PITTSBURGH -- January 15, 2009 -- Paediatric pneumococcal conjugate vaccine (PCV7) appears to be effective in reducing the rates of pneumococcal meningitis in children and adults, according to a multicentre study published in the January 15 issue of the New England Journal of Medicine.
Based on a detailed review of pneumococcal meningitis cases, researchers also noted an increase in strains of pneumococcal meningitis not covered by the vaccine and those resistant to antibiotics.
Lee Harrison, MD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and colleagues reviewed 1,379 cases of pneumococcal meningitis from 1998 through 2005.
They found that rates of the disease decreased in children and adults after the introduction of PCV7 in 2000. Incidence rates for pneumococcal meningitis in all age groups declined 30.1% from 1998 to 1999 and 2004 to 2005. After PCV7 was made available, the incidence of meningitis decreased by 64% in children and by 54% in older adults.
The authors also observed that non-PCV7 strains increased by 60.5% from the 1998 to 1999 period to the 2004 to 2005 period, and the percentage of strains that were not sensitive to penicillin, which initially declined, increased from 19.4% in 2003 to 30.1% in 2005.
"PCV7 has been highly successful in preventing pneumococcal meningitis, but it remains a very serious and deadly disease," said Dr. Harrison. "Of the patients in our study, 8% of children and 22% of adults died. These findings indicate the need to continue to explore new methods of prevention with a special emphasis on strains that are not covered by PCV7 and strains that are drug resistant. Next-generation vaccines are in development and patients and physicians need to avoid unnecessary use of antibiotics."
SOURCE: University of Pittsburgh Schools of the Health Sciences
7-valent pneumococcal conjugate vaccine (PCV7)
Vaccine cuts bacterial disease in US
In 2003, routine immunization of US children with a vaccine that protects against bacterial infection prevented nearly 30,000 cases of severe disease, researchers from the Centers for Disease Control and Prevention report.
The 7-valent pneumococcal conjugate vaccine (PCV7) vaccine protects against a variety of infections caused by Streptococcus pneumoniae, many of which, such as meningitis or pneumonia, can be fatal.
"Routine use of PCV7 in young children has reduced the (rate of severe pneumococcal infections) in children and adults, and these reductions have increased since 2001," Dr. Deron C. Burton and colleagues note in the CDC's Morbidity and Morality Weekly Report. The use of the vaccine was tied to a drop in all pneumococcal infections, not just those that the vaccine was specifically designed to combat, the so-called vaccine-type infections.
In 2000, PCV7 was licensed for routine use in children under 5 years of age. In the years preceding licensure, the rate of vaccine-type infections among young children was 80 cases per 100,000 population. By 2003, this rate had dropped 94 percent to just 4.6 cases per 100,000 population.
However, it is not just the direct protective effects that make PCV7 important from a public health standpoint, but also the "herd immunity" that occurs.
Herd immunity occurs when a large proportion of the population is vaccinated against a particular microbe, which, in turns, makes the odds of infection among unvaccinated individuals low. In the present analysis, the herd immunity effect was actually twice as large as the direct protective effect.
Of the 29,599 vaccine-type infections prevented by PCV7 in 2003, just 9140 were through direct protective effects. The rest of the prevented infections were the result of herd immunity.
Outside of the target population, the greatest declines in both vaccine-type and overall pneumococcal infections occurred in people who were at least 65 years of age, the report indicates.
SOURCE: Morbidity and Mortality Weekly Report, September 16, 2005.
Vaccine Teen Meningitis Jab
WASHINGTON (Reuters) - Teen-agers and preteens should be routinely immunized against meningitis using Sanofi-Aventis's newly approved Menactra, U.S. vaccine advisers agreed on Thursday.
The vaccine can prevent a serious form of meningitis that can kill adolescents, the U.S. Centers for Disease Control and Prevention (news - web sites)'s Advisory Committee on Immunization Practices said.
It protects against four strains of Neisseria meningitidis bacteria and is licensed for use in adolescents and adults aged 11 to 55.
The new recommendations advise that children 11 and 12, teens entering high school at age 15 and college freshmen living in dormitories should be immunized against meningococcal meningitis.
