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What's Next? Bubonic Plague?

October 31, 2006

Ahh, the golden days of yore: family dinners in front of the fireplace, unlocked front doors, children riding bikes trailed by streamers, softly squeezing their horns as the ice cream truck sings – and mumps and whooping cough and tuberculosis, oh my.

At colleges and universities, yesteryear can be interchangeable for yesterday, as re-emerging diseases like mumps and whooping cough are increasingly showing up on campuses. Even tuberculosis, a disease by all accounts on a continuing decline in the United States, can pose a threat within the increasingly international populations that make up the country and its college campuses today.

At Missouri Southern State University, 12 students tested positive for the latent version of the bacteria causing tuberculosis last week, though they did not show symptoms, and another student fell ill with the actual disease earlier this month, a university spokesman, Stephen Smith, said Monday. Two upstate New York institutions – Cornell University and the State University of New York at Binghamton -- announced suspected cases of pertussis, or whooping cough, on their campuses earlier this year.

Meanwhile, the mumps virus is still rearing its head on campuses this semester after the worst outbreak in 20 years struck the country this spring. Of the 5,783 people affected from January 1 through October 7, the outbreak disproportionately affected college students, with the median age of those affected just 22. The number of cases decreased throughout the summer months, when college students went home, but universities in Illinois, Kansas and Virginia have been struck so far this fall, with 84, 22 and 12 cases in each respective state, according to last week’s Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention. In recent years, mumps cases had been limited to just a few hundred cases a year nationally.

The mumps outbreak offers a frightening example of what can happen when a disease nearly dead in this country migrates from another county where it’s still prevalent and enters an environment in which people live in close quarters and are liable to spread their germs, said Jane Seward, acting deputy director of the division of viral diseases at the CDC.

“A disease could become easily transmitted if it gets into certain populations, like the mumps did, and college campuses have very, very good potential for transmission and outbreaks,” Seward said.

“These diseases are just a plane ride away."

Mumps

The resurgence of mumps in the United States probably stemmed from a 2004-5 outbreak of the disease in the United Kingdom, said William Schaffner, chair of the department of preventative medicine at Vanderbilt University and vice president of the National Foundation for Infectious Diseases. “Almost assuredly someone got off the plane incubating mumps and spread it throughout the United States,” he said.

Mumps, commonly associated with swelling of the salivary glands, can, in rare circumstances, lead to side effects including meningitis, inflammation of the testicles, spontaneous abortion and permanent deafness. Like whooping cough, the disease does not tend to be especially serious when it strikes college-aged populations, but James Turner, executive director of the University of Virginia’s student health center and chair of the American College Health Association’s committee on vaccine preventable diseases, said cases among college-aged students can lead to lost productivity and pose a risk of transmission to more vulnerable populations, including young children. And serious consequences, although rare, are not unheard of. “For the individual, the risk is fairly low, but if we take an aggregate, thousands of cases, there are going to be a few that have serious complications,” Turner said.

The vast majority of those who have fallen ill this fall received the recommended two doses of vaccines, which are, taken together, about 90 percent effective, according to the CDC. At the University of Virginia, where there are 29 reported and suspected mumps cases so far this fall, 100 percent of those affected have had both shots, Turner said.

“If I have 20,000 human beings on my campus, and let’s say they’ve all been vaccinated, and you introduce the virus into the community, 5 to 10 percent of those 20,000 people would come down with the disease. And 5 to 10 percent of 20,000 people is a lot of people,” Turner said.

Perhaps promisingly, 96 percent of college students affected so far this fall have had two doses of the vaccine, the CDC says.

“Having exceedingly high vaccination rates is singularly the most important thing,” Turner said. “On my campus, where we’ve had 29 cases, it could be hundreds, or thousands, if we didn’t have a 99.6 percent vaccination rate.”

Whooping Cough

“Whooping cough clearly is a re-emerging disease,” said Schaffner of Vanderbilt University’s School of Medicine. “The populations at risk are U.S. children in high school and young adults. Of course that would include those young adults and teenagers who are in colleges and universities.”

Pertussis is a highly contagious disease characterized by a persistent and spasmodic cough that can persist for many weeks. Schaffner said that immunity against whooping cough, provided in a series of immunizations for infants, typically wanes by adulthood. But while 7,008 of 25,827 pertussis cases reported to the CDC in 2004 were among people ages 19-64, a vaccine for adults was not available until 2005. Two different whooping cough vaccines have recently been placed on the market, Curtis Allen, a CDC spokesman said, appropriate for both the adolescent and adult populations.

The new vaccine options protect against tetanus, diphtheria and pertussis (Tdap) and have generally replaced the old tetanus/diphtheria booster shot administered every 10 years, Shaffer said. Yet, many of this generation’s college students received their last tetanus booster before 2005 and haven’t been re-immunized against whooping cough.

“Any adolescent who gets a tetanus shot now should get Tdap,” Turner said. “These kids will be going up and into college in the next five to eight years.” In the meantime, he said the American College Health Association is recommending that current college students get a Tdap shot -- depending on a student’s age, he said it is safe to administer the vaccine two to five years after they have received their last tetanus vaccination.

Tuberculosis

College campuses generally are not considered hot spots for tuberculosis infections, and tuberculosis, once the leading cause of death in the United States, is steadily on the decline domestically. A total of 14,097 cases of tuberculosis, a bacterial disease that typically affects the lungs, were reported in 2005, a 2.9-percent decrease from 2004 and a 47-percent decrease from 1992, the CDC says. But the positive test results at Missouri Southern State University are a reminder that tuberculosis is prevalent in many parts of the world, and there’s no lack of people within this country who have been exposed to the disease and risk developing and spreading it, said Petros Karakousis, an assistant professor of medicine at Johns Hopkins University who works with the institution’s Center for Tuberculosis Research Laboratory.

“The numbers have been declining in general in the United States. But because of our constant influx of immigrants from all over the world, and even U.S. travelers to other places, there are still plenty of people who have been exposed to TB in this country who can then go on to develop active TB,” Karakousis said. An individual who has been exposed and does not undergo preventative treatment will typically face a 10 percent risk of developing the disease over a lifetime, he added, while those with compromised immune systems, such as due to HIV, face a 10 percent annual risk of the latent form of the disease waking up, so to speak.

The American College Health Association recommends screening students studying health-related fields, in addition to high-risk students, including those who have worked in health care facilities, inject drugs, have HIV, or have been in close contact with someone with tuberculosis. Karakousis said he would not recommend universal screening of incoming students, as to do so would result in a large number of false positives, leading some students to take a nine-month course of drugs for no reason.

“I don’t think it’s something that we need to suddenly become alarmed about,” Karakousis said. “I think it’s something that’s always going to be there as a risk, especially with a relatively international population.”

 

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