September is nigh and for college freshmen thoughts turn to school and the upcoming move into a dorm. Headaches and neck pain from meningitis are likely the last thing on a new student’s mind but an increasing number of US colleges require proof of meningitis vaccination for those planning to live on campus, or, at some colleges, for all students. College freshmen are at an increased risk of bacterial meningitis compared to their peers, presumably due to the close quarters in which they live and the lifestyle changes accompanying college life which can compromise immunity (such as diet, alcohol and drug consumption, and altered sleep patterns). A small number of meningitis outbreaks at US universities in recent years have colleges increasingly concerned about students’ immunity to the infection, as does a particularly virulent strain of bacteria causing meningococcal meningitis. Some colleges even require students to sign a waiver indemnifying the institution against legal action should a student choose not to be vaccinated.
There is a legal requirement in almost all states for colleges to provide information for students regarding meningitis, and more than a dozen have made meningitis vaccination mandatory, unless a waiver is signed. A list of the state-wide mandates on vaccination can be found here. Most college freshmen will have received education on meningitis in high-school and are familiar with its symptoms. However, determining the cause of neck pain and discerning a headache with neck pain due to bacterial infection from a tension-related headache with neck muscle cramps can be difficult at the best of times, making early identification of meningitis in busy, stressed, and fatigued freshmen particularly problematic. So-called ‘Fresher Flu’ is also rife in dorms in the first weeks of college and as bacterial meningitis is transmitted through nasal and throat secretions, kissing, coughing, sneezing, and sharing glasses, beer bottles, or cigarettes increases a student’s risk of infection. Good hygiene practices (such as handwashing) are clearly paramount in controlling the spread of disease.
Students who have not had the vaccination prior to school starting are likely to be directed towards their campus clinic or a local physician for immunization against bacterial meningitis, with the vaccine Menactra considered 83% effective against four of the five strains of bacterial meningitis. This vaccine is only approved for use in those over eleven years of age, with a different vaccine used for infants. The Centers for Disease Control recommend use of Menactra for all those between eleven and eighteen years of age, although only 12% or so of teens are thought to receive the vaccine.
The numbers of college students taking up the offer of the vaccine is steadily increasing however as awareness of the seriousness of the disease improves through educational efforts. The vaccine is usually covered by health insurance and costs around $120 for most college students. There are, however, possible side-effects to the vaccine, including a link with Guillain-Barre syndrome, which can give some students pause for thought, but most consider vaccination the better choice. Campaigners against mandatory vaccination believe in giving people the choice rather than enforcing immunization of college students against what is considered a rare disease. Such arguments, citing the possible hazards of vaccination, once again highlight the need for better recognition of the signs and symptoms of meningitis so as to provide early treatment that can save lives.
Headache and Neck Pain – Symptoms of Meningitis
Anyone suffering from a headache, fever, neck pain, and a rash should seek immediate medical attention as bacterial meningitis can quickly spread and cause lasting neurological damage. Nausea and vomiting may occur, along with loss of vision and/or hearing, discomfort when looking at bright lights, numbness in the extremities that spreads across the body, confusion, sleepiness, seizures, and coldness in limbs through a loss of circulation. The infection may be relatively rare but is fatal in 10-12% of cases of meningococcal meningitis as infection causes the body’s organs to shut down. It is the rapid progression of the disease which makes it so terrifying; headache and neck stiffness can quickly develop into paralysis, loss of vision, and a general inability to summon help. Of those surviving the infection, which affects the meninges lining the central nervous system (including the spinal cord and brain), around 20% suffer brain damage, kidney damage, limb amputation following ischaemia, or permanent loss of hearing or vision. Other complications can also arise due to the systemic nature of the infection.
Bacterial meningitis affects less than 3,000 people in the US each year, but most of these are either very young infants (under one-year old) or college students. Doctors are also quite fearful of the infection as it is easy to dismiss symptoms as minor ailments and send patients home only to have them return as emergency cases hours later. In most flu-like cases a doctor will be reluctant to carry out a spinal tap procedure to check for bacterial meningitis as the procedure itself carries the risk of spinal cord damage or infection. If a rash is present along with flu-like symptoms, and the rash does not disappear under glass, the doctor is likely to suspect meningitis and carry out appropriate testing. Early intervention with antibiotics can successfully treat meningitis, but even the slightest delay in treatment can be deadly. Going to bed with a headache and a stiff neck, some students will simply not wake up in the morning, making meningitis a real fear for college freshmen and their parents.