October 30, 2003

Meningitis cases in Iowa
considered cluster, not outbreak

Virginia Wilber
digital iowa staff reporter
Drake University

DES MOINES, Iowa -- The four cases of meningitis simultaneously appearing in Black Hawk and Buchanan counties have been categorized as a cluster and not an outbreak, according to Iowa Department of Public Health.

"It is a natural phenomenon that rare diseases tend to cluster and this was a cluster because the cases weren't the same strains," Dr. Patricia Quinlisk, medical director and state epidemiologist for the Iowa Department of Public Health, said. "In an outbreak of a disease, there is one common organism."

In Black Hawk County, Elizabeth Huddleson, 20, a University of Northern Iowa student, and an unidentified 29-year-old female county jail inmate died from the C strain of the disease. Caleb Twito, a 20-year-old Hawkeye Community College student, is still recovering from strain B.

A 5-year-old boy in Buchanaa County's Amish community was also hospitalized with the disease.

Ann Rogers, community health program manager with the Black Hawk County Health Department, said these were distinct and separate cases. No common connection between these people was found.

Meningitis is caused by the meningococcal bacteria. The bacteria are divided into several strains: A, B, C, W and Y. Each strain is more common in different areas of the world. For example, the A strain is found mostly in Sub-Saharan Africa and the C strain is found mainly in Europe and the East and West coasts of the United States. In the Midwest, strain B is the most common. Vaccines exist for all strains of the meningococcal bacteria except for strain B.

Quinlisk said about five to 10 percent of the population carries the bacteria that causes meningitis but that does not mean carriers will contract the disease. It is only when the mucus membrane around the brain and the spinal cord are damaged that the meningococcal bacteria can invade causing the membrane to become inflamed.

Such things as smoking and having viral illnesses can cause the membrane to become damaged. Quinlisk said there have been cases where a cluster of meningitis cases has occurred after such serious viral diseases as the flu or pneumonia, especially in school children.

Therefore, as the flu season approaches in Iowa, Quinlisk said it may be more beneficial to spend money on a flu shot rather than on the actual disease-specific shots.

True influenza, also known as the flu, can cause a breakdown of the mucus membrane and may cause a person to be more at risk for contracting such diseases. Her guess, which hasn't been proven, is that the flu shot might be very beneficial to prevent meningitis.

"The flu shot may be better at protecting you against pneumonia and meningitis because it keeps you in a good shape in the first place," Quinlisk said.

The Iowa Department of Public Health is prediciting that one of the next several years will be a bad flu year.

"We've had several years of mild flu so we are overdue for a very bad year," Quinlisk, said. "I would strongly suggest people consider getting the flu vaccine because it is much easier to get and cheaper than the disease-specfic vaccines."

Quinlisk said meningitis is not very contagious and that there are normally around 30 to 50 cases in Iowa a year.

"I've been in my career for almost 15 years... in all of that time only twice has the disease spread from one person to another," Quinlisk said.

Certain groups such as first-year college students, military personnel, people traveling and people with genetic defects are more at risk for contracting the disease.

"It is situations like these when you take people and put them in a stressful atmosphere mixed with people from around the world that can make a person more at risk," Quinlisk said. "Stress lowers the immune system."

Even though the meningitis vaccination does not protect against strain B, Quinlisk still recommends the vaccine because there are other strains that can appear. Quinlisk said first-year college students especially should consider getting the vaccine because they are six times more likely to contract the disease.

Quinlisk said the health department will not conduct a mass vaccination in Black Hawk County because the cases were not connected. Also, the vaccine would not even prevent half of the cases resulting from strain B that could occur in Iowa.

Symptoms of meningitis are very similar to those of the flu and may include a fever, headache, nausea and or a stiff neck. A person with the disease can become very anxious, irritable or very sleepy. Symptoms can occur in one or two days or in several hours so medical attention should be sought immediately.