Killer at college: Meningitis threatens students

Mandatory vaccine for deadly bacterial disease sparks debate

Ashley Lee thought it was just the flu coming
on. A little headache, an upset stomach — nothing to skip a hometown
frat party for, reasoned the 18-year-old as she cruised the 90 miles
from Indiana University in Bloomington back home to Terre Haute, Ind.
But
at the party, the college freshman ran to the bathroom to vomit every
half hour and eventually headed home, where her parents figured she’d
feel better after a good night’s sleep. The next day, she collapsed on
her way to the bathroom. Her dad carried her to their car, and they
sped toward the local hospital. At the emergency room, she lost her
vision for several terrifying seconds.
“That scared me half to death,” Ashley says. “I knew something wasn’t right.”Hours later, Ashley was diagnosed with meningococcal meningitis, a rare but potentially deadly bacterial infection.
The
doctor’s words hit Ashley’s stepmom with a sickening thud. Sam Lee had
taken her daughter to the doctor just six weeks earlier to get
vaccinated against this very disease before sending her off to college.
The doctor didn’t have it in stock right then. It’s such a rare
disease, though, he had said, that Ashley could just get the shot once
she got to campus.
Statistically speaking, the doctor was right.Meningococcal
meningitis strikes fewer than 3,000 people in the United States each
year, many of them college students or children under age 1. But while
the bacterial infection is relatively rare, it’s also deadly, killing
10 to 12 percent of those it infects, sometimes within hours. The
disease attacks and shuts down major organs and prevents blood from
circulating to limbs, causing tissue to die. Among survivors, 20
percent suffer brain damage, kidney disease, loss of hearing or sight,
limb amputations or other severe complications.
The
disease is spread through air droplets and direct contact with someone
who is infected. College students, particularly freshmen living in
dorms, are at increased risk because of their lifestyle. They’re living
away from home for the first time and many share everything from drinks
to drags off each others’ cigarettes. And too many late nights of
studying and partying can leave their immune systems run-down and
vulnerable.


During her first weeks of college in 2005, Ashley was too busy with
new friends and a full class schedule to seek out the vaccine, and it
didn’t seem like a big deal anyway.

“I just didn’t know the severity of it. I thought it was just, like, another vaccination,” Ashley recalls.
It
wasn’t until Ashley’s dad told her that the doctors were going to have
to take her left foot that she truly understood what meningitis meant.


Life and death debate

After
the disease attacked Ashley, each of her family members was vaccinated
with Menactra, which is approved by the Food and Drug Administration
for those ages 11 and older. It’s 83 percent effective in preventing
four of the five strands of bacterial meningitis.
“Why would you take the chance?” says Sam Lee.
That’s a question that has sparked a national debate.
Twenty
states now require college students to either get the vaccination or
sign a waiver that says they’ve read about the disease. Three more
states mandate the vaccination for college students, but allow
exemptions for religious or medical reasons. Eleven states require only
that information about the vaccine and the disease be provided on
campus.
A
growing grassroots movement is pushing for more states to require the
shot. Currently, the Centers for Disease Control and Prevention
recommends Menactra for kids ages 11 to 18, but only 12 percent of
teenagers got the vaccine in 2006.

Many of those advocating for mandatory
vaccinations are parents, including Frankie Milley, who have lost
children to meningitis. Nine years ago, her 18-year-old son, Ryan, died
of the disease, and since then, she has worked in her home state of
Texas to make meningitis education available to all families. She also
supported a bill currently being considered by the Texas Legislature
that would require college students to get the vaccine.

After
visiting her son’s grave recently, Milley wept during a phone
interview. Her memories of her only child are intertwined with regret
and anger. When Ryan was alive, she wasn’t aware of the vaccination
that could have prevented the disease that killed him.
“The
hardest thing was to walk to the cemetery, to see his name on a
gravestone,” Milley says. “His name shouldn't be on a gravestone. It
should be on a wedding invitation, a birth announcement. … If he'd had
that vaccine he wouldn't be there.”
Dr.
Jim Turner, the executive director for the department of student health
at the University of Virginia, was skeptical in 2001 when Virginia
passed a law mandating that all students attending four-year
universities must get the vaccination or sign a waiver. He thought most
students would just choose to sign the waiver. But it seems that
education about the disease has motivated many to get the vaccine. He’s
seen the numbers climb from 55 percent of students getting vaccinated
to 95 percent.
“It’s
a safe vaccination, it’s an effective vaccination, and it’s one of
those terrible, terrible risks — albeit extremely rare — that you can
really minimize by spending money on the vaccine,” says Turner, who is
also the chair of the Vaccines Preventable Diseases Committee for the
American College Health Association. The vaccine is generally covered
by insurance and costs around $120 on most college campuses.

vital, but families should know the risks and be able to make their own
decisions, says Dr. John Dorman, a committee member of that same ACHA
committee and a clinical professor of medicine at Stanford University.
Like any vaccine, Menactra may carry side
effects such as allergic reaction and redness or pain around the
injected area, according to the CDC. Menactra has also been linked to a
few cases of Guillain-Barre syndrome, which attacks the peripheral
nervous system and causes gradual, temporary paralysis. Data from the
Vaccine Adverse Event Reporting System suggests this happens 1.25 times
for every 1 million meningitis vaccines given.

