Broad use of meningitis vaccine questioned

Beverly Beckwith had just started working as the director of nursing at the University of Connecticut when an epidemic struck the student body.

“It was initiation by fire,” Beckwith said.

On April 30, 1993, a UConn student came down with bacterial meningitis. Within a week, two more students were diagnosed with the same strain of the disease. Since the strains of bacteria were the same in all three cases, it was labeled as an epidemic.

The State Health Department mandated that the university immunize all its students. In one weekend, 13,000 UConn students were given the meningococcal vaccine.

A new Connecticut law seeks to prevent similar outbreaks by mandating vaccination against meningitis for all college students in the state.

But even as Yalies face the needle, a number of experts question the wisdom of vaccination on such a wide scale.

Outbreak

After the discovery of the UConn epidemic, volunteers sprang into action to deal with the overwhelming panic and immediacy of the situation.

“It was dramatic and extremely wonderful the way people came in to help,” Beckwith said.

No one died from the outbreak.

“It was diagnosed immediately and antibiotics were started,” Beckwith said. “The bacteria stopped and within a week or so [the patients] were better.”

Although there was a degree of panic in response to the outbreak, UConn’s health department made sure to educate the students by providing them with information on the disease.

“We educated students so they understood they would be okay,” Beckwith said. “People responded maturely once they got the information.”

The University of Connecticut made history by being the only institution to have three cases of meningitis in one week and by staging the largest mass inoculation at a single site in state history.

The risk?

Again, meningitis has made the news.

Recent Centers for Disease Control and Prevention studies show that college students, especially freshmen living in dormitories, are at increased risk for meningococcal meningitis. Certain lifestyle factors common among college students appear to be linked to the disease, including communal living, bar patronage, smoking and irregular sleep patterns.

According to the Meningitis Foundation of America, meningococcal meningitis strikes about 3,000 Americans each year, causing more than 300 deaths annually. It is estimated that 100 to 125 cases of meningococcal meningitis occur annually on college campuses and five to 15 students die as a result.

Meningococcal meningitis is transmitted through droplets in the air and direct contact with infected persons. It occurs most often in late winter and early spring, a time when most college students are at school.

Symptoms of meningococcal meningitis are often misdiagnosed as something less serious. Symptoms can resemble the flu and may include high fever, headache, stiff neck, confusion, nausea, vomiting, exhaustion, and a rash. If not detected early, the disease can progress, often within hours of the first signs of symptoms.

Connecticut state law now requires students living in on-campus housing to be vaccinated with the meningococcal vaccine. The legislation was passed in 2001 and goes into effect in September 2002. Maryland is currently the only other state that mandates the vaccine for college students who reside in on-campus housing.

Since meningitis strikes rarely, many people question the cost-effectiveness of mandatory vaccination. The meningococcal vaccine costs between $55 and $75. Protection lasts approximately three to five years, the length of time most students are away at college.

State Sen. Toni Harp chairs the Public Health Committee that pushed for the legislation in 2001. She believes that the benefit to be derived from mandatory vaccination is worth its high cost.

“This is a disease where the prevention is a lot easier than the cure,” Harp said. “The cost of the disease is higher than the cost of the vaccine.”

Harp said the committee wanted to prevent meningitis outbreaks before more lives were lost.

“[The legislation] had a lot to do with the outbreaks and the fact that there is a vaccine available to prevent the disease.”

A lukewarm response

The State Health Department is taking a neutral stance on the issue. James Hadler, director of the Infectious Diseases division, said the Department first took a look at how many vaccine-preventable cases Connecticut was getting each year. He said the number came out to only about one or two.

“At first, we found it worthwhile to recommend the vaccination rather than to mandate it,” Hadler said. “Of the colleges in Connecticut with on-campus housing, almost all were putting out information and offering the vaccine to those who wanted and could pay for it.”

Hadler said that since colleges were already making independent efforts to offer the meningococcal vaccination to students, the State Health Department did not feel ready to mandate the vaccination. But when the legislation was proposed, the Department chose to remain neutral.

