CONTAINING MENINGITIS FEAR SOMETIMES SPREADS FASTER THAN THE DISEASE.

Byline: Evan Henerson Staff Writer

Meningitis is a true Jekyll-and-Hyde disease.

The common germ that causes the disease often passes through a person's body without ever causing the carrier to experience a single symptom. Then there's viral meningitis, which can make your life miserable for a week to 10 days before your immune system fights it off.

And in its contagious bacterial form, certain strains of meningitis can cause a brain disease - called meningococcal meningitis - or blood disease (meningococcemia), both of which can be deadly.

An infection of the spinal cord and the fluid surrounding the brain, meningitis frequently causes its victims to suffer high fever, headaches and a stiff neck as well as nausea, confusion and sleepiness. Infants who contract the disease often are lethargic or irritable, refusing to eat. The bacterial form is treatable. If you have the virus, doctors can only treat the symptoms.

When meningitis kills, as it did recently in Alliance, Ohio, where two high school students contracted a fatal blood disease caused by the bacteria, and as it has on three Los Angeles-area college campuses since January 1998 - county and school health officials go into crisis control. And worried parents often send their school-age children for a vaccine that is both expensive, temporary and not as effective as doctors would like.

The vaccine, a shot in the arm, protects people for three to five years against most, but not all, strains of meningitis. It does not work on children younger than 2.

Even so, that $65-$100 vaccine - which is not covered by most insurance carriers - is protection against a disease the very mention of which can cause people to conjure up images of a plaguelike illness spreading among family and friends of the infected person.

In a set of guidelines that are followed by many school and county health agencies, the Advisory Committee on Immunization Practices, a division of the Centers for Disease Control and Prevention, recommends that college students consider getting the vaccination. Incoming freshmen who will be living on campus are at slightly higher risk than other students, according to the guidelines. Some student insurance plans cover the cost of the shot.

``I would bet that this upcoming year, more than half of our incoming students are going to get the vaccination, and I would hope it would be more,'' said Dr. Larry Neinstein, executive director of the University Park Health Center at USC. ``Because of all the information we've passed out and the information that has been in the national news, the disease has been in the media a lot.''

Neinstein experienced the effects of a meningitis scare first-hand at the end of January when freshman Jared Chesser died of Type C meningococcal meningitis, a strain that could have been prevented by the meningitis vaccine. After Chesser's death, the Student Health Center sent letters to 13,000 undergraduates, held a vaccination program and set up an informational hotline.

The situation is more critical in Ohio, where the state health department is inoculating 5,800 students and school staff members at six high schools in and around Alliance after the deaths of two students from the same high school. A third student has been hospitalized but is expected to recover. Another 37,000 residents of nearby communities have received antibiotics.

The disease is transmitted through shared saliva, such as drinking out of the same cup, licking the same ice cream cone, using the same toothbrush or kissing. Ohio health officials suspect that Jonathan Stauffer and Kelly Coblentz, both 15, shared a water bottle at a school picnic.

Could such a scenario happen in L.A.? According to county health officials, a deadly meningitis outbreak could happen in any densely populated area. College students entering on-campus housing and military personnel are historically at greatest risk.

But is such an outbreak likely to happen?

Probably not, say officials at the Los Angeles County Health Department, which tracks and records all instances of meningitis both within L.A. County and in all the county school districts, including L.A. Unified. The county reported 53 instances of meningococcal disease in the year 2000 and 49 in 1999. Ventura County reported three cases in 2000 and none in 1999.

Isolated cases - such as the hospitalization of Kennedy High School senior Clifford Mack last June - aren't outbreaks, and in most cases they are contained before the disease can spread.

``How do you define an outbreak of this disease?'' says Dr. David Dassey, medical director of the acute communicable disease control unit, L.A. County Department of Health Services. ``The easy way is to say if you have two or more cases close together. But how close is close?

