Colleges Send Mixed Signals About Meningitis Vaccine

Last February, a student at the Virginia Military Institute was hospitalized with severe pain and chills. He had felt fine just a day earlier.

On Oct. 9, a sophomore at Michigan State contracted the same illness and was hospitalized for almost a month.

And, last June, a Dartmouth junior died of the same ailment.

These students had all contracted bacterial meningitis, a disease that in recent years has increasingly hit college campuses, drawing the media's eye and prompting thousands of students to pay for costly vaccinations.

The number of people between the age of 15 and 24 who have contracted bacterial meningitis has doubled in the last decade, according to the Centers for Disease Control and Prevention (CDC). Only 3,000 Americans come down with meningitis every year; but students living on college campuses are three times more likely than others to catch it.

Fortunately, there is a vaccine for the disease. Last October, in the wake of reports about several meningitis cases, the American College Health Association (ACHA) issued a statement urging college students to "consider" getting vaccinated.

But the vaccine is expensive, and lately some doctors have been questioning its cost-effectiveness. These experts argue that the vaccine would save few lives, even if widely administered to college students.

Harvard has not had a case of meningitis in at least a decade, according to University Health Services (UHS) Director David S. Rosenthal '59, who says he is neutral on whether to recommend that students get vaccinated.

And because of this debate among the medical profession, there is no clear answer for students wonder how best to protect themselves against meningitis.

Meningitis Unmasked

John H. Turco, director of Dartmouth College Heath Services, said bacterial meningitis actually exists in two common forms. Meningococcal meningitis causes inflammation of tissue surrounding the spinal cord and brain. The other form, meningococcemia, occurs when the meningococcal bacteria gets into the bloodstream. Turco said that this second form is more deadly.

"The blood infection is what kills you," he said.

The disease is spread through close contract between two people, such as sharing a drink. Not all cases of contact actually spread the disease, however, since the bacteria cannot survive for long outside the body.

Meningitis is extremely powerful. According to CDC statistics, roughly 13 percent of bacterial meningitis cases result in death, including 20 to 25 percent of meningococcemia cases.

Those who contract the disease initially experience flu-like symptoms. The disease progresses extremely rapidly, though, and life-threatening symptoms--such as inflammation of the brain and the spinal cord--can appear within a matter of hours.

The other form of meningitis, caused by a virus, is far less serious than the bacterial strain.

A.J. Lardner, public health nurse at the University of Massachusetts at Amherst, where a student survived a case of meningitis last fall, said first-year students' unfamiliarity with crowded dormitory living and their tendency to partake in "high risk behavior," such a drinking and smoking, makes them most likely to contract the disease.

Lardner said students' chances of getting meningitis decreases steadily after their first year.

"By the time people are seniors, their risk behavior has gone down some," Lardner said.

Not Quite 100 Percent

Although the ACHA statement might seem like a clear message to get vaccinated, Lardner said the statement was far from a recommendation.

"It was worded rather funny," Lardner said, adding that to her it seemed vague.

Although the meningitis vaccine is completely safe, it only immunizes recipients from four of the five strains of the disease. It offers no protection from the other strain, which causes about 30 percent of the cases on college campuses.

And Lardner said the vaccine is not 100 percent effective against the other four strains. So even if students receive the vaccine, they should not ignore the disease, she said.

"You don't want to get a false sense of security," Lardner said.

The ACHA cites two CDC studies indicating increased risk of meningitis among first-year students living in dormitories, but many people believe the new policy was caused primarily by media pressure. This fall, ABC ran a profile on college meningitis cases in its newsmagazine "20/20" that some health professionals said they credit with raising parental awareness of the disease.

"It's in the press. It's in the media. It's on '20/20.' It's on '60 Minutes.' You have to respond to that," Lardner said.

But other critics charged that the money and attention given to meningitis should instead be focused on drug and alcohol abuse, which result in far more deaths on college campuses.

All this attention and the ACHA and CDC policies have led to different reactions on various college campuses.

Although UHS has complied with the CDC's recommendation, Harvard is doing little to encourage students to get the vaccination.

Last fall, UHS distributed a brochure on meningitis to all dorms and Houses. The brochure includes information on the effectiveness of the vaccine and on what students should consider when deciding whether to be vaccinated.

