Symptoms can appear and progress very rapidly — in a matter of days — which makes it important that medical attention is sought immediately if symptoms occur.
So far the efforts at Princeton and UCSB appear to be working, although it is impossible to say if and when the outbreaks will stop at the schools or elsewhere, Dr. Sejvar told Neurology Today.
“It is reassuring that we have not had any more cases so far, and these outbreaks tend to be limited, even in institutional settings,” he said.
According to the CDC, students traveling for the holidays present little risk of spreading illness to friends and family members however the agency has also said that it expects some new cases in the months ahead.
VACCINE DEEMED SAFE
The use of an unlicensed vaccine in the U.S. is unprecedented, but officials at the CDC and the Food and Drug Administration determined that its safety had been confirmed in multiple studies that led to European approval of the vaccine, as well as the severity of the illness and the risk of it spreading.
The European Union approved it in January 2013, Australia in August 2013, and Canada in early December. More than 8,000 infants, children, adolescents, and adults have been safely vaccinated as part of the studies and post-marketing monitoring, according to the CDC.
The vaccine is currently in phase 2 clinical trials in the US as part of a broader Novartis vaccine against multiple strains of meningitis.
Meningitis B bacteria are harbored in the nose and throat, and infection typically is spread through respiratory excretions and saliva. Some infected individuals are asymptomatic carriers, and because initial symptoms are similar to those of a bad cold or the flu, early diagnosis can be difficult. The infection can progress very quickly — in a matter of days — into a seriously disabling or life-threating state if medical care is not sought.
According to the CDC, symptoms may include sudden onset of a high fever, headache, stiff neck, nausea, vomiting, rapid breathing, or a rash. In a special bulletin on its website, the agency noted that “it is important to remember that someone with meningococcal disease may have a high fever and no other symptoms.”
College campuses are especially suitable for the spread of meningitis because many students live in close proximity, especially in fraternities and sororities where the sharing of cups, glasses, and cigarettes, as well as kissing, can transmit the disease, as can being near to an infected person who coughs or sneezes.
In a press briefing, Amanda Cohn, MD, a pediatrician and an expert in meningococcal disease at the CDC, told reporters that while the illness can prove very serious, it should not raise undue anxiety among students or parents.
“Fortunately, meningococcal bacteria are harder to spread than viruses that cause things like the flu or respiratory viruses, and they don't live long outside the body.”
Moreover, the bacteria are not spread by casual contact, she noted, adding that around 10 percent of individuals across the US carry the bacteria in the back of their nose or throat and never develop symptoms.
‘WAIT AND SEE’
Kenneth L. Tyler, MD, the Reuler-Lewin Family professor and chairman of the department of neurology at the University of Colorado School of Medicine, in Aurora, is an expert in infectious diseases of the central nervous system.
“Even though there is some controversy about access and availability of the vaccine, I think the CDC and the FDA responded well to the outbreaks,” he told Neurology Today in a telephone interview.
“It is interesting that the vaccine was not also made available at UCSB, and there is a lot of concern among parents — why the Princeton students got it and UCSB did not.”
Determining how many people have been exposed to the two strains is impossible, added Dr. Tyler, who is an associate editor of Neurology Today.
“Meningitis B is very tricky because we have asymptomatic people who are carriers, so it is possible that there may be more infections. I doubt this will happen at Princeton, because the outbreak began last March, only eight students developed the disease, and there have been no new cases. And with the vaccination program, most of the at-risk student population is no longer very susceptible. But there is no way of telling, so we will also just have to wait and see.”
Dr. Tyler noted that vaccines have dramatically altered the epidemiology of bacterial meningitis, particularly with more common forms of meningitis — such as Streptococcus pneumoniae and Haemophilus influenzae. Haemophilus influenzae (H. flu) Type B (Hib) has dropped precipitously in importance, he said, and S. pneumoniae has also been dramatically reduced since vaccines were available. “Many of the cases we see of this are due to strains not covered by the vaccine.”
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