This time of year always reminds me of American humorist Erma Bombeck, who once wrote: “I take a very practical view of raising children. I put a sign in each of their rooms: ‘Checkout time is 18 years.’”
When our teenagers go to college, we want them to acquire many things: new friends with diverse backgrounds, expanded interests, more independence, and, if they have time, an education. What we don’t want them to get? Sick. In an outbreak.
An outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. A recent example includes last year’s mumps outbreak at Temple University.
Here are some other real examples:
Case 1: A student was rushed to the hospital after presenting to the student health center with a headache, stiff neck, and fever. Diagnosis: meningitis.
Meningitis is inflammation of the membranes surrounding the brain and spinal cord, causing headache and stiff neck. Although most cases are caused by viruses, this student had a bacterial infection caused by Neisseria meningitidis. It is spread by sharing respiratory or throat secretions (such as coughing or sneezing); about 10% of people have the bacteria but do not have symptoms (asymptomatic carriers). Symptoms happen rapidly; treatment requires hospitalization and intravenous antibiotics. Even with treatment, as many as 20% of those affected have long-term complications including limb loss, deafness, or seizures and as many as 10% die.
Prevention: Vaccination. The Centers for Disease Control and Prevention recommends a meningococcal conjugate (MenACWY) vaccine for college students living in dorms. If given before age 16, a booster dose is needed. In recent years, however, college campuses have reported outbreaks of meningitis caused by serogroup B, not covered by MenACWY vaccines. The CDC recommends a serogroup B meningococcal vaccine for people identified to be at increased risk because of an outbreak.
Case 2: A student presented to student health with headache, fever, and right-side facial pain. Diagnosis: mumps.
Mumps is caused by the paramyxovirus. The common symptom is swelling of the salivary glands. It is spread by sharing respiratory or throat secretions; about 33% of people are asymptomatic carriers. Initial body aches, headache, and fever are followed by painful and swollen parotid glands. Because mumps is viral, antibiotics are not helpful. Symptoms usually resolve within two weeks. Meningitis, encephalitis (inflammation of the brain), and pancreatitis (inflammation of the pancreas) are possible complications. The most common complication in males is orchitis (inflammation in one or both testicles).
Prevention: Vaccination. Protection from childhood vaccines may fade with time; hence, outbreaks. The CDC recommends two doses of the combined measles-mumps-rubella (MMR) vaccine given during childhood. A third dose of vaccine isn’t routinely recommended; however, a study of Temple’s mumps outbreak showed that students who received a third dose of MMR had a much lower risk of getting mumps.
Case 3: A student came to student health complaining of cough for two months. Diagnosis: Pertussis.
Pertussis, also known as “whooping cough,” is a respiratory infection caused by the bacterium Bordetella pertussis. It is spread through respiratory droplets or by direct contact with infected throat or nasal discharge. Early symptoms include runny nose, mild cough, and fever. The cough develops into repeated fits followed by a “whooping” sound and sometimes vomiting. Complications include pneumonia (lung infection).
Prevention: Vaccination. The CDC recommends a Tdap vaccine for rising college students.
Case 4: A student came into student health with the sudden onset of fever, muscle aches, and sore throat. Diagnosis: influenza.
Flu is a respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes lungs. It is spread through respiratory droplets. A person might get flu by touching a surface that has flu virus on it and then touching mouth, nose or eyes. Symptoms start suddenly and include fever, cough, sore throat, runny nose, muscle aches, headaches, and fatigue. Most people recover within a few weeks. However, flu can make chronic medical problems such as asthma or heart disease worse. Other complications include sinus and ear infections, pneumonia, myositis (muscle inflammation), myocarditis (heart inflammation), and encephalitis. Multi-organ failure and sepsis (extreme inflammatory response) can cause death.
Prevention: Vaccination, Every year. The flu vaccine is modified each year to provide maximum protection.
My not-so-subtle advice: Vaccinate whenever possible. Many colleges require certain vaccinations, such as MMR, for incoming students before they come to campus, but for those who don’t, there are plenty of options. Missed the opportunity to vaccinate and have already said goodbye to your college student? No worries. Get them vaccinated when they’re home for fall break. Your college student isn’t coming home for fall break? No worries. The needed vaccines are available from student health. Vaccination is simple and can help your child have a healthy school year.
Rima Himelstein is a pediatrician and adolescent-medicine specialist at Nemours/Alfred I. duPont Hospital for Children.