01:06am Sunday 22 October 2017

Identifying the devious disease

By Linda Weiford, WSU News

Dr. Dennis Garcia, senior associate medical director of WSU’s Health and Wellness Center. Photo by Linda Weiford, WSU News.
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College students living in close quarters are at higher risk of contracting bacterial meningitis. Photo courtesy of Webmd.com

PULLMAN, Wash. – Bacterial meningitis, the devious culprit that gravely sickened a Washington State University student this month, is a rare but deadly disease that can be transmitted by sharing a drink or swapping a kiss. It’s more likely to do its dirty work among large gatherings of people who live close together.

Because of this, college students are often in its path.

While not highly contagious like the flu, bacterial meningitis inflames the protective coating — called meninges — of the brain and spinal cord. Approximately 10 percent of the 4,100 Americans infected each year will die, according to the Centers for Disease Control in Atlanta. Of those who survive, one in five will be left with permanent health problems. (This is not the type of meningitis linked to the national outbreak caused by tainted steroid injections, which is fungus-related.)

Bacteria at the gate

“It’s an opportunistic infection,” said Dr. Dennis Garcia, senior associate medical director of WSU’s Health and Wellness Center, where a suspected case of meningitis puts staff on high alert. “The lifestyles of college students provide more opportunities for the bacteria to spread and infect.”

First, students tend to live in close quarters where the microbes can spread more easily via nasal secretions and saliva, he said. Additionally, days packed with classes and socializing followed by late nights of studying and partying can leave out-of-whack immune systems vulnerable to infection, he said.

“Students in communal living conditions such as residence halls, sororities and fraternities face a greater risk than the general population. Not only are they in close proximity of each other, but they’re often dealing with stress related to studies, have irregular sleep patterns and unbalanced diets.”

Scientific data backs this up. In the 1990s, the CDC began tracking the disease among college students nationwide. The agency found that the risk among students living in on-campus housing was about three times higher those who lived off campus and roughly twice as high as people in general who are the same age.

‘Medical emergency’

Fortunately, students don’t get meningitis by simply breathing the air of someone infected, as they can by inhaling influenza, common cold or measles germs.  But because the disease can be so disabling and lethal, and because outbreaks do occur — “once we suspect it, we treat it as a medical emergency,” said Garcia, who has seen eight student cases of meningitis at WSU in the past 15 years. “Every one of them landed in the intensive care unit but survived. We’ve been lucky,” he said.

But the University of Oregon wasn’t lucky last May, when the disease killed a 21-year-old sorority member in less than 48 hours. Two weeks before her death, the young woman majoring in psychology had completed a half-marathon with her mother, according to the Eugene Register-Guard.

In her case, and any time a case is suspected, the student is immediately hospitalized, blood and spinal fluid are drawn for testing and a massive antibiotic counterattack is launched.

“Unless they receive antibiotics, the prognosis is not good. And obviously, sooner, not later,” said Garcia, is the best.

Flu vs. meningitis symptoms

But the devious nature of meningitis can nix the sooner part. At first, it looks like flu: headache, fever, achiness, nausea and a stiff neck. Students, thinking they have a flu bug that will clear up on its own, may not seek medical care until the bacteria have multiplied tens of thousands of times while marching through the blood, ultimately infiltrating the membrane encasing the brain and spinal cord.

Sometimes the process moves like a stampede, killing victims within 24 hours of the first symptoms. Other times, it creeps along for days. As for the WSU student, he experienced flu-like symptoms for two weeks before it was apparent that something else was going on. (See http://news.wsu.edu/pages/publications.asp?Action=Detail&PublicationID=33430)

Symptoms that can set meningitis apart from the flu include a red or purple rash, intense sensitivity to light, profound neck stiffness, severe headaches and muscle pain and confusion, according to the World Health Organization, which monitors cases worldwide, especially in Africa’s infamous “meningitis belt,” a swath of 25 countries with the highest rates on the planet. 

Another thing that makes meningitis so sneaky is that many people have the bacterium lodged in their noses and throats but never develop symptoms. Then, one day, they unknowingly pass it to someone who’s susceptible and that person gets sick. For university and public health officials trying to pinpoint the source of the spread, it can be like searching for a hypodermic needle in a haystack. 

Taking a shot at it

This leads to the subject of immunization. Considering that college students are vulnerable to such a deadly, contagious disease, why not give all of them a shot to prevent it? Some states, including Texas, Florida and Pennsylvania, require incoming freshmen be vaccinated against meningitis. Washington, however, does not. 

The controversy: Why require students be vaccinated against an uncommon disease?
 “There have been plenty of conversations about whether an immunization should be mandated,” said Michele Roberts of the state’s immunization office. “For now, the focus is on educating people about the disease and letting them know that a vaccine is available.” 
 

At WSU, freshmen are alerted to the dangers of meningitis in information packets distributed at the beginning of the school year. They are also made aware of a vaccine that blocks four of the five bacterial strains, offered through the university’s Health and Wellness Center. 

Most insurance plans, including WSU’s Student Health insurance, pay 100 percent of the shot’s $164 cost, a requirement of the nation’s new health-care reform law, said Merry Lawrence, the campus’s health and wellness billing supervisor. 

“If students don’t have insurance?  We don’t believe finances should be a deterrent to them getting vaccinated against this disease,” she said. “We’ll figure out a way to help.” 

 

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Contacts:
Dr. Dennis Garcia, senior associate medical director of WSU’s Health and Wellness Center, djgar@wsu.edu
Linda Weiford, WSU News, 509-335-7209, linda.weiford@wsu.edu

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