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Meningitis Vaccinations to be Offered at Dec. 7 Student Health Clinic

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Duke Health News 919-660-1306

DURHAM, N.C. - Hundreds of Duke University students are
expected to line up Dec. 7 for vaccinations against bacterial
meningitis at a special immunization clinic organized by
Student Health Services (SHS).

The clinic, to be held from 11 a.m. to 6:30 p.m. in the
Bryan Center on Duke's West Campus, comes in the wake of
national media attention to the rare but deadly disease,
outbreaks on several college campuses and revised vaccination
guidelines from the U.S. Centers for Disease Control and
Prevention (CDC).

SHS Director Dr. William Christmas and campus administrators
began fielding questions from concerned parents and students in
early October after a series of broadcast and newspaper stories
appeared which questioned the lack of meningococcal
vaccinations among college-age students. Inquiries intensified
around Parents' Weekend, Oct. 22-24, which coincided with the
release of revised vaccination guidelines by the Advisory
Committee on Immunization Practices (ACIP) concerning the
disease that inflames brain and spinal cord tissue.

"During that weekend, it became clear that this was an issue
in the minds of the parents," said Sue Wasiolek, assistant vice
president in Duke's Office of Student Affairs.

Several parents asked questions about meningitis and the
need to get their children vaccinated during a panel
discussion, she said. Another 200-300 inquiries have come into
Student Health Services in the past two weeks.

"It's a personal decision for parents and students,"
Christmas said. "We provide information and let them decide. If
they have concerns, we inform them that they probably should
consider getting vaccinated."

ACIP, which offers advice to the U.S. Surgeon General and
CDC, recommended on Oct. 20 that universities and colleges give
information to students and their parents about meningococcal
disease and the benefits of vaccination.

"Vaccination should be provided or made easily available to
those freshmen who wish to reduce their risk of disease," ACIP
advised in a statement. "Other undergraduate students wishing
to reduce their risk of meningococcal disease can also choose
to be vaccinated."

Stopping short of advocating routine immunization for all
undergraduates, ACIP cited results from two CDC studies done in
1998 which identified a "modestly increased risk" among
freshman dormitory dwellers. While the likelihood of any 18- to
23-year-old in America contracting bacterial meningitis is
about 1.1 in 100,000 annually, that rate rises to 3.1 cases per
100,000 U.S. college dormitory residents each year and 5.2
cases per 100,000 freshmen living in residence halls.

"Fifty-five dollars, to me, is very inexpensive insurance
against a very serious disease," said ACIP member Dr. Samuel
Katz, who is Wilburt C. Davison professor and chairman emeritus
of Duke's Department of Pediatrics. "This is a very unusual
disease, but if my son or daughter were entering college today
I'd recommend they get the shot."

ACIP's recommendation comes two years after similar advice
was given by the American College Health Association (ACHA),
which represents about one-half of U.S. colleges with student
health services, including Duke. ACHA advocated in September
1997 that "college health services [take] a more pro-active
role in alerting students and their parents about the dangers
of meningococcal disease" and that "college students consider
vaccination against potentially fatal meningococcal
disease."

Since 1997, that recommendation has appeared, under the
heading "Attention Future Duke Students!!!!," at the top of a
letter sent with medical history forms to all incoming Duke
undergraduate, graduate and professional students.

"I believe that already meets the recommendation of the
ACIP," Christmas said. "If, in the future, the Advisory
Committee on Immunization Practices changes its stance on this
issue, we will follow their advice. For now, we leave this
decision to students and their parents." The consequences of
contracting the disease can be grim.

Of the approximately 3,000 cases of meningococcal disease
diagnosed each year in the United States, about 300 patients
die despite receiving antibiotics early in illness. About one
in 10 survivors has serious aftereffects, including mental
retardation, hearing impairment and loss of limbs.

"You can be fine now and go into shock and die six hours
later," Katz said. "And all you need is one death to throw
everybody into a panic. If that person was your roommate or
your child, it doesn't matter if the disease was considered
rare."

Three Duke students and a college student who visited campus
were diagnosed with meningococcal meningitis shortly before
spring break in 1987, Katz recalled. Campus health officials
scrambled to amass an adequate supply of vaccine, set up an
immunization clinic and vaccinate several thousand students
before the campus emptied.

Nearly all campuses, including Duke, require all incoming
freshmen to be immunized against measles, mumps, rubella,
polio, diphtheria and tetanus. But Duke and most others do not
require meningococcal vaccinations.

"That's the big conversation going on right now," Christmas
said. "What do you recommend and what do you require? Is that
the most efficient use of funding or could it be better spent
on other campus health issues?"

The meningococcal vaccine, which offers protection for three
to five years, is generally well tolerated and has a low
incidence of side effects, he said. But it is only about 70
percent effective because it doesn't protect against one of the
five strains of bacteria that cause meningococcal disease.

More than 100 Duke students have gotten vaccinated against
meningococcal meningitis so far this fall, said Jean Hanson,
SHS assistant director. "We have the vaccine. It's available,"
she stressed. "We haven't turned anyone away who was serious
about getting immunized."

The Dec. 7 clinic is targeted at undergraduates, especially
freshmen and sophomores, who still want the vaccination, she
said. Those students who wait until next month's clinic for
their meningococcus immunization will save $20 off the current
$75 charge, Hanson added. The university has secured 800
multi-unit doses, which are cheaper than the single-unit doses,
and is passing the savings along to the students.

SHS will accept university debit card or bursar account
charges at the clinic to cover the $55 fee for the vaccine.
Hepatitis A, hepatitis B and flu shots also will be
available.

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