Last months article looked at meningococcal disease. This was in response to an ABC segment of 20/20 which discussed the devastating effects of this infection on college students living in a dormitory. They chronicled a number of students who had disastrous outcomes after suffering the ravages of this deadly disease--amputated limbs and death. They discussed the fact that a vaccine against N. meningitides is currently available. The families of the unfortunate students that had become afflicted all lamented, "If only we had known that such a vaccine was available...just for the cost of a pair of running shoes..."
Are college students, particularly those living in dormitories, at increased risk for meningococcal disease? Should all college-bound students be vaccinated against N. meningitides?
A paper written by Dr. Lee H. Harrison, appearing in the May 26, 1999 issue of the Journal of the American Medical Association, compared the incidence of invasive meningococcal disease in Maryland college students with that of the general population of the same age from 1992-1997. In this 5 year period there were 228 cases of meningococcal disease in the entire state--67 cases of which involved 16-30 year olds. Of the 67, 11 attended a four year college, and 3 attended a two year college. 12 of the 14 college students who developed the disease were infected with sero-types of meningococcus that are in the vaccine (sero-types A, C, Y and W-135--see last months article). When comparing the incidence of meningococcal disease in the 14 college students (1.74 per 100,000) with the general population of the same age (1.44 per 100,000) there was no statistical difference. The incidence however, in college students who lived on campus (3.2 per 100,000) was far greater than those students who lived off campus (0.96 per 100,000). This, no doubt, is what sparked the interest in the 20/20 writers.
Given this information, is there a need for universal immunization of ALL college students against N. meningitides? Probably not...at least not yet. The number of college students who become infected with N. meningitides is still very small. This in NO way makes light of the devastation that this disease can cause to a healthy and bright young student who is entering the peak of their lives--or the grief and suffering that the entire families must endure. But the Maryland study showed that of the 228 cases in the state during a five year period, 14 involved college students. Since 1996 in Los Angeles county, the incidence of meningococcal disease is as follows: 59 cases in 1996, 74 cases in 1997, 50 cases in 1998, and so far this year there have been 39 reported cases. The vast majority of cases have been in children under 3 years of age.
A paper published in the American Journal of Public Health (June 1995) looked at the projected cost of immunizing all college students in the U.S. against N. meningitides. The cost of purchasing and administering the vaccine would be $56 million per year. The problem is not so much the cost of the vaccine as much as it is the vaccine itself.
The current vaccine contains sero-types A, C, Y and W-135. There are 13 different sero-types of N. meningitides that cause disease. Serotype A is prevalent in Asia and Africa but is extremely rare in this country. Serotype B, which accounts for around 46% of all cases of meningococcal disease, is not even in the vaccine. The vaccine is not recommended for children under 2 years of age, yet by far the highest incidence of this disease occurs in infants 3-12 months of age. Clearly what is needed is a better vaccine that will protect all of the at risk groups.
The article by Dr.Harrison and shows like the 20/20 segment have generated great interest in this matter. The Center for Disease Control, and the Advisory Committee on Immunization Practices (ACIP) are looking into the status of vaccinations for college students. The ACIP has formed a working group that will meet this month (October 1999) to discuss possible recommendations.
In the meantime, it is important that parents and college students be made aware that a vaccine is available--albeit a far from perfect vaccine. The side effects include fever, redness at the injection sight and rarely allergic reactions (9.2 per 100,000 doses) so it is a relatively safe vaccine. The cost of the vaccine is around $60-$75 per dose. The protection from the vaccine lasts around two years after which it drops to less than acceptable levels. It may therefore, need to be repeated every 2-3 years.
When patients ask for the vaccine, it should be given without reluctance provided there are no medical contraindications...the choice is really theirs. In this case there is no right or wrong answer. It is imperative that they at least know all of the facts. Are we ready to recommend that ALL college-bound students routinely receive the vaccine?...not just yet.