Dec. 10, 2003 -- You've read the story before: A high school or college student complains about sudden flu-like symptoms or a stiff neck. There's a trip to the emergency room but within a day or two, the popular kid with so much promise is dead -- another victim of meningitis.
This story, sadly, is told about 300 times a year in the U.S. -- nearly once a day. Another 300 Americans, also typically teenagers, are left with permanent brain damage, hearing loss, or amputation because of meningococcal infection, an inflammation of the brain lining and cerebrospinal fluid that flows throughout the brain and spinal cord.
What's rarely mentioned, however, is that a vaccine available for the last two decades may have prevented these infections.
"I was vaguely aware of the vaccine because we actually had information on it buried in with the other college information that my son received. And now, I'm a parent who lost an 18-year-old to this killer," says Mike Kepferle, whose son died from meningitis within 24 hours of contracting it while a college freshman in March 2000.
"At the time, we really didn't know how dangerous this disease was. Since then, I have -- and I've made sure my other children were vaccinated."
Yet despite being safe and effective, the meningococcal vaccine is unknown to most Americans. That's because it is not part of the recommended immunizations schedule for children or adolescents and is routinely given only to military recruits.
Vaccine Not Mandatory
In recent years, with many meningococcal deaths occurring on college campuses, the vaccine has been recommended -- but usually not mandated -- by most colleges for incoming freshman who will live in dorms. Often, the colleges only alert parents of the vaccine but leave it to them to have their children inoculated by their own doctors.
Patrick Kepferle, who died in March 2000, had delayed getting the inoculation recommended by his university.
In this week's New England Journal of Medicine, a nationally recognized expert on vaccinations questions why more doctors and health groups haven't advocated for greater use of this vaccine -- and urges them to do so.
"I would argue that this vaccine is a perfectly reasonable choice to give everyone in adolescence," Paul A. Offit, MD, tells WebMD. "Here is a disease that affects some 3,000 Americans a year. A few hundred die from it. Another few hundred are left without limbs [from amputations] or with permanent brain damage from it. And we have a safe, effective vaccine that could prevent much of this.
"But the most striking thing of all is that most parents have never even heard there is a vaccine ... until their child is in intensive care," says Offit, chief of infectious diseases and director of the Vaccine Education Center at The Children's Hospital of Philadelphia.
Close Contact Heightens Risk
Meningitis and other meningococcal infections typically occur in children before age 5 or in adolescents and adults living in close proximity to each other, such as in a dormitory. Offit advocates that the vaccine be considered by parents of teens, especially those in close living quarters with strangers.
"That's when the risk factors are more apparent -- crowding from living in dorms or at summer camps, where you're in close quarters to new people," he says. Add to that the dorm-life behaviors such and smoking and drinking, which can weaken the mucous-protective lining of the respiratory tract, making it easier for the potentially fatal bacteria to enter the bloodstream.
His article explains why the vaccine has not been endorsed for routine treatment in young patients by the CDC, the American Academy of Pediatrics, and other health groups: It's not considered cost-effective -- meaning the money it would cost to immunize everyone couldn't be justified against what it costs to treat the disease.
Instead, the CDC and the American Academy of Pediatrics recommend that students entering collage be informed about the risks of the disease and the benefits of the vaccine.
Few Doctors Mention It
Another reason why the vaccine may be news to you: It's not covered by most insurance companies, so many doctors might hesitate in discussing it with their patients -- who would have to pay the average $80 in out-of-pocket costs to vaccinate their child for what is, statistically, a one in 125,000 chance of contracting meningococcal infection.
Another reason for doctors to hesitate: "While the vaccine is available, it's not readily available," says Carol Baker, MD, professor of pediatrics at Baylor College of Medicine and a member of the AAP's Committee on Infectious Diseases.
"Doctors have to work harder to locate the vaccine because it's not routinely recommended. And while most physicians would be willing to give this to patients, the vaccine comes in a multidose vial -- you have to pay for 10 doses for a vaccine that has the same (short) shelf life as a single-vial vaccine," she tells WebMD. "That means that many doctors are very unlikely to not lose money by having this vaccine in their office."
Would she have her own teenaged children vaccinated? "In a second," says Baker, who praised Offit's article for "clearly laying out the issues of a controversial issue and being well-balanced."
Offit, author of a consumer book, Vaccines: What You Should Know, says he hopes his article will at least urge more doctors to discuss the vaccine with parents of their teenaged patients so they can decide if it's worth the expense. He and co-author Georges Peter, MD, of Brown Medical School, also advocate that physical exam forms for schools, camps, and sports activities include information about the vaccine.
In the meantime, Mike Kepferle is doing his part. After his son's death, he and four other parents of teens killed or handicapped by meningococcal infections formed the National Meningitis Association Inc. Besides operating a web site, they are currently mailing an alert to parents of high school seniors across the country that there is a vaccine that may help them prevent the fate of their children. Kepferle serves as director of the nonprofit group.
"And next year, we'll expand it to parents of younger kids," he tells WebMD. "What we want is for other parents to get the information they need -- and know there's a vaccine that's been around for decades that can help prevent meningitis. We're not telling them what they should do. We just want them to know what they need to know so they can make their own decision."