College, a petri dish for mumps

When Iowa college students early this year began turning up in doctors’ offices with puffy necks, headaches, fevers and, among some young men, swollen testicles, many physicians missed a diagnosis most doctors could have made in their sleep 25 years ago.

These patients had the mumps -- as do at least 1,100 in eight Midwestern states as of Friday. The outbreak is still unfolding, spreading east and west, and beyond the 18- to 25-year-old set.

Their affliction was missed by many physicians unaccustomed to seeing -- especially in college students -- a childhood disease largely quashed by widespread vaccination in the 1980s.

Now public health officials are trying to understand how this disease, which in rare cases can cause deafness, encephalitis and male sterility, could have regained a foothold in the U.S. after so many years.

The Midwest mumps outbreak has been all the more surprising because it has largely affected the first generation of young adults to have commonly had not one, but two doses of the vaccine that protects against measles, mumps and rubella. Double vaccinations, widespread since a 1989 outbreak of measles, were thought to confer complete mumps immunity to about 90% of recipients.

Experts suspect two factors: spotty vaccination coverage among college-aged kids and the unique bacterial and viral mixing bowl that is dorm life.

The virus that causes mumps appears to have found its perfect home in the college scene -- with multiple kids lolling on beds in great heaving groups, swigging drinks in common, kissing and cruising the bars even when they’re sick, and -- oh, yes -- attending classes en masse.

“They eat after each other, drink after each other, share other personal items -- we know that living under those settings, people run higher risks of infection,” says Dr. Georges Benjamin, executive director of the American Public Health Assn.

Health experts say the outbreak should help focus new attention on the need to vaccinate adolescents against a growing variety of diseases before they leave the nest and dive into this unique germ pool.

The U.S. military ensures comprehensive vaccinations for new recruits. Given its unique powers of enforcement, coverage is virtually universal there.

But on campuses, lax rules and even more casual living arrangements provide ideal conditions for the spread of germs.

On many college campuses, vaccinations are recommended but not mandated. Waivers are granted -- ostensibly on health or religious grounds -- liberally.

A call to change this state of affairs has been building steadily, fueled by the development and approval of a raft of new vaccines designed for youths between 10 and 18 years of age.

In February 2005, the Centers for Disease Control’s Advisory Committee on Immunization Practices recommended that all teens -- especially those about to enter college dorms -- receive a new vaccine against meningococcal disease, which can cause meningitis and lead to brain damage; loss of hearing, eyesight or limbs; and death.

The CDC’s advisory committee has also recommended that all adolescents get a booster of a new tetanus, diphtheria and pertussis (or Tdap) vaccine that protects against the bacterial infection pertussis, also called whooping cough. Whooping cough cases have been on the rise across the nation, especially among young adults.

In the next few years, additional vaccines aimed at teens are expected to win Food and Drug Administration approval, making it likely that young adolescents will have a list of recommended immunizations almost as long as the preschool set.

Among the vaccines moving through the pipeline are ones to protect against sexually transmitted diseases such as human papilloma virus -- a principal cause of cervical cancer -- as well as chlamydia and gonorrhea.

In the coming years, vaccines that would protect against the herpes simplex virus (which causes fever blisters and genital sores) and the respiratory syncytial virus (which causes flu-like respiratory illness) are also expected to be recommended for children 12 to 18 years old.

Roughly half of the states, including Iowa, do not have precollege vaccination requirements in place, according to Dr. Jane Seward, acting deputy director of the CDC’s viral diseases division.

Such rules are typically left to colleges to enforce, and where state rules are absent, colleges and universities are left to adopt regulations on their own. “It’s more rigorous at some schools than others,” says Victor Leino, research director of the American College Health Assn.

The result: When students at a college in Dubuque, Iowa, returned to homes across the Midwest for winter break, they brought with them the highly contagious mumps virus, as well as their own vulnerability.

In fewer than five months, the outbreak spread to Kansas, Nebraska, Minnesota, Missouri, Wisconsin and Indiana. It’s expected to move next toward Arizona and the Eastern Seaboard.

Seward said that many heads of state and territorial public health agencies were confronting for the first time a gap in their state vaccination requirements at the crucial college entry point.

“They’re certainly going to be thinking about that” now, she added.

But if teen vaccinations are the immunization community’s next big push, health officials have their work cut out, says Dr. Robert S. Lawrence, a dean at Johns Hopkins Bloomberg School of Public Health.

Unlike preschoolers, whose parents drive them to yearly check-ups, adolescents are less likely to see a physician for routine physicals, more likely to reject a shot when they feel fine and often not covered for preventive healthcare.

Adding to the problem, parents of teens often think childhood vaccinations should have been enough and have less power to persuade their older children to get immunized.

“Teens are pretty unresponsive in general -- they tend to believe that they’ll live forever and don’t need these things,” says Lawrence, who led a study by the Institute of Medicine of future U.S. vaccine priorities.

To get around this problem, some experts have suggested making immunization a requirement for getting a driver’s license -- a powerful lever of enforcement that would cover college-bound kids as well as those who move into the job market.

“It’s very hard to capture this group of kids,” says Benjamin. He recently learned this firsthand as one of his own kids got ready to go off to college.

Excited to get her school experience underway, his daughter was a little too eager to sign a college release form waiving the need for immunization with the new meningococcal vaccine.

“I had to suddenly become a more firm parent,” says Benjamin. “The last thing I want is for my child is to die from a vaccine-preventable disease.”