The threat posed by a bacterial illness that killed two teenagers prompted at least three Ohio school districts last week to end the school year prematurely, as state health officials distributed preventive antibiotics to thousands of people and prepared to vaccinate nearly 6,000 students and school employees.
The threat posed by a bacterial illness that killed two teenagers prompted at least three Ohio school districts last week to end the school year prematurely, as state health officials distributed preventive antibiotics to thousands of people and prepared to vaccinate nearly 6,000 students and school employees.
School officials found themselves trying to strike a balance between preventing the spread of the illness—called meningococcal disease—and reassuring parents that it was highly unlikely their children would contract it.
The disease is caused by bacteria that are benignly carried by about 10 percent of people but can also cause infections of the brain area and spinal cord—called meningitis—or of the blood, according to public-health officials. About 10 percent to 13 percent of the 3,000 people each year who contract the illness in the United States die from it.
“It’s difficult for people to cope with because it’s with us all the time. It’s actually spread by all these people who you don’t see,” said Dr. Lisa A. Jackson, an associate professor of epidemiology at the University of Washington in Seattle. She co-wrote a 1995 article in the Journal of the American Medical Association that called meningococcal disease “an emerging threat.”
In the past five years or so, the pattern of the disease has been changing, Dr. Jackson said. Infants are the most susceptible to the illness, but “we have higher rates among adolescents and young adults than we used to,” she said.
Ohio’s Response
Over Memorial Day weekend in Alliance, Ohio, two previously healthy students, 15- year-old Jonathan Stauffer and 16-year-old Kelly Coblentz, who attended West Branch High School, were hospitalized with flu-like symptoms. They died within a couple of days of a severe blood infection.
Another student, 18-year-old Christin VanCamp of neighboring Marlington High School,attended the funeral of Ms. Coblentz in Salem, Ohio, and soon after was hospitalized with the same illness. Last week, hospital officials said Ms. VanCamp had moved from serious to stable condition. All three students were found to have been infected by Neisseria meningitidis, a bacterium that can spread from one person to another.
Public-health officials couldn’t figure out how the teenagers caught the infection. They knew that the last event that the two students from West Branch had attended before they became sick was a school picnic.
While health officials assured the public that the bacteria could be spread only through close contact—an exchange of respiratory or throat secretions that could occur through kissing or sharing the same drinking container or eating utensils—they recommended that people in the community take preventive antibiotics. In the 2,600-student West Branch district, which includes the high school attended by the two students who died, district officials cut the school year short by more than a week, closing the school on May 29 even though public-health officials assured them they could keep it open.
“We didn’t really believe we’d have enough participation by the student body to be effective the last couple of days of school,” said the district’s superintendent, Louis A. Ramunno.
The 2,800-student Marlington Local school district and 2,500-student Salem City school district cut the school year short as well. They also rescheduled their graduation ceremonies.
During that time, school leaders also worked with state health authorities to give the community an opportunity to take the antibiotics.
And late last week, the Ohio Department of Health, in consultation with the federal Centers for Disease Control and Prevention in Atlanta, mobilized to give 5,800 students, faculty members, and other staff members at six high schools in the Alliance area vaccinations against the illness.
Other Outbreaks
Alliance, Ohio, isn’t the only place where meningococcal illness has disrupted a school community this year.
New Caney Independent School District in Texas dealt with a similar outbreak of meningococcal disease in January. Three students in the 6,400-student district came down with the illness. One of them—a 15-year-old—died, and a middle school student lost one hand, two feet, and a couple of fingers as a result of the illness.
Publicity about the outbreak and the vaccination campaign that followed it helped raise awareness of meningococcal disease in the state and aided passage of a new law last month addressing the issue. The law requires the Texas Education Agency and the Texas Higher Education Board to set procedures ensuring that parents of school-age children and college students are informed by schools and colleges about the disease and its vaccine. Most cases of meningococcal illness are isolated ones; fewer than 3 percent are part of outbreaks. But the outbreaks tend to be among adolescents and young adults, Dr. Jackson of the University of Washington said.
The CDC defines an “outbreak” as the occurrence of at least three cases in an organization or community, resulting in a disease attack rate of at least 10 per 100,000 people within three months.
“Outbreaks were rare in the 1980s,” but “there are about 15 outbreaks a year now,” said Dr. Nancy E. Rosenstein, a specialist in meningococcal disease for the CDC. However, she pointed out, the overall number of individual cases per year has remained steady for 30 years.
Researchers don’t know why the number of outbreaks has increased, added Dr. Jackson. “Are there changes in the bacteria that have made it more likely to be spread? Are people more susceptible? We really don’t know,” she said.
Despite the increased number of outbreaks, Dr. Rosenstein and Dr. Jackson agreed that it doesn’t make sense for health officials to give routine childhood vaccinations for the illness nationally.
Dr. Rosenstein said such a change in policy would make sense only if a more effective vaccine were available. The current one provides protection for only three to five years, she said.
Cheryl Lufigz, a spokeswoman for the Ohio health department, said her agency chose to vaccinate students and employees from the six high schools in the Alliance area because the cases appeared among high schoolers and “there’s a lot of socializing between schools.”
Texas’ Vaccination Effort
The vaccination effort against meningococcal disease scheduled to occur last Friday in Ohio was believed to be the first in the history of that state.
Not so in Texas.
Neil Pascoe, a nurse epidemiologist for the Texas Department of Health, said Texas experienced a lengthy outbreak from 1994 to 1996 in the northeastern part of the state, involving 95 cases 0of meningococcal disease. The health department responded with mass vaccinations.
There wasn’t another outbreak of the disease in Texas requiring mass vaccinations until the one that occurred in New Caney, Texas, this past January.
At that time, health officials gave vaccinations to 8,500 people between the ages of 2 and 24 in the New Caney school district.
Then, two weeks later, when the number of cases of the illness in nearby Conroe, Texas, met the CDC criteria for an outbreak, the state health department gave 47,000 more vaccinations.
None of the incidents of meningococcal illness involved school-age children, and none of the incidents was fatal, but everyone in the 3,400-student Conroe school district who had a Conroe address was encouraged to get a vaccination.
Later, in March, Texas health officials carried out a vaccination campaign against meningococcal illness at Smithson Valley High School in New Braunfels, after two soccer players were hospitalized with the illness.
“We’ve been devoting hundreds of extra hours of limited resources to nothing but this issue since January,” Mr. Pascoe said. “There’s a tremendous amount of concern in the community, and a lot of other issues, including the need to give accurate information to people.”
School administrators involved in the Texas outbreaks empathized with school officials in Ohio last week, saying they know how difficult it is to reassure parents that their children are safe.
Faith J. Casperson, the head nurse of health services for the Conroe school district, said she had tried to reassure parents that “it takes close contact to get it. We tried to reassure people that just passing in the hall isn’t a reason to be worried. But people were.”
Ohio school officials said last week they had found themselves repeating over and over to parents that the chances a child would contract the illness were highly unlikely.
Arthur D. Garnes, the superintendent of the 3,500-student Alliance City School District, said health officials had told him that “someone has to literally sneeze up your nose for you to get it.”
Mr. Ramunno, the West Branch superintendent, said that parents’ concerns about the immediate well-being of their children seemed to have calmed down somewhat by the end of last week, but that many were still worried about the ongoing threat of meningococcal illness.
“It’s gone from the immediate concern to a long-range concern. They’re worried about their children’s interaction over the summer at games, and parties, and playgrounds,” Mr. Ramunno said. “The only thing that will dispel any anxiety on their part is understanding more about what this disease is.”
