Schools face suspected bacterial meningitis cases

January 2005

Students and staff lined up at a New Jersey high school to receive ciprofloxacin, rifampin or a vaccine after three students were admitted to a hospital with symptoms of serious bacterial infection last month.

On Dec. 10 and 11, a 14-year-old female cheerleader and two 17-year-old male basketball players from Camden Catholic High School, Cherry Hill, N.J., were admitted to Cooper University Hospital, Camden, N.J., with suspected bacterial infection caused by Neisseria meningitidis.

Symptoms among the students included headache, variable chills, diffused myalgias, nausea and emesis, said Anat Feingold, MD, division head of pediatric infectious disease at the hospital.

Two patients had a purpuric skin rash. All three complained of sore throat, which Feingold said is somewhat unusual for this infection. Each student had a history of fever at home, although none presented with a fever in the emergency department.

Preliminary diagnosis indicated all three had bacterial meningitis; lab test results confirmed two cases of meningococcal bacterial infection, with the same strain of bacteria found in the bloodstreams of the female student and one of the male students. One of the patients had meningitis.

However, no traces of bacteria were found in the second boy’s blood, despite symptoms.

“Two of the three patients grew Neisseria meningitidis serotype C from the blood, and one patient did not have any positive cultures but has probable illness because he had all the symptoms,” Feingold said. A serum sample for a polymerase chain reaction test is pending.

The students all underwent complete blood count tests with differential platelet counts and coagulation profiles; electrolytes, liver function and spinal fluid were also tested.

All students were treated with ceftriaxone, Feingold added.

The two male students were released from the hospital on Dec. 15 and 16. The female student is in stable condition, recuperating and continuing to improve in a standard room, school officials stated in a Dec. 20 news release.

Another case surfaces

While these New Jersey school and public health officials were dealing with this cluster of cases, a Pennsylvania teacher was admitted to a hospital with similar symptoms.

Officials from the Hempfield School District, Lancaster County, Pa., notified parents that a faculty member at Centerville Middle School may have bacterial meningitis.

“At this point, we don’t know if it is meningococcal or not,” said Richard McGarvey, spokesperson for the Pennsylvania Department of Health. “Certainly, all the signs and symptoms are pointing toward bacterial meningitis.”

While McGarvey said it is unlikely the students’ health is at risk, the Department of Health still notified the school district about the “probable case.”

“Further testing is being done, but from our standpoint, it is not something we want to wait on the results and come back for. We automatically move forward with the case,” he told Infectious Diseases in Children.

The school distributed a letter and afact sheet to parents to make them aware of the rapid symptoms and ongoing investigation.

No other precautionary measures have been deemed necessary, McGarvey said.

The health department and school district would not release the teacher’s name, hospital location or health condition.

Feingold said she doesn’t believe there is a “need to even postulate any kind of connection” between the Pennsylvania case and the New Jersey cases.

“What was concerning here at Cooper and to the health department was that there were three cases within one school, two cases with absolute confirmation and one case that is presumed,” she told Infectious Diseases in Children.

There were no other cases of bacterial infection at either school.

Screening, evaluation and prophylaxis

At Camden Catholic, health officials and school administration took necessary precautions to ensure the health of both the students and staff.

Feingold said that within 24 hours of the three students presenting, the Camden County Health Department, in conjunction with Cooper University Hospital, offered an estimated 75 potential contacts immediate screening, evaluation and prophylaxis with ciprofloxacin and rifampin at the hospital.

School officials at Camden Catholic urged students who may have been in contact with the sick students to seek medical attention.

Over a two-day period at the school, students, faculty, staff and administrators were offered either antibiotics or vaccine, based on the recommendation of the New Jersey Department of Health and Senior Services and the Camden County Health Department, in consultation with the CDC.

Health care professionals were available at the school to answer questions or concerns for students and their families. A special hot line to the school’s health office was also set up for those with further questions and concerns.

Despite all the screenings and evaluations, classes and school activities went on as normal.

“We remain committed to acting as responsibly as possible to do everything possible on behalf of the students and people we serve,” said Tom Kiely, principal of Camden Catholic, at a media briefing.

Feingold would not speculate as to how the three students acquired the disease. Transmission occurs through close personal contact, which allows sharing of oral secretions. Discouraging teens from sharing oral secretions certainly could help reduce transmission, but “I’m not sure how much of an impact we’ll ever have upon adolescent behavior in that regard.”