Barbara
Loe Fisher, president and co-founder of the National Vaccine
Information Center, believes more attention should be drawn to these
potential hazards. Her Washington, D.C.-based nonprofit works on the
prevention of injuries and deaths caused by vaccinations.

“I just I don’t understand why we have to force people,” Fisher says.
“We should make [vaccinations] available at low or no cost, but forcing
people is another issue.”

A rare disease

Those opposed to a mandatory meningitis vaccination also cite the low occurrence of the disease in the United States.

“I
guess I err on the side of wanting to make mandatory those things of
major public health significance,” Dorman says. “(Meningitis) isn’t a
particularly common phenomenon.”
But the disease can be horrific when it does strike.

When Lynn Bozof’s son Evan was a teenager,
there was a meningitis outbreak in a neighboring county. Evan was
worried, and he asked his mom if he should get the vaccination.

“‘Mom,
how do I know if I’ve got meningitis?’” Bozof recalls her son asking.
And she remembers her reply: “Oh Evan, you don’t need to worry about
meningitis!”
But
five years later, as a junior at Georgia Southwestern University in
1998, Evan called his mom complaining of a migraine. It got so bad that
he went to the emergency room, where he was diagnosed with meningitis
and placed in intensive care. His kidneys shut down. His liver stopped
functioning. Both arms and legs had to be amputated. After a 26-day
fight against the disease, Evan died.
As Bozof watched her son’s losing battle, the memory of a teenage Evan asking about meningitis cruelly replayed in her mind.
“I
feel like that came back to haunt me because I didn’t take the time to
find out about the disease,” Bozof says. “Just because this disease is
rare doesn’t mean it’s not going to affect you or someone you know.”


‘It happens so quickly’

The disease’s hard-to-spot symptoms and rapid progression make meningococcal Meningitis a “great fear” for doctors, says Dr. Tom Clark, a medical epidemiologist
for the CDC’s National Center for Immunization and Respiratory
Diseases. The symptoms are devastatingly easy to overlook, to dismiss
as something minor. The only way to definitively diagnose meningococcal
meningitis is through a spinal tap, he says, something not routinely
done on people who have flulike symptoms.
In
Ashley’s case, the doctors at first assumed she was merely dehydrated
and tried to send her home, the family remembers. Even after a purplish
rash — a classic sign of meningitis — spread across her body,
emergency-room staff still had no idea what was wrong.
Terrified
for his daughter, Ashley’s dad, Tom, demanded that she be transferred
to a larger hospital. Ashley screamed in pain the entire time it took
the ambulance to get to the hospital in Indianapolis, 77 miles away.
“It
was a ride from hell,” Ashley recalls. “Now that I know about the
disease, I could almost feel the disease running through my body, just
eating at me.”

When she reached the second hospital, a doctor
recognized the disease for what it was. By that time, Ashley’s parents
say her whole body had swelled to twice its normal size, and the purple
rash now covered her head to toe. The disease had taken only a little
over an hour to overtake her entire body.

“It’s
not unusual to hear a story of a kid not feeling well on a Friday night
and going to bed, and being dead on Saturday morning,” says the CDC’s
Clark. “It happens so quickly.”


Lingering effects

Even when a victim survives meningitis, the nightmarish battle against the disease is far from over.
As
Ashley fought for her life in the hospital, she and her father made the
devastating decision to let her doctors take her left foot and three of
her fingers.
They
talked about it at length and cried about Ashley’s loss. But when she
woke up hours later, she had no memory of that conversation.
“She’d
wake up after each surgery and say, ‘Dad, what happened to my foot?’
Tom Lee remembers. Brokenhearted, he would tell her again.
Now,
two years after she got sick, 20-year-old Ashley’s right arm is scarred
from skin grafts and she wears a prosthetic foot. Her other leg is in a
cast, following the latest of 11 surgeries.
At home in her bedroom painted two shades of pink, pictures of her physical therapist among those of her friends and family. At first the therapists were
skeptical about whether she’d be able to walk at all. But Ashley was
determined to get back on her feet. Despite pain from the recent
surgery and a pronounced limp, she refuses to even use a cane for
support, walking instead entirely on her own.
Ashley
spent last summer covering up the lasting marks of meningitis. Despite
the sweaty, humid Indiana summer, she wore shrugs and pants to keep
people from seeing her scars. But the following year when she returned
to school, she made a series of bold moves: She put on a tank top. She
had her seven remaining fingers professionally manicured. And she
started to tell her story.

Now that is some scarey stuff right there...