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Meningococcal Disease in College Students

Several recent studies highlighted a risk of meningococcal disease in U.S. college students and led the American College Health Association to recommend that college students consider immunization with the quadrivalent meningococcal vaccine. However, these studies were small, and concerns had been raised about their generalizability. Two new studies now provide further perspective.

Bruce and co-workers report a collaborative, CDC-coordinated study that prospectively evaluated all cases of meningococcal disease in U.S. college students from September 1998 through August 1999. Ninety-six cases were identified, 8 (9 percent) of which resulted in death. Serogroup information was available for 79 cases: 38 (48 percent) were group C, 22 (28 percent) were group B, 15 (19 percent) were group Y, and 1 was group W-135. The overall incidence of meningococcal disease per 100,000 undergraduates was 0.7 (95 percent confidence interval, 0.5-0.8). This rate was significantly lower than the 1.4 per 100,000 (95 percent CI, 1.3-1.7) for 18- to 23-year-old nonstudents in the U.S. (P < 0.001). The incidence per 100,000 first-year students living in dormitories, however, was 5.1 (95 percent CI, 3.4-7.2). In a case-control substudy, significant risk factors for meningococcal disease included being a first-year student living in a dormitory, white race, and having an upper respiratory tract infection during the preceding month.

Harrison and colleagues performed a population-based study of meningococcal disease in Maryland from 1990 through 1999 and identified 295 cases. The average annual incidence per 100,000 from 1992 through 1999 was 0.7, but varied substantially by age. It was greatest in children younger than 5 years and in adolescents aged 15 to 19. Seventy-one cases (24 percent) occurred in people 15 to 24 years old; the incidence per 100,000 in this age group progressively increased from 0.9 in 1990-1991 to 2.1 in 1996-1997, and then declined to 1.0 in 1998-1999. For this age group, 47 percent of cases were caused by serogroup C, 31 percent by serogroup Y, 12.5 percent by serogroup B, and 5 percent by serogroup W-135. The mortality rate was 22.5 percent for people 15 to 24 years old, 4.6 percent for people younger than 15 (P=0.002), and 16.5 percent for those 25 and older (P=0.7). Compared with disease in people 25 and older, meningococcal disease in people 15 to 24 years old was associated significantly more often with shock, meningitis, ecchymoses, male sex, tobacco use, and serogroup C infection.

Comment: These 2 studies highlight a significant risk of meningococcal disease in the college-aged population. The Bruce study reaffirms prior evidence that first-year college students living in dormitories are at particularly high risk, although the college population in general is not. The Harrison study confirms the potential severity of illness in this age group and shows the marked year-to-year variability in the epidemiology of this disease. As noted in the accompanying editorial, both studies affirm a potential advantage to immunization targeted at first-year college students planning to live in dormitories.

— R Ellison

Published in Journal Watch Infectious Diseases September 6, 2001

Citation(s):

Bruce MG et al. Risk factors for meningococcal disease in college students. JAMA 2001 Aug 8 286 688-693.

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• Medline abstract (Free)

Harrison LH et al. Invasive meningococcal disease in adolescents and young adults. JAMA 2001 Aug 8 286 694-699.

• Original article (Subscription may be required)
• Medline abstract (Free)

Wenger J. Toward control of meningococcal disease. Reducing risk in college students. JAMA 2001 Aug 8 286 720-721.

• Original article (Subscription may be required)
• Medline abstract (Free)