Moving in to a DORM? Double Check Your Vaccinations!

Why do COLLEGE STUDENTS need the Meningitis Vaccine?

What is meningococcal disease? The bacteria Neisseria meningitidis causes a range of illnesses that can rapidly progress to be fatal if not immediately recognized and treated. Meningitis is an infection of the lining of the brain that can cause coma, sepsis and death. Early symptoms start like the flu- fever, headache, body aches, and possibly nausea and vomiting, then the headache progresses in severity, the neck becomes very stiff and painful, and the person may become confused or even unconscious. A very specific RASH can alert clinicians to this dangerous disease- it is dark red/purple and does not whiten if pressed upon. This rash is caused by leakage of blood vessels as the bacteria releases toxins into the blood stream. Survivors of a severe meningococcal infection may have lost fingers, toes or even limbs as a direct result of this blood vessel damage.

Meningococcal disease is especially noteworthy here in Texas, where we were the first state to pass legislation to require the meningococcal vaccine for every college student. Sadly, this legislation came after one student at Texas A&M died (Nicolis Williams) in 2011, and a University of Texas sophomore (Jamie Schanbaum) had lost both legs, fingers, and narrowly survived meningococcal infection. The Texas law is named for both of these students. Jamie has remarkably gone on to not only champion efforts to educate about vaccine prevention for meningococcal disease, but to win a gold medal in the paralympics.

Who needs this vaccine?  The meningococcal vaccine has NEW RECOMMENDATIONS- all adolescents should still receive their first shot (the MCV4) at age 11-12, as previously recommended, but now we know they need a BOOSTER DOSE at or after age 16, before they head off to college. Although initially thought to offer protection for a decade, it turns out that the immunity begins to wane in this age group after 5 years. Yes, they still needed that earlier vaccine to protect against the herds of kids joining them in close quarters at school and summer camp, but we want them maximally protected as well when they move into that dorm!

In addition, military recruits (also living in crowded quarters like a dorm) and anyone who has had their spleen removed should get this vaccine.  Travelers to sub-Sahara Africa during the dry season are also at increased risk, so vaccination is recommended for this group as well.

BOTTOM LINE: Protect your adolescent against this rapidly progressive, dangerous disease by making sure they received not only their initial vaccine at 11-12 years, but also their BOOSTER before they head off to college! (If they are already in college but missed their booster, add this to their holiday wish list...)

Image above from NY Times

Did I Hear a WHOOP?

As a Texas Aggie, I generally love to hear a "WHOOP" (especially during football season- gig 'em, Ags!) However, as a doctor, the word or sound "whoop" triggers concerns about Pertussis, the bacteria that causes whooping cough, which has been unfortunately on the rise in our community and across the United States.

What is whooping cough?

This highly infectious respiratory disease only infects humans, and causes nearly 50 million cases of disease each year. In the United States, we only see around 40,000 documented cases/year, but certainly have many more infections that are not recognized and treated.  Smokers, asthmatics, infants, pregnant mothers and people with compromised immune systems are at the highest risk for catching pertussis, but we are also seeing outbreaks in healthy, previously immunized populations (whose immunity has worn off over the years since their last booster vaccine.)

There are several stages of whooping cough infections. The first stage is like a common cold- stuffy, runny nose, low grade temperature and a slight cough. However, the second stage is what sets this disease apart. Instead of a mild lingering cough, the cough becomes more frequent and can be intensely severe- causing fits and spasms of coughing so hard that you vomit, and occasionally creating a "whoop" sound as you suck in air after a fit of coughing. Typically people describe this as the "worst cough" they have ever had. Finally, there is a several week convalescent stage where the cough gradually decreases and fades away.

How is pertussis diagnosed?

For a variety of reasons, doctors do not often test for pertussis. The test for pertussis requires a specific nasal swab that should be immediately sent off to the health department lab for evaluation. Blood tests can help to confirm an acute case as well (checking antipertussis toxin IgG levels).

How is pertussis treated?

Short courses of azithromycin or erythromycin will eliminate the virus from the upper respiratory tract. More serious infections (especially in infants) may require hospitalization for more aggressive treatment.

Why can't I get a zpak for my cough?

The vast majority of coughs are NOT pertussis, and in fact, are not caused by ANY bacterial source. The zpak, or any antibiotic, will only help improve coughs caused acutely by a bacterial infection (such as a pneumonia). The good news here is that although coughs can hang on for up to six weeks after a viral infection or with allergies, we do have other (non-antibiotic) medications such as broncho-dilating inhalers that can help clear them up.

How can I prevent pertussis? 

In a flashback to the previous blog on TETANUS, here is your answer: All children should receive the combination vaccine DTaP (diphtheria, tetanus and pertussis) five times in early childhood, at 2, 4, 6, 15-18 months, and age 4-6 years. Then, at 11-12 years, they should receive a BOOSTER combination vaccine, called Tdap (which has lesser, booster-level doses of the diphtheria and pertussis portions, noted with the lower case letters). Finally, everyone over the age of 19 who did NOT receive that Tdap during adolescence should get a one time vaccination with Tdap "now", regardless of the interval since their last tetanus booster, which was most likely simply a Td (tetanus/diptheria booster).

What's that little "a" for in Tdap and DTaP? 

That little "a" is for "acellular" pertussis. There were concerns about side effects from the original whole cell pertussis vaccines, so scientists were able to develop a newer version of the vaccine that only used a small portion of the pertussis cell. This section of the bacteria is still "large" enough to trigger a robust immune response, yet has fewer side effects.

BOTTOM LINE: Adults who have never received a tetanus booster that contains pertussis should update their immunizations at their next check up!