Rare Meningitis Outbreak Puzzles Health Investigators

A middle-aged woman. A 2-year-old boy. They were not neighbors. They did not attend the same church services or drink from the same faucets. They had no mutual acquaintances and no physical contact.

But they had one thing in common, and it killed them.

Both died of a rare strain of bacterial meningitis that has been detected six times in three counties in southwestern Missouri--and nowhere else in the country.

The strain that caused the epidemic is deemed so unusual that the Centers for Disease Control and Prevention in Atlanta is sending a federal researcher to begin an in-depth study.

“This is a strain that we haven’t detected as being associated with clusters of illness,” said Dr. Bradley Perkins of the CDC. “We feel like it’s important to go down and characterize the cases as carefully as possible.”

The four people who survived the illness--three grade-school-age children and one young adult--are vital to the study. They have no obvious links to each other or to the two victims who died, but the CDC hopes to learn more about risk factors by interviewing them and their families.

The health department declined to release the names of the survivors or the dead, citing confidentiality laws.

Outbreaks of meningitis are not unusual. In fact, cases of viral meningitis are so common that health officials don’t require notification. The disease is rarely fatal.

Bacterial meningitis occurs less frequently, but progresses more rapidly and is more often fatal. The CDC expects one case per 100,000 people each year; more than that is considered an epidemic. The Joplin area had 11 bacterial cases among 130,000 people in 1995.

Meningitis symptoms include high fever, severe headache, lethargy, vomiting, a rash and neck stiffness. The disease is spread through kissing, sharing utensils or by being exposed to the nasal or oral secretions of an infected person, such as caused by sneezing or coughing.

Most of the bacteria that cause meningitis are classified as serogroup B or C. Group C clusters occur frequently--two broke out just last month in Dixon, Ill., and Okaloosa County, Fla.--but they cause less concern because vaccines can prevent broader outbreaks.

Serogroup B clusters, however, are rare, and there is no prevention--thus the concern in Missouri.

The Missouri meningitis belongs to a serogroup B strain of Neisseria, one of the fastest-working bacteria. Victims can go from flu-like symptoms to death in just six hours.

“It’s frightening as rapidly as those things go, because people can deteriorate right in front of you,” said Dr. Jim Pyron, emergency room chief at Freeman West Hospital in Joplin, where several patients were treated. “There’s very few things that can kill you as fast as that.”

Before Missouri, the last B-strain outbreak in the United States occurred in Oregon in 1993, when a Neisseria strain identified as enzyme type-5 made its American debut. It has since caused scores of cases, with three deaths this year alone. Before reaching U.S. shores, enzyme type-5 meningitis had caused outbreaks in Europe, Cuba and South America.

In Oregon studies similar to the one planned for Missouri, the CDC found that tobacco smoke that irritated the throat seemed to increase the risk of either falling sick or carrying the Neisseria bacterium, Perkins said.

The Missouri outbreaks began last year when 14 cases were reported in Jasper, McDonald and Newton counties. Eleven were bacterial, and four were fatal. Six of the 11 bacterial cases were from serogroup B--from an enzyme type never before seen. (It has since been designated enzyme type-566.)

That helps explain the size of the outbreak: People have little resistance to new bacteria strains, Perkins said.

Dan Pekarek, director of the Joplin Health Department, said the cases frustrated him because they cannot be tracked like such illnesses as salmonella or hepatitis A.

“With this, there’s no nice little linkage. There’s no line between the cases,” Pekarek said.

On any given day, 5% of the population carries the Neisseria bacterium in human nasal passages. That is good, because carrying bacteria helps build immunity.

But the bacteria are passed rapidly among people and, because not everyone becomes sick, links are extremely difficult to make among those who do fall ill.

As with many bacterial sicknesses spread by contact and body secretions, young people are the most susceptible.

Joplin High School Principal Keith Zeka said the 42-year-old woman who died in December had a sophomore daughter at the school. Two other students were younger sisters of a college student who died of a C-group infection in April. Rumors flew for months, and students made anxious trips to the school nurse.

Zeka went on closed-circuit television at school twice during the outbreaks to calm fears.

“Combating the rumors is the most important thing,” he said. “The more knowledge they have, the more comfortable they are.”

That goes for the community in general, Pekarek said. He’s optimistic that the CDC study will help allay concerns and further educate area residents--because up until now, he’s been at a loss.

“Everyone wanted us to wave a magic wand and make it go away,” he said.