After the hospitalization of a student with a probable case of bacterial meningitis, the University is preparing for the potential of a meningitis outbreak, though the likelihood of the infection’s proliferation is low.
“I want to stress that although bacterial meningitis is a serious disease, the risk of transmission is very low,” said Director of Yale Health Paul Genecin in a Sunday campus-wide email.
Still, the University is taking substantial precautions, including providing those at risk of contagion with doses of the antibiotic ciprofloxacin and being extra-vigilant for symptoms that may indicate meningitis.
The suspected case comes less than two years after an outbreak of type B meningitis at Princeton that infected nine within the span of 12 months and left one Drexel University student, who had visited Princeton, dead.
Moreover, on Monday, Rhode Island health officials confirmed that a Providence College student, who had been vaccinated against meningitis, was diagnosed with the disease. On Thursday night, officials confirmed the existence of a second probable case, the Providence Journal reported.
Physicians interviewed said an outbreak is unlikely but not impossible. In an interview with the News, Genecin said that “these things come in clusters,” explaining that despite the low transmission rate, the school cannot rule out another case of meningitis cropping up.
However, Louise-Marie Dembry, professor of medicine and epidemiology at the Yale School of Medicine and hospital epidemiologist at Yale-New Haven Hospital, said that in most cases, meningitis is sporadic, and does not arise again within communities.
“It is more common to have a single case [of meningitis],” she said. “Only 2 percent of the time do you have more than one case.”
Medical school professor Onyema Ogbuagu said the chances of an outbreak are low, and even in cases where there have been outbreaks, such as at Princeton, very few students were affected. He also added that because the disease is spread by close contact, particular demographics, including college students, are particularly susceptible. But Dembry noted that because the type of meningitis is not yet known, it is hard to know how likely an outbreak will be.
During the outbreak at Princeton, the university imported Bexsero, a vaccine used in Europe but not yet approved by the Food and Drug Administration, in December 2013 to manage the outbreak.
According to the Princeton Infirmary website, the vaccination was encouraged because, though it had not been cleared for U.S. use, it had already been proven successful and safe to use. In January, the FDA approved Bexsero.
Yale is currently recommending that only people who have been in close contact with the affected student should take one 500-milligram dose of ciprofloxacin. But physicians, including Ogbuagu, said that if the student has type B meningitis and further cases occur on campus, it would make sense to vaccinate the entire student body. At Princeton, which had eight cases of meningitis by the time it decided to administer vaccinations, 90 percent of students were vaccinated. In contrast to Yale, Princeton did not offer its students antibiotics, said Princeton junior Sharim Esteves.
Though the vaccine was not compulsory, the University highly recommended it, said Princeton sophomore Tiffani Hanson, adding that few students chose to forgo a vaccine that had proven to be effective in Europe.
After the mass vaccination, no other Princeton students became infected, though a visiting student from Drexel contracted the disease and later died.
Although Connecticut state law requires all college students living on campus to have a meningitis vaccine, the two vaccines that are currently approved in the U.S. only protect against type A meningitis. Type B meningitis, the strain that caused the outbreak in Princeton, cannot be prevented by either of those vaccines.
“It is a response that has happened in the past, and would be appropriate here if the student has a non-vaccine strain of meningitis,” Ogbuagu said, using the term “non-vaccine” to refer to strains of meningitis that are not covered by the two FDA-approved vaccines in the U.S.
In conjunction with the vaccination campaign, Princeton stressed public hygiene measures, particularly not sharing cups, said Princeton sophomore Erik Massenzio. Students were told that especially at home, it was important to not share cups with family members, added Esteves.
Dembry, Obguagu and Genecin all said it can be especially difficult to manage meningitis outbreaks because they often occur during influenza season, and meningitis, early on, presents symptoms very similar to those of influenza. But Dembry stressed that meningitis symptoms tend to become extremely severe, so people do not usually stay home for long. She added that the disease progresses very quickly, so early diagnosis can be the difference between successfully treating a patient and failing to do so.
Although all the Princeton students affected recovered, the Drexel student who had been visiting Princeton for a weekend contracted the disease and died.
“When the Drexel student died, we were really shocked,” Esteves said. “Everyone knew what was going on, but we didn’t think it was serious.”
Because meningitis affects the brain and spinal cord, neurological symptoms may arise, and persist even after a patient gets better, Ogbuagu explained. He said neurological deficit persists in 20 percent of meningitis survivors and that 10 to 15 percent of people who get meningitis die of the disease.
While all nine Yale students interviewed said they first heard about Yale’s first case of meningitis in a campus-wide email, at Princeton, rumors circulated by word of mouth before students were formally notified by the University, Princeton students interviewed said. Following the initial case, students were informed of subsequent cases by campus-wide emails.
At Princeton, very few students worried about the severity of the disease on campus until the University made the decision to import the then-unapproved vaccines, Esteves said.
Yale students interviewed were calm and optimistic about the University’s ability to handle a possible meningitis outbreak.
“Until there are more outbreaks, there is no reason to be too concerned,” said one student in Calhoun. “I have faith that Yale Health and the administrators are taking enough preventative measures.”
Even the patient’s suitemates said they were not alarmed by the potential for an outbreak. One suitemate said they are not worried about becoming infected, but understands why others would be. They added that the nurse who spoke with her told her that unless they had been within three feet of the patient for more than eight hours, they are unlikely to be infected.
According to the National Institutes of Health, approximately 2,600 people contract meningitis in the United States every year.