Advisory on meningococcal meningitis

Posted 08/06/02

On Aug. 3, a Dartmouth undergraduate student — a member of the Dartmouth Class of 2004 — was admitted to Dartmouth-Hitchcock Medical Center and diagnosed with meningococcal meningitis. The student was treated and is expected to make a full recovery.

The Dartmouth College Health Service has made contact with everyone with whom the student has recently been in close physical contact, and has distributed prophylactic antibiotics to all those contacts. So far the health service has neither found any further cases nor received reports of any.

Dartmouth is working closely with appropriate public health agencies and following the recommendations of the infectious disease specialists at the Dartmouth Hitchcock Medical Center to ensure that appropriate steps are being taken to address any health concerns of students and other members of the community.

Although the New Hampshire Public Health Department does not feel that this one case indicates an increased risk to others on campus, the Dartmouth Health Service is reminding all members of the Dartmouth community currently on campus to be aware of what may constitute early symptoms of meningococcal infection and to seek medical evaluation if such symptoms occur. These symptoms include fever, sore throat, severe headache, lethargy, nausea, vomiting, stiff neck and rash. Caught early, treatment with an appropriate antibiotic can quickly and completely cure the infection.

Meningococcal bacteria usually cannot live for more than a few minutes outside the body. As a result, they are not easily transmitted except through close physical contact. Only those who have had intimate contact with the oral secretions of a person with meningococcal disease are at risk of contracting disease and should receive one dose of prophylactic antibiotic in consultation with their physician.

Meningococcal Disease Information
Sources: The American College Health Association, the New Hampshire Divisions of Public Health, and the Dartmouth College Health Service

What is meningococcal disease?
The bacterium called Neisseria meningitidis causes meningococcal disease. This bacterium comes in many different subtypes; however, most disease in the United States is caused by subtypes A, B and C. Meningococcal disease occurs when the bacteria move from the throat into the bloodstream where they can cause a serious disease called meningococcemia. The bacteria can also enter the spinal fluid and cause an inflammation of the lining of the spinal cord and brain (the meninges) which is called meningococcal meningitis.

How many cases of meningococcal disease occur each year?
The annual incidence of meningococcal disease in the United States is about one case per 100,000 population. Most people who contract this disease recover fully however, there is a low rate of mortality (about 12 percent) in people who are not treated early.

Can meningococcal disease be mistaken for other health problems?
Meningococcal disease is potentially dangerous because it is relatively rare and can be mistaken for other, milder conditions. Someone who feels ill may not consider the possibility of having meningococcal infection, and early signs and symptoms may be ignored. A person may have symptoms suggestive of a minor cold or flu for a few days before experiencing a rapid progression to severe meningococcal disease.

What are the signs and symptoms of meningococcal disease?
Understanding the characteristic signs and symptoms of meningococcal disease is critical and possibly lifesaving. Common early symptoms of meningococcal meningitis and meningococcemia include high fever, severe sudden headache, sever body aches (myalgias), accompanied by mental changes (e.g. malaise, lethargy), and neck stiffness. Some people also develop nausea, confusion, sleepiness or a rash, which may begin as a flat, red eruption, mainly on the arms and legs. It may then evolve into a rash of small dots, called petechiae, which do not change with pressure. In more serious cases, delirium and coma appear.

What is the treatment for meningococcal disease?

Treatment of infected persons
Meningococcal disease can be rapidly progressive. With early diagnosis and treatment, however, there is good likelihood of full recovery. Early recognition, obtaining blood cultures, performance of a lumbar puncture (spinal tap) to obtain a sample of the spinal fluid, and prompt initiation of the proper antimicrobial therapy are crucial.

Chemoprophylaxis
The use of such prophylactic antibiotics as ciprofloxacin (Cipro) or rifampin may be recommended for those who may have had intimate exposure to a person diagnosed with meningococcal disease. The type of antibiotic given depends on the individual's age, and pregnancy status, as well as the organism's sensitivity to the drug. Anyone who suspects possible exposure should consult a physician immediately. Prophylactic antibiotics may also be prescribed for meningococcus carriers who are not exhibiting symptoms of disease.

Vaccination
Immunization against the meningococcus bacterium is recommended for young adults, including college students. The vaccine is highly effective in most common subtypes, with the exception of subtype B. The vaccine should not be used in place of chemoprophy laxis for those exposed to an infected person; the protection from immunization is too slowly generated in this situation.

How can one reduce the risk of contracting meningococcal disease?
Maximize your body's own immune system response. A lifestyle that includes a balanced diet, adequate sleep, appropriate exercise, and the avoidance of excessive stress is very important. Taking care to avoid upper respiratory tract infections and cigarette smoke may help to protect from invasive disease. Everyone should be sensitive to public health measures that decrease exposure to oral secretions, such as not sharing eating utensils, covering one's mouth when coughing or sneezing and washing hands after contact with articles that are freshly soiled with discharges from the nose or throat of a person infected with the organism.