“We are pro-vaccination, but neutral on whether to mandate it or not,” Hadler said.

Hadler said he recognized the cost issues that go along with mandatory vaccination.

“We are forcing people to spend for a disease only one or two people are going to get, but for those one or two people, it is worth it,” Hadler said.

The CDC is against requiring the meningococcal vaccine for college students. Instead, the CDC recommends that college freshmen living in dormitories be educated about the vaccine.

“The risk for meningitis is low and vaccination of college students is not cost-effective to society as a whole,” CDC spokesman Curtis Allen said.

But Allen said that the CDC’s decision was a difficult one. Vaccination of freshmen who live in dormitories would result in the administration of approximately 300,000-500,000 doses of vaccine each year, preventing 15-30 cases of meningococcal disease and one to three deaths each year.

“Seven to 20 million dollars for each potential death is a lot of money to society, but to the individual, how do you put a price tag on a life?” Allen asked. “That’s the sort of decision public health has to grapple with.”

But Allen is not taking any chances with his own college-aged son.

“My son’s a freshman in college. He lives in a dormitory, and he was not going to college until he had that vaccine,” Allen said.

Robert Baltimore, Yale professor of epidemiology and public health, said that the peace of mind offered by the vaccine outweighs its cost.

“[Mass vaccination] is unlikely to be highly beneficial or considered cost-effective. However, the solace and security provided to students, families, and institutions provide more than sufficient rationale for its use,” Baltimore wrote in his commentary on the vaccine.

He also made sure his son was vaccinated for meningitis before going to college.

“As a friend of mine said, if you are paying $30,000 a year for college, another $64 is not unreasonable,” Baltimore said.

Scare tactics?

Many people partly attribute meningitis legislation to the heightened visibility of the disease after a sudden plethora of information on the disease arose in the last few years.

“The impetus for a lot of this has come from increased public awareness,” said Dr. Ravi Durvasula, medical director of University Health Service.

But sometimes information can scare more than it can comfort.

In August 1999, the television journalism program “20/20″ ran a segment on meningococcal disease in college students. The program was provocative and ended dramatically with the tragic and gruesome deaths of the two students highlighted in the program.

The segment did much to raise the awareness level of the disease throughout the country and caused many students to seek vaccination, but many people criticize the “20/20″ story as an over-sensationalized piece of journalism.

The introduction to the report on the disease stated, “Tonight — a warning to parents about a secret killer in a place you’d never expect, at college, where a deadly bacteria is stalking students.”

“I don’t think it was a very balanced way of reporting it,” Durvasula said. “[Meningitis] is an extremely rare entity and whenever something like that is reported in television media, it is easy to focus on the horrific part of one or two cases, but easy to forget the context of it.”

A meningitis scare came after “20/20″ reported that the Advisory Committee on Immunization Practices urged college freshmen to be vaccinated against the disease and recommended that colleges make the vaccines and information about the disease available to students.

“A lot of legislation has as much a scientific basis as a public health hysteria basis,” Durvasula said.

But regardless of the impetus for the legislation, Connecticut universities will have to comply.

Starting this month, vaccine clinics are to be held in Yale’s residential colleges. All Yale students who have not had the meningococcal vaccine must attend the scheduled clinic at their college. Present seniors will not receive the vaccine.

The meningococcal vaccine prevents type A and type C meningitis, but it does not prevent meningitis type B. The vaccine is considered very safe, with no recorded side effects. It is virtually 100 percent effective.

Current University Health Plan members will receive reimbursement for the vaccination.

“There’s no question the vaccine has saved lives,” Baltimore said. “The question is, how many people have to be vaccinated to save a life?”

A meningococcal vaccine like the one above is now required by law in Connecticut. It is intended to prevent outbreaks of the disease among at-risk populations, including college students.
AFP
A meningococcal vaccine like the one above is now required by law in Connecticut. It is intended to prevent outbreaks of the disease among at-risk populations, including college students.

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