"Meningococcal meningitis, caused by the bacterium Neisseria meningitidis, is a dangerous, potentially fatal bacterial infection that strikes nearly 3,000 Americans each year," the National Meningitis Association said in a statement endorsing the recommendation.
"The NMA believes these new recommendations will help save the lives of teens and college students across the country," said NMA executive director Lynn Bozof.
"Research shows adolescents and young adults are at increased risk for meningococcal disease and more likely to die as a result of the disease than younger children or older adults," Bozof said.
Meningitis starts out with flu-like symptoms but can progress rapidly to cause hearing loss, brain damage, limb amputation and death.
Symptoms include high fever, headache, stiff neck, confusion, nausea, vomiting and exhaustion.
Immunizations and Teens
Measles, mumps, and other diseases may seem like relics to students of the 21st century. But outbreaks of these and other contagious diseases can actually cause problems on campuses where large numbers of people are living and studying together in close quarters.
Many of the contagious diseases that are less common in the United States are still epidemic in other parts of the world and can be brought across borders by travelers. Some serious infections, like bacterial meningitis, may even have life-threatening consequences for students.
Luckily, the risk of coming down with a serious disease is far less when you and your peers are immunized. That's why so many colleges require that students get certain immunizations (also known as vaccinations) before they attend school. Most schools give students a grace period of a week or 2 in which to get vaccines. After the grace period, though, some colleges will suspend students who haven't fulfilled their immunization requirements - that's how seriously they take the issue.
How Does Vaccination Work?
Vaccines contain either parts of microbes (bacteria or viruses) or whole microbes that have been killed or weakened so that they don't cause disease. When a person is vaccinated, these harmless versions of the microbes enter the body, where they stimulate the immune system to react as if a real infection had developed. The immune system makes antibodies to these microbes that "remember" a virus or bacterium should it be encountered again. That way, the body can fight off the real microbe quickly if it enters the body in the future.
After getting a vaccination, it generally takes 10 days to 2 weeks for the body to build up immunity to a disease.
We usually think of vaccines as the shots we were given as kids. But not all vaccines are shots - some are given orally (by mouth) or in other forms like nasal sprays.
What Vaccinations Do I Need for College?
The American College Health Association's (ACHA's) Vaccine-Preventable Diseases Task Force provides a list of recommended vaccines on its website (click on the Resources tab at the right for more information). However, because college immunization requirements are based on state law, not all the vaccines they recommend will be required in different parts of the country. The best idea is to check with your school to make sure you have all the vaccines necessary to matriculate. Students entering medical programs have slightly more stringent requirements than other students.
The vaccinations most commonly required on campuses are:
tetanus booster (Td)
measles, mumps, rubella (MMR)
polio, in the form of inactivated polio virus (IPV) or oral poliovirus (OPV)
hepatitis B (HepB)
varicella (chickenpox) if you have not had the disease
Your school may also recommend immunizations to protect you from certain diseases such as:
meningococcal meningitis - some schools allow you to sign a waiver if you have not been vaccinated
The following are particularly encouraged for students who have chronic illnesses, such as diabetes:
influenza - this needs to be given annually to offer protection because the makeup of the vaccine changes with each flu season
Some of these vaccines are given as a single dose; others, like hepatitis B, involve a series of shots separated by a specified number of weeks or months. Still other vaccines require a periodic booster shot to ensure that a person's level of immunity remains high. You can check with your doctor to make sure you have had the requisite number of doses of each vaccine.
Your school may also require tuberculosis (TB) screening. This is a simple skin test that involves a slight prick to the skin and then waiting to see if there's a reaction. You'll need to see a health care provider between 48 and 72 hours after the test is given so he or she can look at the skin prick and interpret the results.
TB screening is not a vaccine, but it does allow doctors and student health staff to identify people who may have TB. The disease can then be treated and prevented from spreading to others. Your doctor can give you more information on the tuberculosis skin test and the meaning of its results.
How Do I Find Out If I've Had the Right Vaccinations?
