so they can be vaccinated, said MarJeanne Collins, MD, Co-chair of the ACHA Vaccine-Preventable Disease Task Force. The meningococcal vaccine available to the public is 85% effective against serogroups A, C, Y and W-135, which account for approximately 70% of cases in college-age students.
According to Bruce, 83 cases of meningococcal disease were studied between September 1998 and May 1999. In terms of serogroup distribution, information was available for 75 cases.
Slightly less than half were serogroup C, 21% serogroup Y, 27% serogroup B, 5% were not able to be grouped and there was one case of serogroup W-135, said Bruce. "We looked at college students in terms of serotype and know that in that group we could prevent 70% of disease," said Collins. In 15- to 24-year-olds overall, 64% can be prevented, she said.
"Since the vaccine currently available could potentially prevent 70% of the college cases that are occurring today, an excellent case can be made for giving the vaccine to subgroups that can be identified as having an increased risk," Collins said.
Bruce added that although the disease rate is highest in young children, parents and students should be informed of the disease and informed that the current vaccine is safe.
To collect data, the CDC worked with the Council of State and Territorial Epidemiologists in all 50 states to study the possible increase of meningococcal disease. State health department surveillance officers screened cases of meningococcal disease occurring in 17- to 30-year-olds to determine the status of college student.
The CDC gave surveillance officers a brief supplemental case report to complete for each college student presenting with disease. The CDC asked class level, housing situations and diagnoses, said Bruce.
The surveillance was very helpful. It indicated that freshmen are at an increased risk, said Nancy Rosenstein, MD, CDC Meningitis and Special Pathogens Branch. There are, however, still questions to be answered, like why freshmen have this increased risk.
Results from this surveillance study do not allow identification of specific risk factors of freshmen who live in dormitories, said Rosenstein. "We have an important second study to help us identify those factors."
The CDC, with the ACHA, is now conducting a second study, which is a national case-controlled study to examine these increases. The results should be available in the fall.
"In collaboration with the ACHA through this case-controlled study, we should be able to better identify why and what the risk factors are," said Bruce.
The study is looking at behavioral risk factors, said Collins. In addition to on- and off-campus living, the national study is looking at smoking, tobacco use, bar patronage, work setting and other types of activities that students might participate in clusters, like sports.
Meningococcal disease is relatively rare in the United States, with approximately 3,000 cases occurring each year. Despite its rarity, it is one of the few infections in which someone can be well and then die within 24 to 48 hours of becoming infected, said Rosenstein.
"Certainly, that makes it more important that we make every effort that we can to prevent the disease," she said.
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