The first case of meningitis here barely caused a ripple of concern. After the second and third cases, parents murmured their anxiety. Today, seven cases of the disease have been recorded here, and Staunton residents are nervously asking what has caused the disease to spread and wondering where it will end.
Last week, a neighboring school administrator called to ask Staunton School Superintendent Kenneth B. Frank if his team would be at risk by hosting a squad from Staunton's Robert E. Lee High School. A woman who was to organize a book fair at a Staunton elementary school said she could not make it. Then, a Staunton teacher who was scheduled to attend a conference out of town told Frank she would rather not go; she feared that people at the event would shun her.
"It was kind of like we had the plague here," Frank said.
In the opinion of many townspeople, the plague is an apt description of the outbreak of life-threatening bacterial meningitis and a related blood infection that has shaken this Shenandoah Valley town of 22,000 during the past six weeks. Meningitis is an inflammation of the membranes covering the brain and spinal cord that can cause brain damage, hearing loss, speech defects, cerebral palsy and death.
The outbreak in Staunton is from a strain of the disease that is different from the isolated cases reported recently in Montgomery and Fairfax counties.
Wednesday, Staunton recorded its seventh case of the disease and the sixth within the school system. One infected student whose legs were amputated last month is still listed in critical condition. Five other victims of the disease are out of the hospital, and one remains hospitalized in good condition.
By North American standards, "that's considered a very big outbreak," said Dr. Seth F. Berkley, an epidemiologist at the federal Centers for Disease Control in Atlanta.
"You could even call it an epidemic," said Clifford W. Caplen, the health director for Staunton and the surrounding area.
Tuesday night, Frank closed all six of Staunton's schools, sending the town's 2,980 students home for the rest of the week.
The decision was made largely to buy time; school and health officials acknowledge that closing the schools is of little value in combating bacterial meningitis, caused by the meningococcal bacterium, which is not generally considered a highly infectious disease.
Health officials said it is usually spread through close contact such as kissing or sharing a drinking glass.
But in the context of the gathering anxiety surrounding the disease, shutting the schools was a psychological salve that Frank hopes will allay fears, particularly among parents.
In the meantime, school and health officials are conducting an inquiry into what has caused the disease to spread. The investigation has turned up a link among three students who have contracted the disease.
Although officials acknowledged it is unproven, they said they believe that a clique of teen-agers passed the bacteria among its members, producing three cases of the disease.
The clique, composed of friends, siblings and two couples who swapped partners, has come under increasing scrutiny in the past several days as the investigation proceeds.
Four of the teen-agers in the clique who have not contracted the disease -- all boys -- piled into a car in front of King's Daughters' Hospital Thursday. All wore earrings, an apparent trademark of the clique; some wore several.
The four had just been given doses of Rifampin, an antibiotic that kills the meningococcal bacteria in the nose and throat. For some, it was the third time the dosage had been administered.
"We've been cured three times now," said the driver, smiling.
"Our parents have to take the pills, too," said another.
The boys acknowledged that three of their friends had contracted the disease, and they said school and health officials had been questioning them at length about their associations and social habits.
Although officials said they believe that the clique may account for three of the cases, they remain unable to explain the source of the disease in the remaining four victims, one of whom is a 5-year-old boy.
"It's so elusive," said Charles F. Kurtz, Lee High School principal and an Andy Griffith look-alike. Finding a connection among the victims, Kurtz said, "is sort of like quicksilver -- you put your finger on it and it squirts away."
So far, the most serious consequences of the disease have befallen 17-year-old DeWanna Christian, a Lee High School senior who lost both legs and fingers on both hands when doctors were forced to amputate because of clotting problems and gangrene.
Christian at first had been diagnosed at King's Daughters' Hospital in Staunton as having "generalized . . . flu-like symptoms," according to a statement issued by the hospital. The next evening, Feb. 14, she collapsed and was taken to University of Virginia Hospital in Charlottesville for treatment. Five weeks later, she is still there, listed in critical condition.
That case underscores the dilemma facing doctors in Staunton, who were swamped with simultaneous outbreaks of influenza and meningococcus.
In its early stages, the doctors say, the bacterium is impossible to distinguish from influenza. The symptoms -- including headache, muscle aches, a fever and vomiting -- are virtually identical.
"That's the scary thing from a medical aspect," said Dr. Stanley E. Heatwole, head of the emergency room physicians at King's Daughters' Hospital. "It's like walking through a mine field. You can't really see which fever is going to be significant."
Doctors at the hospital have been deluged by telephone calls at home and in their offices from parents and others in the town with questions about the disease. In the hospital's emergency room, doctors have recorded a sharp increase in the number of people coming in to ask if their symptoms are dangerous.
"There's a fear that you've got this unknown thing out there ready to grab you," said Heatwole. "That's very disquieting to any community."
In an effort to deflect the barrage of calls and visits, several doctors wrote a question-and-answer column for Thursday's issue of the local newspaper, The Daily News Leader, titled "Meningitis: The Facts." Some parents and officials said the column should have been printed earlier.
Many parents only recently learned that while the infection can be treated with antibiotics and penicillin, there is no vaccine or drug that can be taken in advance to prevent the particular strain of meningococcal bacteria, called serogroup B, that has afflicted Staunton.
Some parents are bewildered by the steps taken by the school administration and health department in response to the outbreak of the disease. The first case was diagnosed Feb. 7 at Lee High School. Another four cases, including three more at Lee, were recorded in the following three weeks. Finally, on Feb. 28 and March 3, the health department administered the antibiotic Rifampin to students at Lee.
The capsules were accompanied by a note explaining the drug's side effects, which include discoloring urine and staining soft contact lenses. And they cautioned students who drank alcohol, took oral contraceptives or were pregnant of possible negative side effects.
The result was that more than 100 students at the high school, out of about 950, did not initially take the drug. Even today, about 15 students at the school have not taken the medication.
That rate of compliance, officials acknowledge, diminished the treatment's effectiveness, because students who took the antibiotic could still contract the infection from a student who had not taken it.
When two more cases were reported, one each on March 11 and March 18, parents were dumbfounded and distraught, thinking that the antibiotic had protected their children. They demanded that Frank close the schools, and he complied. "There's so much confusion," said Jane Crabill, a Lee High parent who is on the parents advisory committee. "I'm not sure that we didn't prolong the disease by giving medication."
The drug also was administered, with apparently better results, at one elementary school where a student had contracted the disease.
Twila Wilfong, the mother of one boy who caught the disease, said she has received angry, threatening phone calls from parents who think she has not adequately supervised her children and their friends.
"I can't help what those kids do," she said Thursday. "I try to live a Christian life, but I don't watch the kids every minute. It's hard to keep a 14-year-old down."
She said it was "by the grace of God" that her 14-year-old son, Timmy Williams, is alive. He was released from King's Daughters' Hospital Friday.
Frank, who tentatively plans to reopen the schools tomorrow, said the students who have not taken the drug will not be allowed to resume classes. For the time being, he is anxiously hoping that the outbreak of meningococcus runs itself out.
"If nothing happens," said Elizabeth S. Willson, a 17-year-old senior at Lee High, Frank "will look like a hero. But if there's another case , he'll look like a jerk."
Said Kurtz, the school principal: "We would just like to know what in the hell it is at Lee High School that's causing our kids to have meningitis."