Even if you don't remember receiving them, you probably had most of the vaccines necessary to attend college before you started elementary school. Contact your pediatrician or family doctor to find out. Someone from the office can send your health records to your school or fill out the forms the school provides.
If it's unclear whether you had the infection or received a particular vaccine, your doctor may be able to measure antibodies in your blood to the infectious agent that causes that disease. This measurement is called a titer, and it can be taken with a simple blood test. A certain level of antibodies indicates that you have immunity to a disease, in which case you may not need to be vaccinated.
If it turns out you missed out on one or more of the required immunizations, you can receive them from your doctor or your school's student health center. Health centers typically offer vaccinations at a low cost, and some insurance companies will pick up the tab, too. Your school may even have an annual immunization day, when you can get many of the shots you need. Check the student activity calendar or call your health center for more information.
Are Vaccinations Safe?
Like any medicine, vaccines may cause side effects - but getting a vaccine is far safer than getting the disease it prevents. The most common reactions include soreness, redness, and swelling in the area of the shot or a low-grade fever. Usually acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin) will take care of these side effects.
Adverse reactions to vaccines are rare. Reactions will depend on the type of vaccine given, so ask your doctor about the possible reactions. Also, if you've had reactions to vaccines in the past, let your doctor know.
Who Should Not Be Vaccinated?
Some students might need to hold off on getting their vaccines. If you are pregnant, have a compromised immune system (from AIDS or certain cancers, for example), or are undergoing chemotherapy or receiving other types of medication that can weaken the immune system, consult with your doctor before receiving any shots. Temporary medical exemptions are usually available to enable you to enroll and register for classes if medical reasons prevent you from getting all of the requisite vaccinations.
People with certain allergies may need to exercise caution with specific vaccines. The influenza vaccine, for example, is developed using chicken eggs. So if you're allergic to eggs, be sure to discuss that with your doctor. People who have severe allergies to gelatin or the antibiotic neomycin should also be careful with the MMR and varicella vaccines. And if you are extremely allergic to baker's yeast, which is used to make bread, you should not get a hepatitis B vaccine.
In some cases, schools will allow students to opt out of immunizations on religious grounds. However, schools usually require documentation to confirm this.
What About Travel?
Studying abroad? Depending on where you're going, you may need additional vaccinations. Visit the Centers for Disease Control and Prevention website (see the Resources tab at the right of this article) for a list of specific vaccines recommended for various destinations. Or ask your health care provider or the staff at student health services for information.
Don't put off getting your vaccinations until the last minute. Some immunizations require a series of shots, and it may take time to get the full cycle. To ensure immunity, most immunizations should be given at least 1 month before you travel.
Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: August 2004
Note: All information on TeensHealth is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
Meningococcal disease is a rare but potentially fatal bacterial infection. The disease is expressed as either meningococcal meningitis, an inflammation of the membranes surrounding the brain and spinal cord or meningococcemia, the presence of bacteria in the blood.
What causes meningococcal meningitis?
Meningococcal disease is caused by the bacterium Neisseria meningitidis, a leading cause of meningitis and septicemia (or blood poisoning) in the United States. Meningitis is one of the most common manifestations of the disease, although it has been known to cause septic arthritis, pneumonia, brain inflammation and other syndromes.
How many people die from meningococcal meningitis each year?
Meningococcal disease strikes about 3,000 Americans each year and is responsible for approximately 300 deaths annually. It is estimated that 100 to 125 cases of meningococcal disease occur annually on college campuses and five to 15 students die as a result.
How is meningococcal meningitis spread?
Meningococcal disease is transmitted through the air via droplets of respiratory secretions and direct contact with an infected person. Direct contact, for these purposes, is defined as oral contact with shared items such as cigarettes or drinking glasses or through intimate contact such as kissing.
What are the symptoms?
The early symptoms usually associated with meningococcal disease include fever, severe headache, stiff neck, rash, nausea, vomiting, and lethargy, and may resemble the flu. Because the disease progresses rapidly, often in as little as 12 hours, students are urged to seek medical care immediately if they experience two or more of these symptoms concurrently.
Who is at risk?
