One medical school experience was indelibly written into our collective memories.
A fourth-year student felt unwell, having aches, pains and a slight runny nose. As the student left the hospital early for home, nothing appeared ominous. Anyone would have considered the symptoms as the early stages of a mild, upper-respiratory infection – a cold. Neither the student nor the physician-spouse was concerned, until the former awakened in the wee hours of the morning with headache, shaking chills and a red-spotted rash over most of the body.
They both instantly recognized the diagnosis. The student, on a pediatrics rotation at (then) Boston City Hospital, had been caring for two young kids with meningitis – type not yet determined. Wasting no time, the couple immediately went to the nearby Massachusetts General Hospital. On arrival, our student was prostrate with rapid pulse and falling blood pressure. She died in the emergency room.
The student died of meningococcemia, a sudden overwhelming invasion of the blood stream by the bacterium Neisseria meningitidis – which also causes meningoccal meningitis – involving the meninges of the brain and spinal cord. In the U.S., the average, annual attack rate of meningococcal disease is one case per 100,000 people. The rate is considerably higher in sub-Saharan Africa and during periodic “outbreaks” in prisons, military barracks and college dormitories – especially freshmen.
One fascinating detail is the “carriage” rate of the meningococcus: About 10 percent of the population may carry the bacteria in their noses and throats for varying periods of time – without disease or ill effect. Nonetheless, high-carriage rates may result in outbreaks of either meningitis (more commonly) or meningococcemia. Decades ago, in a crowded military barracks with beds spaced 6 inches apart, the carriage rate was 70 percent, and an epidemic occurred.
Where beds were spaced 3 feet apart, the carriage rate was considerably less. In a Houston elementary school, an outbreak occurred where desks were spaced less than 3 feet apart. Thus, there appears to be a relative margin of safety when the nose-to-nose distance is 3 feet or greater. Any guess as to what the nose-to-nose distance is in a row of airline seats?
Prison overcrowding has not escaped notice. Inmates of one jail had a carriage rate of about 20 percent and only 3 percent for jail employees. Randomly selected community residents were 1 percent. Carriage rates also climb after 30 days of incarceration. Tobacco smoke, either to the smoker or second-hand, also increases the rate. Significantly, about 60 percent of meningoccal disease occurs in the population older than 11 – the target group for immunization.
Five meningococcal serogroups (or types) cause most human disease. The current vaccine covers four – but not the “B” type – and can protect about three-quarters of adolescents and college students. Serogroup B vaccine is in use in Europe, Canada and Australia, but not yet in the U.S. except in outbreaks. Notably, not many survivors of meningococcal disease are 100 percent normal – hearing loss, neurologic disability, amputations. Is your student protected?
www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.
