It’s that time of year – parents are sending their offspring to university, worrying how said child is going to cope with washing, ironing, cooking and hangovers. What rarely crosses their mind is the possibility of meningitis.

Usually perceived as a disease of early childhood, meningitis is classed as either bacterial or viral [1]. Bacterial meningococcal disease is caused by the bacterium Neisseria meningitides, (common types being A, B, C, W, X and Y) [2] and causes serious and life-threatening diseases including meningitis.

While the overall incidence is dropping relative to the take-up of the meningitis C, pneumococcal, and MMR vaccines, succumbing to a viral or bacterial episode is not uncommon, particularly in places where people are in prolonged close contact, such as halls of residence. Kissing and coughing can also spread the disease. A study [3] of first year university students which aimed to determine the rates of, and risk factors for, meningococcal carriage and acquisition, found that:

• Carriage rates for meningococci increased rapidly in the first term among students living in catered halls; the average rate during the first week was 13.9% (October), increasing to 31.0% in November and 34.2% by December.
• Independent associations for acquisition included frequency of visits to the hall bar, smoking, attending night clubs, kissing and being male. Lower rates of acquisition were found in female only halls [3]

Viral meningitis is considered to be less serious than bacterial with fewer long-term effects. However, a survey commissioned by the Meningitis Trust in 2012 suggested that 97% of respondents had been left with long-term effects such as exhaustion, headaches and memory loss [4]. Bacterial meningitis is usually serious and requires immediate medical attention – death is not uncommon. In the long-term, it can cause [5]:

• Memory problems
• Coordination difficulties or weakness
• Residual headaches
• Hearing/speech problems
• Epilepsy
• Sight problems

Unfortunately, the signs and symptoms of meningococcal infection often mimic those of student life in general. They include:

• Fever and/or vomiting
• Cold hands/feet, shivers
• Pain in limbs, joints or muscles
• Pallor
• Breathlessness or fast breathing
• Sleepiness, hard to wake
• Appearing vacant, or confused, or delirious
• Rash/dislike of bright lights

Thus, those going to university should be aware that these symptoms may be a cause for concern.

Vaccination

Approximately 90% of cases of meningococcal disease in the UK are caused by type B disease (MenB) [2]. Meningococcal W (MenW) is an aggressive bacterial strain (ST-11), the numbers of which have been increasing – in the UK in 2005 22 cases were identified (1-2% of meningococcal cases), in 2014, the number had risen to 117(15%) [5]. MenW has a particularly high death rate – 13% compared to 5-10% in other cases [5]. University students in particular have been affected [4].

As a result, the Joint Committee on Vaccination and Immunisation (JCVI) reviewed the outbreak in detail and concluded that as this increase was likely to continue unless action is taken. They therefore advised that 14 to 18 year olds should be immunised against meningococcal group W (MenW). Public Health England (PHE) launched the MenACWY vaccination programme in June 2015. Starting with the vaccination of those aged 17-19 years, the aim is to protect against the four meningococcal strains that cause meningitis or septicaemia, including MenW [6].

The vaccines used will be Nimenrix® or Menveo®.  Both are conjugate vaccines and come in a powder and solvent for solution for injection in pre-filled syringe [7]. They contain small amounts of polysaccharides extracted from the A, C, W135 and Y groups of the N. meningitidis bacterium, which have been attached to a protein carrier, tetanus toxoid, improving the immune response to the vaccine [8].

Conclusion

Both students and clinicians need to be aware of the risks of contagion while at university, particularly in the first terms. Early recognition of the signs and symptoms is key.

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

References

1. NHS Choices. Meningitis. 2015 Available at: http://www.nhs.uk/Conditions/Meningitis/Pages/Introduction.aspx Accessed August 2015
2. University of Oxford Vaccine Knowledge Project. Meningococcal disease. 2015. http://www.ovg.ox.ac.uk/meningococcal-disease Accessed August 2015
3. Neal KR, Nguyen-Van-Tam JS, Jeffrey N, Slack RCB et al. Changing carriage rate of Neisseria meningitidis among university students during the first week of term: cross sectional study. BMJ. 2000. 320:846-840. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27326/pdf/846.pdf Accessed August 2015
4. Meningitis Now. Viral Meningitis, the facts. Meningitis Now. 2015. http://www.nhs.uk/ipgmedia/National/Meningitis%20Now/assets/ViralMeningitis.pdf Accessed August 2015
5. Meningitis Research Foundation. MenW. Meningococcal W meningitis and septicaemia: a new, virulent strain. 2015. Available at: http://www.meningitis.org/menw Accessed August 2015
6. Public Health England. New meningococcal vaccination programme expected to save lives. 2015. Available at: https://www.gov.uk/government/news/new-meningococcal-vaccination-programme-expected-to-save-lives Accessed August 2015
7. European Medicines Agency. Nimenrix®. 2015. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002226/human_med_001548.jsp&mid=WC0b01ac058001d124 Accessed August 2015
8. European Medicines Agency. Menveo®. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/001095/human_med_001323.jsp&mid=WC0b01ac058001d124 Accessed August 2015

Resources

Meningitis Research Foundation. Meningococcal meningitis and septicaemia. Diagnosis and treatment in general practice. 2014. Available at: http://www.meningitis.org/assets/x/50631

Meningitis Research Foundation. Management of Meningococcal Disease in Children and Young People. 2015. Available at: http://www.meningitis.org/assets/x/50150 Accessed August 2015