Recent evidence found students residing on campus in dormitories appear to be at higher risk for meningococcal disease than college students overall. Further research recently released by the CDC shows freshmen living in dormitories have a six times higher risk of meningococcal disease than college students overall.
Although anyone can come in contact with the bacteria that causes meningococcal disease, data also indicates certain social behaviors, such as exposure to passive and active smoking, bar patronage, and excessive alcohol consumption, may put students at increased risk for the disease. Patients with respiratory infections, compromised immunity, those in close contact to a known case, and travelers to endemic areas of the world are also at increased risk. Cases and outbreaks usually occur in the late winter and early spring when school is in session.
How often do outbreaks occur in on college campuses?
From 1980 to 1993, there were 21 outbreaks, three of which occurred in colleges. From 1994 to 1996, there have been 26 outbreaks, four of which occurred in colleges. Between 1986 and 1993, an outbreak was defined as five cases of the same serotype in 100,000 people with at least three occurring within three months. From 1994 to present, 10 cases of the same serotype in 100,000 people with at least three occurring within three months constitute an outbreak.
Is one type of serogroup of meningococcal meningitis more common in college students?
Recent evidence shows the epidemiology of meningococcal disease is changing with a majority of cases (65 percent) in the college age group caused by either serotype C, Y, or W-135, which are all vaccine-preventable.
What is ACHA's recommendation on meningococcal disease?
ACHA Vaccine-Preventable Diseases Task Force has agreed to adopt the new ACIP recommendation, which recommends that undergraduate college students, particularly freshmen who live in or plan to live in dormitories or resident halls, consider getting the vaccine to reduce their risk for meningococcal disease.
Does the CDC recommend vaccination for college students?
As of October 20, 1999, the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC) recommends that individuals who provide medical care to college freshmen, particularly those who live in or plan to live in dormitories or residence halls, should provide information about meningococcal disease and the benefits of vaccination with these students and their parents. ACIP further recommends that immunization should be provided or made easily available to those who wish to reduce their risk for meningococcal disease. Other undergraduate students wishing to reduce their risk for meningococcal disease can also choose to be vaccinated.
Additionally, the ACIP recommends that colleges and universities provide information about meningococcal disease and the vaccine to freshman, particularly those who plan to live in dormitories and resident halls, and encourages public health agencies to serve as a resource for information about meningococcal disease and vaccination, including how to obtain the vaccine.
Why should college students consider vaccination with the meningococcal vaccine?
Data from the U.S. Centers for Disease Control and Prevention (CDC) demonstrate increasing incidence of outbreaks on college campuses. Data further suggests that sub-populations of college students are at increased risk for meningococcal disease. Pre-exposure vaccination enhances immunity to four strains of meningococcus that cause 65 to 70 percent of invasive disease and therefore reduces a student’s risk for disease. Development of immunity post-vaccination requires 7-10 days.
Who be vaccinated pre-exposure?
* Entering college students, particularly those living in dormitories or resident halls, who elect to decrease their risk for meningococcal disease.
* Undergraduate students 25 years of age or under who request vaccination in order to decrease their risk for disease and are not pregnant.
* Students with medical conditions that compromise immunity (e.g., HIV, absent spleen, antibody deficiency).
* Students traveling to areas of the world with endemic meningococcal disease.
Are colleges and universities following ACHA's recommendation?
Since the release ACHA's recommendation in 1997, it is estimated that as many as 200 colleges and universities have included the ACHA recommendation on their college entrance health forms and/or are conducting awareness campaigns to educate parents and college students about this disease.
How effective is the vaccine?
The meningococcal vaccine has been shown to provide protection against the most common strains of the disease, including serogroups A, C, Y and W-135. The vaccine has shown to be 85 to 100 percent effective in serogroups A and C in older children and adults.
Is the vaccine safe? Are there adverse side effects to the vaccine?
The vaccine is very safe and adverse reactions are mild and infrequent, consisting primarily of redness and pain at the site of injection lasting up to two days.
What is the duration of protection?
The duration of the meningococcal vaccine’s efficacy is approximately three to five years.
