Meningitis Risks

In recent weeks, three different college campuses have seen instances of meningitis -- one which resulted in the death of a university employee -- but only one of those instances qualified as an outbreak prompting widespread vaccinations of the student body.

Bacterial meningitis is a rare but dangerous infectious disease that affects the brain and spinal cord. It can cause neurological damage, necessitate amputation or lead to death in some cases. It’s relatively rare on college campuses, being more prone to affect adolescents, but there have been a number of outbreaks on campus in the last year, at the University of Oregon, for example, and Princeton University, and almost 30 reported infections on campuses between 2013 and 2015, according to data from the National Meningitis Association.

In the most recent outbreak, at Santa Clara University, three students had been infected as of Friday, two with meningitis and one with a bloodstream infection caused by the same bacteria. One of the students has been discharged from the hospital, and the other two are in fair condition, according to a university spokeswoman.

In response the university has set up a free vaccination clinic and is encouraging all its students to visit. As of Friday morning, 1,496 of its 9,000 students had been vaccinated, and another 200 who had come in close contact with the infected students had been treated with antibiotics.

While appropriate in Santa Clara’s case, widespread vaccination for the category of meningococcal infection reported there -- known as serogroup B -- is not recommended for college students and universities, even ones with recent case of meningitis, said Craig Roberts, a past chair of the Emerging Public Health Threats & Emergency Response Coalition for the American College Health Association and an epidemiologist at the University of Wisconsin-Madison Health Service.

Strains of the bacteria in serogroup B have become more common after an effective vaccine for the other four groups -- A, C, Y and W, against all of which most college students are already vaccinated -- was released about a decade ago. But a vaccination for B group strains was only approved by U.S. Food and Drug Administration last year, Roberts said, and even that has some significant limitations. Group B strains are prone to mutation, so new types that the vaccine hasn’t been tested against pop up from time to time, and the vaccine itself doesn’t appear to have a very long duration.

“From talking to other experts, it doesn’t appear that the protection will be sustained” beyond “a year or two,” he said. It might not last that long, either. No one really knows yet.

And, while it is a “devastating disease,” Roberts said, it’s also “very, very rare,” particularly for college students, because the bacteria is more prone to target adolescents.

Colleges also possess risk factors, though. The disease is spread through “respiratory and throat secretions … during close or lengthy contact,” according to the Centers for Disease Control and Prevention, “especially if living in the same household.” Places where large numbers of people gather together also increase risk, so the CDC recommends all students living in dorms be vaccinated for the A, C, Y and W groups.

Even though the B group vaccine’s short duration doesn’t make it worth recommending all 18 million college students be vaccinated against that strain, it’s still “great for outbreaks,” Roberts said.

Qualifying as an outbreak, according CDC, can require as little as two infections from bacteria in the same group if the community or institution is small enough. But just one probably wouldn’t be enough to warrant widespread use of an expensive vaccination with limited protective ability.

At Argosy University in Alameda, Calif., a for-profit university owned by Education Management Corporation, an employee died from meningitis in late January. Officials there have said several times that there is no indication of any connection to the Santa Clara outbreak, and the college is handling the aftermath differently, although it is keeping details close to the vest.

The response at Argosy has been to treat staff and students who came into contact with the employee, but a university spokeswoman declined to explain how many had been treated, in what way or for what strain of meningitis.

“We are very tight-lipped about every aspect of a communicable disease,” she said, “unless we need the public to take a specific action,” which was not the case here.

Another spokeswoman did clarify that the employee was not a professor, as several media organizations have reported, but she would not go into detail about his position, citing Health Insurance Portability and Accountability Act regulations.

Muskingum University in Ohio, the third to report a case of meningitis in the last few days, is also treating people who came into direct contact with the infected student, who “is recovering and doing very well,” according to a press release from the county health department. It goes on to note, “You need to be within three feet of the infected person for a total of eight hours to be considered as a direct contact.”