Greetings from the front lines of Disease Control. It’s been a little busy over here.
For the past month, I’ve been overseeing the Public Health Department’s coordinated response to the outbreak of meningococcal disease at UC Santa Barbara. I want to give our community a personal update on the latest developments, in an effort to stay transparent and direct with the public we serve.
For those of you playing catch-up on the details of this outbreak, let me give you a quick summary. Four cases of invasive meningococcal disease have been confirmed in UCSB undergraduate students between November 11 and November 21, 2013. All of these students were active in campus organizations and lived in different group-housing units. Three have fully recovered, and one sustained permanent disability and is still hospitalized. All four cases are serogroup B, which is not covered by the meningococcal vaccine routinely used in the United States. We know for sure that the UCSB outbreak is not related to the Princeton University outbreak, despite the fact that both are serogroup B. (A very specific “DNA fingerprint” test showed that the UCSB outbreak is serogroup B strain ST32, and the Princeton outbreak is serogroup B strain ST409.)
Since the moment the first case was confirmed, my goal in this outbreak has been to stay a few steps ahead of the bacteria. I asked myself, what stopgaps would we be trying to institute if there were a fifth case? Let’s do those now. What major decisions would we face? Let’s gather that critical information now, so it’s at our fingertips when the time comes. Our mantra has been to plan ahead, and then plan ahead some more.
Immediately after the first case, Public Health began working closely with UCSB to coordinate giving antibiotic pills to students who were close contacts to the ill student. This is called chemoprophylaxis. As the outbreak grew, the number of people receiving this prophylaxis grew. After the fourth case, we expanded the prophylaxis to include all members of five specific campus groups that we felt were at higher risk, due to overlapping exposures to the index cases. All told, over 1,200 UCSB students have received chemoprophylaxis. We don’t know for sure that this will stop the spread, but it will help.
A critical component of stopping this outbreak has been educating students on how to best protect themselves and to seek early medical care if they have symptoms. We know that attending social functions where there is smoking, alcohol, and close personal contact (kissing, sharing cups) is associated with a higher risk of contracting this disease. UCSB continues to educate and update students and parents via frequent emails and the UCSB student health website. I issued two Provider Alerts, asking our medical community to have a heightened awareness for meningococcal symptoms in college-aged students, and to have a low threshold to send suspected cases to the emergency room for blood cultures. Our department has conducted more than 30 media interviews with both local and national media, and even held our own press conference, in an effort to keep the public up to date on new developments and educate students. UCSB also cancelled fraternity/ sorority social events through December, at our request.
Since day one, we have worked closely with experts at the Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH). At a very early stage we began discussing the possibility of obtaining the “investigational” vaccine targeted at serogroup B, which Princeton is now using after a long approval process. I want to be clear about the prospects of obtaining this non-FDA-approved vaccine for UCSB students. Yes, it’s a possibility. No, it isn’t available yet.
Immediately after the fourth case was confirmed, I invited CDC and CDPH investigators to come to Santa Barbara for an on-site visit at UCSB. We all agreed that we should work under the assumption that the vaccine would be needed at UCSB, and a site visit was the first step in moving the vaccine issue forward. Although we know that most outbreaks of serogroup B stop at three or four cases, staying a few steps ahead meant planning for the outbreak to grow. During their visit to campus, the CDC learned more about the four students who became ill, assessed the living arrangements and patterns of interactions among students, and discussed logistics of a potential vaccination campaign. Samples of the bacteria are also being tested against the vaccine, to ensure that it would protect against the very specific strain causing the current outbreak. We anticipate that the vaccine will be effective since it works against similar strains, but the specific bacteria associated with the UCSB outbreak have to be tested to be certain.
The CDC is continuing to work with UCSB on the multistep process involved in obtaining access to the vaccine, should it be necessary, under an Investigational New Drug (IND) application to the Food and Drug Administration (FDA). This process will take weeks and is not a guarantee that the vaccine will be recommended for use at UCSB, but it does keep all options on the table.
We are lucky to live in such a close-knit community that rallies together when our kids get sick. Although I think there is a greater than 50 percent chance the outbreak is over, we are planning as if it is not. The attitude of partnership I have witnessed over the past month between medical providers, hospitals, UCSB, and health officials has made me proud to live in this community.
For more information, please see the following websites:
Santa Barbara County Public Health Department: http://www.countyofsb.org/phd/
UCSB Student Health: http://studenthealth.sa.ucsb.edu/
Centers for Disease Control and Prevention: http://www.cdc.gov/meningococcal/surveillance-outbreaks/ucsb.html
Charity Thoman, MD, oversees the communicable disease, HIV, and tuberculosis functions at the Santa Barbara County Public Health Department.