Lawrence and Sharif Muhammad stood frozen with indecision at the doorstep of a University of Massachusetts vaccination clinic.
Their mom was worried about them catching meningococcal meningitis. She had heard that it can kill an otherwise healthy teenager in hours. Two students had been stricken this fall at the university.
But they got better. And with 18,000 undergraduates at UMass-Amherst, how much of a threat was there, really? Besides, at $75 a vaccination, the price looked pretty steep.
The Muhammad brothers finally turned around and left.
Spurred by the latest federal recommendations, colleges, including several in the Washington area, are mounting a widening attack on meningitis this fall with health advisories, educational campaigns and vaccination clinics. The aim is to curb the spread of meningitis in dormitories.
But the latest studies suggest that only a few meningitis deaths might be avoided each year in dorms--leading some health authorities to wonder if they could do better by working against more common college scourges such as drunken driving or sexually transmitted diseases.
"You're talking about millions of dollars per life saved. There are known to be many interventions in public health that do better than that," said Milton Weinstein, a risk expert at the Harvard School of Public Health. On his doctor's advice, he is letting his own 18-year-old son go unvaccinated at college.
Meningococcal meningitis is an infection of the membranes around the brain and spinal cord that can be spread by kissing or even sharing a drinking glass. The symptoms include fever, neck stiffness and headache. The disease kills in roughly 10 percent of cases and does serious harm, including brain damage, in another 10 percent.
(Meningococcal meningitis is a bacterial infection. The vaccine does not guard against the generally less serious viral meningitis.)
At least 91 campuses warn of the disease on pre-admission health forms, often recommending that students consider the vaccine, according to MarJeanne Collins, the University of Pennsylvania health director who has surveyed campuses nationwide. At least 87 campuses carry out wider educational campaigns and 57 run meningitis vaccination clinics.
The federal Centers for Disease Control and Prevention recommended last month that campuses give easy access to the meningitis vaccine, especially for freshmen.
Yet, of 3,000 cases nationwide in a typical year, just 100 to 125 occur at colleges. The death rate is highest among freshmen living in dormitories. With about 520,000 such freshmen this fall, five deaths would be expected.
Figures on causes of death among college students are hard to find. However, in 1997, there were 10,208 road fatalities, 4,186 suicides and 276 AIDS deaths for young people ages 15 to 24, according to the National Center for Health Statistics.
"You can debate the cost-effectiveness of this," said Len Lavenda, a spokesman for meningitis vaccine maker Pasteur Merieux Connaught. "But the greatest tragedy is when a parent sees their child stricken by the disease--and never knew there was an action that can be taken to prevent it."
The vaccine is deemed 90 percent effective against 70 percent of college cases. In the remaining 30 percent, the vaccine has no effect.
"Deaths from binge drinking and deaths from suicide are probably more common than deaths from meningitis in college students. But--by God!--if we had a vaccine for those things, we'd give it, wouldn't we?" said James Turner, chairman of a committee on vaccine-preventable illnesses for the American College Health Association.