Health officials follow trail of meningitis cases
By WES ALLISON and ED QUIOCO
© St. Petersburg Times, published January 31, 2001
Consider it another good reason to know your children's friends.
When a patient is diagnosed with bacterial meningitis, as two northern Pinellas County teens were this weekend, the discovery sets in motion a system designed to find and protect those most at risk of catching the deadly disease.
Since the county health department learned of the cases Monday morning, epidemiologists have interviewed the boys' family members, friends and classmates at East Lake High School to determine who should take antibiotics to protect against possible infection.
Meanwhile, one of the boys remained in critical condition Tuesday at All Children's Hospital in St. Petersburg. The other was in stable condition at a hospital near Fort Lauderdale, where he was visiting when he became ill Saturday. Their names have not been released.
Diana Jordan, who oversees communicable disease surveillance at the county health department, said investigators contacted 10 to 15 relatives and friends of the boys in Pinellas. They will likely be treated as a precaution with rifampin, a powerful antibiotic.
Health and school officials also will be on the lookout for other potential cases, and local doctors and parents should do the same, she said. Meningitis is dangerous, but parents should not panic.
"This isn't something you would catch ordinarily unless you have close contact with their saliva," Jordan said Tuesday. "If you haven't been close enough to share drinks or a cigarette or kiss them, you're not likely at risk for getting it."
Epidemiologically, however, the East Lake cases are somewhat worrisome because it hit two students simultaneously, and investigators have found no strong link between them except a shared class. Because they both got sick at the same time, one most likely did not give it to the other.
At any given time, one in four people carries the meningococcus bacterium that causes this type of meningitis. Most never get sick, and it's unclear why some do. Health officials are waiting for test results to determine if the two boys were infected with the same strain.
"We don't know yet if it's a communitywide outbreak or a fluke, sporadic two cases at one school," said Dr. Juan Dumois, chairman of the division of infectious diseases at All Children's.
Florida records 200-plus cases of bacterial meningitis every year, and most are isolated. The last outbreak occurred two winters ago in Putnam County, where nine people were diagnosed with meningitis and one died.
Whenever a case is reported, public health officials follow nationally recognized guidelines for finding others who may be at risk for contracting the disease. It's the same system used for tracking a variety of other communicable or food-borne diseases, from tuberculosis to shigella.
Investigators first contact family members or roommates, who are most at risk and who can lead them to close friends, girlfriends or boyfriends. They also contact fellow members of groups where the disease could have been passed: A church youth organization that that recently had an overnight retreat, for example, or a choir, in which members are crowded together while forcibly expelling air.
This system has worked for many years. But epidemiologists acknowledge the public isn't always content to sit quietly as they investigate, and callers often demand to know the names of the infected. Those are not typically disclosed.
"People say, "I want to make up my own mind (whether to be treated),' " said Dr. Steven Wiersma, deputy state epidemiologist for the Florida Department of Health, whose office is following the East Lake cases.
East Lake High School received about 30 calls Tuesday from concerned parents, although attendance was normal, and the health department received scores more.
Symptoms can begin within several hours or one to two days after infection and include a fever, pounding headache and a stiff neck. Antibiotics usually whip it, but 10 to 13 percent of those treated still die, according to the U.S. Centers for Disease Control and Prevention.
School officials emphasized to students that they should not share lipstick, glasses, eating utensils, or cigarettes.
Claire Walker, whose son, Mitchell, is a sophomore at East Lake, said she'll watch him closely over the next few days, but that her fears were largely assuaged by the letter Principal Rick Misenti sent home Monday explaining the disease.
"The more information you have, the better equipped you are to make sure your children are safe," said Walker, president of the East Lake PTSA. "Mr. Misenti getting the word out as soon as possible was the best thing that could have happened."
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