Rosenthal said heightened national awareness about meningitis led to a considerable increase in the number of vaccinations given at UHS, although that number has declined substantially in recent weeks.

"We've probably given [the vaccine] twice as much as we've ever given it before," Rosenthal said.

UHS, however, has stopped far short of recommending that students opt for the vaccine.

Noting that the vaccine may not have prevented cases of meningitis that caused deaths at colleges this year, Rosenthal said individuals should decide on their own whether to get the meningitis vaccine.

"From what I know about the meningococcal vaccine, I am leaving it up to an individual choice," Rosenthal said. "It depends on how people feel about their own health needs."

Rosenthal said people tend to overreact when there are a few well-publicized reports of meningitis cases.

"When someone dies of a devastating disease, everybody wants to cure it or prevent it," he said. "But how significant is that as an overall problem in the United States? That's why its important to look at statistics and approach things as rationally as you can."

Public Policy

At UMass, where four students have contracted meningitis over the last few years--two of them fatally--student interest in vaccination seems to be lukewarm.

Lardner said the ACHA and CDC statements forced UMass to substantially change their meningitis vaccination policy. Previously, UMass rarely recommended the vaccine, despite the previous cases at the university.

"[The vaccine] was only recommended to students going to sub-Saharan Africa," Lardner said.

Lardner said UMass was forced to change its policy because it is a state institution and therefore must comply with CDC guidelines.

Lardner said that before the most recent meningitis case on campus, which coincided with the ACHA's recommendation, virtually no one asked for the vaccine.

"[Students] really didn't even know about it," Lardner said.

Even now, just weeks after the latest meningitis scare created a rush for vaccinations, Lardner said the numbers of those asking for vaccinations is almost as low as it was before.

A High Price to Pay?

Another deterrent to students thinking of getting vaccinated for meningitis is the vaccine's high cost.

Insurance companies do not cover the vaccine, which makes it very expensive. The actual cost varies between colleges. Harvard offers the vaccine for $77. By contrast, students at Yale can be vaccinated for $75, and at Dartmouth students only have to pay $40.

Rosenthal said Harvard provides the vaccine at "just a little bit" above cost and said UHS is not charging a relatively high price on purpose.

"We're always looking for better prices," Rosenthal said. "That's the price we were told."

Rosenthal said he had not been aware that UHS charged a high price and questioned how other schools got the vaccine at such a low cost.

"Most other universities don't have pharmacies like we do," he said. " So I'm not sure what [price] they're quoting."

Turco also downplayed the disparity between the cost of vaccination at Harvard and Dartmouth.

"There are many different costs that the health service has at Harvard that we don't have here," Turco said. "Anything under $100 I would put in a reasonable category."

Still, Harvard's price was higher than those at several other universities. Of 10 schools contacted, only the University of California-Los Angeles charged more.

Dartmouth had the lowest price tag, and the college takes an active stance in preventing the spread of the disease. Even before the student died of meningitis last June, Dartmouth had encouraged students to get the vaccination.

"We've actually recommended at Dartmouth that people get the vaccine," Turco said. "We've been sending out recommendations for the past three years."

Turco said there is no reason for students not to pay for the vaccine, even if the disease is rare.

"I think if you look at the cost of an education at Harvard or Dartmouth, $40 is not an unreasonable cost for the student or family to reduce [the risk]," Turco said.

"I vaccinated my three kids," he added. "And I personally slept better at night."

Turco said he did not agree with the criticism over the cost-effectiveness of the vaccine, noting that the very fact that the vaccine reduces the risk of meningitis justifies students getting it.

"As the director of a college health service, my prime task is to prevent people from getting ill and certainly from dying. I think it's a very very high [risk] to put a price tag on that."

Turco claims Dartmouth has vaccinated over half of its students. Next year, he said, the college plans to send out an even stronger recommendation.

Even if other colleges are not following Dartmouth's lead in recommending the vaccine now, Turco believes that they will soon, even if it takes more meningitis cases across the country to convince them.

"I think in the next few years there's going to be many more kids growing up who are going to get the disease," Turco said. "Slowly schools, one way or another, are going to suggest that people consider it and maybe go even stronger than that."