ASK THE DOCTOR: Meningitis vaccine daughter's decision
By DR. JIM MITTERANDO
The Patriot LedgerQ. My daughter is going to college this fall and she received a letter from her college advising her to consider receiving the meningitis vaccine. What do you recommend?
A. An outbreak of meningococcal meniningits that killed two teenagers in Ohio two weeks ago, has shone a spotlight on bacterial meningitis, a rare but contagious and potentially lethal disease.
Meningitis, an infection and inflammation of the membranes and fluid surrounding the brain and spinal cord, causes severe headaches, high fever, sensitivity to light and a stiff neck.
Most cases are viral, and neither contagious nor life-threatening. Viral meningitis typically occurs in the summertime and particularly affects young children.Whereas the bacterial form of the disease requires intravenous antibiotic therapy, viral meningitis resolves without treatment.
It is important to diagnose and treat bacterial meningitis early to prevent brain damage or death. Diagnosis usually is made by growing bacteria from a sample of spinal fluid.
Distinguishing viral from bacterial meningitis requires a procedure called a spinal tap, which involves inserting a needle between the vertebrae in the lower back and collecting spinal fluid.
Meningococcal meningitis, a form of bacterial meningitis, mostly affects children and kills rapidly in about 10 percent of cases. It is rare, affecting 1 in every 100,000 people. There have been no recent epidemics of meningococcal meningitis in New England. The heightened news coverage of meningitis gives the illusion that this disease occurs commonly.
People who come in close contact with someone who has meningococcal meningitis can protect themselves with a prophylactic antibiotic prescribed by their doctor. I often hear from patients worried about exposure to "meningitis," but usually it turns out to be noncontagious viral meningitis, which does not require preventive treatment.
As a precaution, state and federal officials opted to vaccinate students and faculty members living in or near the Ohio town in which the two teenagers died. Routine immunization is not recommended for the general population, though, because of the rarity of meningococcal meningitis.
The American Academy of Pediatrics, the CDC and many colleges recommend incoming freshmen consider receiving the meningococcal vaccine, because among students living in dormitories the rate of infection quadruples, from 1 in every 100,000 people to 4 in every 100,000 people.
But 70 percent of cases of meningococcal meningitis occur in children younger than 5; unfortunately, though, the vaccine is ineffective in young children.
Generally, because of the rarity of the disease, I leave the vaccination decision to the student. I explain that 30,000 students would have to be vaccinated to prevent one case of meningococcal meningitis and 300,000 students would need to be vaccinated to prevent one death from this illness. But if the disease worries you or your daughter, I recommend vaccination, if only for peace of mind.
Most health insurance companies pay for the meningococcal vaccine for college-age students. The vaccine, which costs around $75 and may protect against infection for only five years, is safe and produces no significant side effects.
People traveling to certain high-risk countries in Africa and Asia may want to consider the vaccine, because meningococcal meningitis may be more common there.
Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2001 The Patriot Ledger
Transmitted June 12, 2001