January 2000
ATLANTA - The Advisory Committee on Immunization Practices (ACIP) modified its guidelines for using the polysaccharide meningococcal vaccine to prevent bacterial meningitis, particularly for college freshmen who live in dormitories.
Citing results of two 1998 studies by the Centers for Disease Control and Prevention (CDC), which identified a slightly higher risk among freshman dormitory residents, the ACIP recommended that those who provide medical care to this group give information to students and their parents about meningococcal disease and the benefits of vaccination. Vaccination should be provided or made easily available to those freshmen who wish to reduce their risk of disease. Other undergraduate students who want to reduce their risk may also choose to be vaccinated.
The currently available vaccine protects against some serotypes of Neisseria meningitidis an important cause of bacterial meningitis and sepsis in children and young adults in the United States. A single dose of the vaccine is recommended, and vaccination will decrease the risk of disease caused by N. meningitidis serogroups A,C,Y and W135. However, vaccination will not eliminate all disease risk because the vaccine does not protect against serogroup B and does not confer 100% protection against serogroups C and Y, although it is highly effective against these groups. From 1998 to 1999, serogroups C and Y caused about 70% of cases among college students.
About 3,000 cases of meningococcal disease occur each year in the United States, and 10%-13% of patients die despite receiving antibiotics early in the illness. The disease progresses rapidly, often in as little as 12 hours. Of those who survive, about 10% have severe after effects of the disease, including mental retardation, hearing loss and loss of limbs, fingers and toes. Outbreaks usually occur in late winter or early spring, when college classes are in session.
High fever, headache and stiff neck are common symptoms of meningitis. These symptoms may develop over several hours, or they may take one to two days, according to the CDC. Other symptoms may include nausea, vomiting, discomfort when looking into bright lights, confusion and sleepiness. In infants, symptoms of fever, headache and neck stiffness may be absent or difficult to detect. Infants may appear slow or inactive, or be irritable, have vomiting or feed poorly. As the disease progresses, patients of any age may have seizures.
The American College Health Association (ACHA), which represents about 50% of U.S. colleges with student health services, released a statement recommending "college health services [take] a more proactive role in alerting students and their parents to the dangers of meningococcal disease," and that they should consider vaccination.
"The ACHA believes the new ACIP recommendations are a significant step toward decreasing individual risk for meningococcal disease by letting students know about the availability of a safe and effective vaccine," said James Turner, MD, chair of ACHA's Vaccine-Preventable Diseases Task Force and director of student health services at the University of Virginia, Charlottesville, Va.
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