This year alone there have been three outbreaks of meningococcal disease on college campuses around the United States. In response to these outbreaks Rutgers University, Columbia University and San Diego State University, along with their respective municipal health departments, have recommended vaccination of at-risk populations.
But what is meningococcal disease? Why is dealing with it so important to college communities?
Meningococcal disease refers to any illness that is caused by a type of bacteria called Neisseria meningitides. There are several serogroups, including A, B, C, Y and W-135. The illnesses they cause are often severe and include infections in the lining of the brain and spinal cord (meningitis) and bloodstream infections. Up to 15 percent of people who contract it die, usually within 24 hours.
It is a vaccine-preventable disease.
Yet even though life-saving vaccines against this disease have been available for many years, most of this year’s college students are not vaccinated, leaving them vulnerable.
I know about this disease first-hand. I contracted it during my first few weeks of college and nearly lost my life. I spent two weeks in a coma and lost my hearing. I had to put off medical school for a year while I recovered.
Meningococcus bacteria are spread through the exchange of secretions like saliva, particularly where large groups of people gather together or live in close quarters. This makes college students one of the most at-risk groups, as was the case for me.
While many states have mandated vaccination against meningococcal ACWY for all incoming college and university freshman, at least 12 states do not require it, including our own state of Michigan. Vaccination against meningococcal B or MenB is still not required for most colleges. This needs to change.
College students interact with other students from out-of-state. We cannot afford a situation where divergent vaccination policies limit the effectiveness of vaccines in states where they are required. To optimize herd immunity, we need to mandate vaccination in all schools in all states.
While meningitis can be treated with antibiotics, quick medical attention is extremely important to save lives. Keeping up with the recommended vaccines is the best defense.
The first vaccine for preventing meningococcal disease was developed in 1912. By the 1970s, vaccines were available for four of the five serogroups that commonly cause the infection. But serogroup B remained elusive until 2013 when Bexsero, a Meningitis B vaccine produced by Novartis, was approved for use in Europe. In 2014, Trumenba, a serogroup B vaccine produced by Pfizer, was approved by the Food and Drug Administration. Bexsero was subsequently approved for use in the United States in 2015.
Thus, vaccines are available. The problem is the policies that govern vaccination in the different states.
The Advisory Committee on Immunization Practices (ACIP) recommends that clinicians administer an initial dose of vaccine that offers protection against serogroups A, C, Y and W-135 to adolescents at age 11 or 12, plus a booster at age 16. As of 2016, New York students entering grades 7 and 12 must be vaccinated against meningococcal disease, for instance, and already 27 states include the vaccine as part of their regular schedule of immunizations.
But ACIP only states that clinicians may choose to administer serogroup B meningococcal vaccine to patients age 16 through 23. In part, this is because important data for making policy recommendations are not yet available as these vaccines were recently licensed for use in the United States under an accelerated approval process. Hopefully in the near future, with more research the vaccine may be mandated for this age group, too.
Since not all states have mandated the vaccine, and college-age students are at a heightened risk, the CDC should do more than just recommend meningitis vaccination for college-age students.
Emily Stillman was a sophomore at Michigan’s Kalamazoo College when she tragically contracted meningitis. On February 2, 2013, after just 36 hours in the hospital, Emily died from complications of the disease. The Meningitis B vaccine was not available before Emily’s illness, but now that it is, her mother Alicia Stillman is fighting to prevent this from happening to other families. She created the Emily Stillman Foundation to raise awareness of the risks of Meningitis B and wants the vaccine to be a requirement for all college students.
Meningitis is preventable through vaccines. Let’s make sure no college student is ever hospitalized or dies from it again.
Dr. Effiong is a certified Internal Medicine physician with MidMichigan Health, affiliated with the University of Michigan Health System. He is also a public health scientist and an international development fellow at the Aspen Institute. Dr. Effiong shared his personal experience with meningitis in a Tedx Talk delivered in Berlin, Germany in 2014.