What is ACHA doing to assess the risk of meningococcal disease among college students?
ACHA is currently partnering with the CDC on a surveillence study to identify potential subgroups of college students that may be at increased risk for meningococcal disease. Results of this study will be published in the near future.
What can a college do to protect students if an outbreak occurs?
If a suspected or diagnosed case of meningococcal meningitis is reported (on campus or in neighboring communities), the following intervention measures should be considered:
* Intensify surveillance and increase awareness among college health services, community physicians and hospitals
* Notify college administration and health care personnel as well as public health departments
* Begin education on the college campus and in surrounding areas about transmission Pursue early diagnosis and treatment of cases and contacts
* Consider mass immunization of students to prevent additional cases if an outbreak occurs, that is, 10 cases per 100,000 and three or more cases of the same serogroup within three months
Because meningococcal meningitis is one of the most feared diagnoses in the United States, sporadic cases and outbreaks almost invariably spread panic through college communities. In order to proactively guard against an outbreak (or endemic disease), ACIP recommends that undergraduate college students, particularly freshmen who live in or plan to live in dormitories or resident halls, should consider getting the vaccine.
In the event of an actual meningitis outbreak, ACHA has developed a response kit to guide college health officials in appropriately and expeditiously responding to sporadic cases and outbreaks. For more information about the kit, e-mail ACHA.
UNIVERSITY OF CALIFORNIA AT DAVIS INFO
Meningococcal Meningitis Vaccination (Menomune)
Because recent studies conducted by the U.S. Centers for Disease Control and Prevention (CDC) and the American College Health Association (ACHA) have identified a modestly increased risk for meningococcal disease for freshmen living in residence halls, Cowell Student Health Center currently recommends Meningococcal vaccination for freshmen living in residence halls. The health center suggests that other students consider the vaccine in light of their own unique health needs, though immunization is neither specifically recommended nor discouraged for them. Freshmen living outside residence halls and other students in residence halls do have a slight elevation of their risk also. Overall, however, in the U.S., university undergraduates age 18-23 have a lower incidence of meningococcal disease than the non-student population of the same age.
While the incidence of meningococcal disease in close-contact populations in the U.S. - such as new military recruits or freshmen students in residence halls can be higher than the general public, the actual disease rates in this country remain quite low. The most recent CDC studies show a national disease incidence of 1.4 cases/100,000/ year for the general population of 18-23 year olds. In 2000, there were no reported cases in the UC Davis student population.
Meningococcal disease can be a catastrophic and even lethal illness. Even with its low incidence, prevention measures are a priority. For those at identified increased risk, immunization is a valuable part of a comprehensive prevention strategy and we strongly encourage students and their families to carefully consider the option.
Persons considering Meningococcal vaccination should, however, be aware of the limitations of this vaccine. The vaccine is not 100% effective. While it offers 85% to 95% protection for the 4 bacterial strains that cause 70% of meningococcal disease in the US, it does not offer protection against the B strain responsible for the remaining 30% of cases. The vaccine also does not provide for lifelong immunity. (Disease protection lasts only 3-5 years.) Because it cannot prevent all Meningococcal meningitis , persons who have been immunized who are knowingly exposed to the disease must still seek medical attention to receive preventive antibiotic medication, or treatment for symptoms of headache, fever, neck stiffness and vomiting.
Persons considering vaccination should also be aware of the possible vaccine side effects. While the vaccine is considered very safe and poses no risk of causing the disease itself, it can occasionally produce local injection site swelling and discomfort. Rarely, a flu-like syndrome or local or systemic allergic reactions may occur as is possible with most vaccine products. Persons with a known history of immunization reactions should review this history with their personal physician or a member of the Cowell Student Health Center clinical staff before seeking immunization. All of these factors must be weighed by students when making their vaccination decisions.
Cowell clinical staff will be happy to discuss each student's own health needs, risks and other issues through an appointment for that purpose. Nurse appointments can be made by calling 752-2349. If you have unique health needs or specific concerns about your risk for this disease, you may make an appointment with a physician or nurse practitioner. To make an appointment, call the appointment desk at 752-2349