``With new tools, hopefully we'll be able to accumulate evidence that helps us determine when a new outbreak is occurring, when we have to worry about a vaccine campaign, vs. saying, 'Hey, what a coincidence. We have two cases in the same group, but they're not related. So don't panic,' '' Dassey added.

Two recent cases of type-C bacterial meningitis at Mira Costa High School in Manhattan Beach turned out not be linked. High school officials worked closely with the county health department, sending out a letter updating all parents. Preventive vaccinations were not offered because, as principal Lynn McCormack noted, the county health department does not recommend routine vaccination. Both students have recovered.

Ventura County health officials are also confident the disease was quickly contained following the May 2 death of 19-year-old Newbury Park resident Kristin Mikesell. A part-time student at Moorpark College, Mikesell exposed 45 students and professors to the disease, prompting the county health department to get ``a lot of calls,'' according to the county's Communicable Disease Programs Coordinator, Marilyn Billimek.

``It's like Columbine,'' said McCormack, referring to the deadly shooting at Columbine High School in Littleton, Colo. ``When you hear something like this happens, everyone just stands back. You do an assessment of where you are, check policy and procedure, and it puts everyone on high alert. It tends to go away and then some other issue comes up.

``We pay attention to any risk kids are exposed to,'' she added. ``The bottom line is that, as far as options for vaccinations are concerned, we make it very clear, our students are best off to discuss this with their own physicians.''

Taking the ACIP recommendations very much to heart, administrators at the Klotz Student Health Center at California State University, Northridge, provide information on the disease and the vaccination in both the orientation and registration materials. Parents and students alike are targeted.

``It's wise for students to be especially aware of the data and the risks involved,'' said Dr. Linda Reid Chassiakos, director of Klotz Student health Center at CSUN. ``A lot of students come in asking for information about meningitis and the vaccine, but the actual number of immunizations we give is not very large.''

MENINGITIS FACTS

Meningitis is an infection of the fluid of the spinal cord and the fluid that surrounds the brain. There are two types of meningitis: viral, which is serious but can usually be fought off by the body's immune system; and bacterial, which is extremely dangerous, can cause brain damage and can be fatal.

< SYMPTOMS (which can develop within hours):

High fever

Headache

Stiffness of the neck

Nausea

Pale, gray skin

Drowsiness 

Muscle cramps

Joint pain

< TREATMENT

The spread of bacterial meningitis can be stopped with antibiotics. Without antibiotics, 10 percent of cases can lead to death within 24 hours.

< VACCINE RECOMMENDATIONS

The following guidelines, modified in 1999 to reflect an increased risk faced by college freshmen, are set forth by the Advisory Committee on Immunization Processes of the Centers for Disease Control and Prevention.

< GENERAL:

Routine vaccination is not recommended because of its relatively short duration of protection and because of its relative ineffectiveness in children under 2.

Vaccine is recommended for control of serogroup C meningococcal outbreaks.

Vaccine is recommended for certain high-risk groups (including persons with terminal complement component deficiencies or anatomic or functional asplenia and research or laboratory personnel at risk of exposure.)

Vaccine may be of benefit to travelers to countries where the disease is hyperendemic or epidemic.

< FOR COLLEGE STUDENTS:

Providers should inform students and their parents about meningococcal disease and the benefits of vaccination.

College freshmen who want to reduce their risk should be given the vaccine or referred to a site where it is available.

The risk of contracting the disease among non-freshmen is similar to that in the general population; however, the vaccine can be provided to non-freshmen undergraduates who wish to reduce their risk.

Colleges should inform incoming and/or current freshmen about meningococcal disease and the vaccine, especially if they plan to or already live in a dormitory.

Public health agencies should provide colleges and providers with information about the disease and the vaccine, as well as how to obtain it.

CAPTION(S):

photo, box

Photo:

(cover -- color) The Meningitis Scare

What parents and students should know about this potentially dangerous disease

Dan Rosenstrauch/Contra Costa Times

Box: Meningitis Facts (see text)

Source: Centers for Disease Control and Prevention Web site, www.cdc.gov.

Jon Gerung/Staff Artist