Feeling “Surrounded”: Enhancing Preparedness for One of the Scariest Disease Threats on a College Campus
I’ve been reflecting recently on the long-lasting impact the events of 2001 have had on public health preparedness in the U.S. The anthrax letters, in particular, still drive much of the focus of our national preparedness agenda – how will we rapidly provide antibiotic pills to the entire local population if a plane drops anthrax spores over a major city like Minneapolis or St. Paul? We’ve been planning for that scenario for so long, it just seems natural. In fact, in 2020 public health officials from across Minnesota will conduct response drills around an anthrax attack scenario. Preparing for other man-made emergencies, like active shooter response, has also become part of the fabric of our work. The epidemic of mass shootings in this country continues to rage on, and we do the best we can to be ready on multiple fronts. There is also the tried and true public health emergency response scenario offered by Mother Nature - influenza pandemics. We’ve got detailed plans for that too!
So what are we missing? Staff in the Health Emergency Response Office (HERO), and our campus partners, ask ourselves that question all the time. In our most recent discussions, we looked at this map created by the National Meningitis Association and found we were “surrounded” by campuses who have experienced meningococcal disease cases in the last several years. We felt vulnerable. We also felt motivated to learn from the experiences of our peers in other campus communities and take steps to enhance our own preparedness. Ironically, the last time we saw meningococcal disease cases on this campus was in 2001.
Meningitis is a scary word that most people do not completely understand. It refers to a swelling of the protective membranes covering the brain and spinal cord. Importantly, and not always understood, this type of swelling can be caused by many things including bacteria, viruses, fungi, parasites, amoeba, and non-infectious reasons such as cancers and head injuries. On a college campus, the type of meningitis of most concern is caused by a bacteria, and is referred to as meningococcal disease.
Meningococcal disease is of grave concern to us because up to one out of seven (10-14 percent) of those who get the disease die. Of those who survive, up to one out of five have permanent disabilities, such as deafness, brain damage, loss of limbs, or seizures.
Symptoms can include high fever, headache, very stiff neck, confusion, nausea, sensitivity to light, vomiting, and exhaustion. A rash may also develop if the infection has reached the bloodstream. It is a challenging disease as early symptoms can easily be mistaken for influenza or other illnesses. When symptoms start; however, they progress quickly and the person may get very sick very fast. Rapid response to prevent further cases is essential.
Meningococcal disease is spread by contact with fluids from the nose and throat. Sharing eating utensils, drinking from the same cup or glass, kissing, sharing a cigarette or lipstick or lip balm, living in the same household are all means of transmission. The good news: the bacteria is not spread through casual contact (being in the same room or touching the same object).
Here’s another fact that most people may not know. There are 13 strains of the bacteria that cause meningococcal disease. Five strains can be prevented by vaccines (A, B, C, W and Y strains). There are two types of vaccine available in the U.S. Fortunately, the vaccine that prevents against A, C, W, and Y is routinely administered to young adults before they head to college. This is the vaccine many people think of as the “meningitis vaccine”. Due to high vaccination rates, outbreaks with these four strains on college campuses are rare. Unfortunately, the available vaccines to protect against the B strain are not routinely given to young adults. This is due to a combination of federal advisory guidelines, insurance company policies on coverage, and lack of awareness about the different types of vaccines. As more college outbreaks from the B strain are documented, I’m hoping we see some changes on all those fronts in the future.
Meningococcal disease outbreaks on college campuses typically impact undergraduate students, particularly freshman students living in residence halls. As shown on “the scary map” as we call it in the HERO offices, 36 college campuses in the U.S. have seen cases in the time period from 2013-2017, including in the states surrounding Minnesota. We have been reviewing lessons learned from these peer institutions. Here is one example:
- University of Wisconsin – Madison: In October 2016, two student contracted meningococcal disease with laboratory tests indicating the causative bacteria were genetically matched. Campus and government health officials declared an outbreak and quickly instituted response measures. Mass vaccination clinics were held for undergraduate students aged 25 and younger, particularly those living in residence halls. Seven clinics were held vaccinating 22,440 students. Counting additional vaccines provided at the health service, 67% of the undergraduate risk group were vaccinated. A multi-faceted communication plan was also established to inform students about the need for vaccination, but also importantly, about prevention behaviors to lower the risk of exposure to the bacteria. Communication strategies included email, texts, classroom presentations, posters, signs, websites, social media posts, multimedia ads (video, radio, digital TV), stickers, flyers, posters, buttons, door knob hangers in residence halls, and table tents. It was a massive effort, involving many campus partners, and assistance from students, staff, faculty, and parents. In the end, only one additional case was diagnosed.
Based on the experiences in Wisconsin, and other states, our Meningococcal Disease Response Project, in partnership with the Minnesota Department of Health, has four goals:
- Create campus meningococcal disease response plans, protocols, and resources including detailed plans on how to rapidly provide vaccine to those who have been exposed and have not already been vaccinated.
- Increase awareness of meningococcal disease and required mass vaccination response actions among U of M Medical Reserve Corps members.
- Increase awareness of meningococcal disease and important clinical care response actions among health service providers.
- Provide opportunity for U of M Medical Reserve Corps members and available health service personnel to drill notification, staff staging, and just-in-time training for an initial mass vaccination site in response to a meningococcal B outbreak on campus.
In addition to making good public health sense, our efforts to prepare for meningococcal disease on our campus are important to me personally. I have two students here, a senior in the College of Biological Sciences and a freshman in the College of Science and Engineering. We recently moved my youngest daughter into her residence hall, one of the prime locations for infectious disease spread in any university community due to the close living quarters. I’m thankful every day for members of the HERO team, members of the U of M Medical Reserve Corps, and our campus partners, who work so diligently to ensure the health and safety of the Golden Gopher community.
Welcome class of 2023!