Look sharp, spot the signs

Jennifer Currie talks to a mother whose student daughter died of meningitis before the government's vaccination programme was put in place

Primary teacher Rita Harries was at school when the call came from a nurse at Manchester Royal Infirmary. Her daughter Elizabeth had collapsed in her hall of residence and was in an intensive care unit.

"My daughter had only completed five weeks of her textile design and design management degree when she contracted meningitis," says Mrs Harries. "We didn't ever get to see her conscious before she died. After we had asked for a second opinion, the machine keeping her alive was turned off on her twentieth birthday, November 9 1991."

Elizabeth had been at a bonfire party shortly before she started to feel ill. According to her friends, says Mrs Harries, she felt no better the next morning. Twenty-four hours later the boy in the next room to hers at Manchester University halls of residence heard her being sick and helped her back to bed. She was complaining of terrible head pains. Then she collapsed.

"Elizabeth always had her feet firmly on the ground. If she had known more about meningitis she would have been more suspicious about the nature of her symptoms and would have perhaps acted earlier," says her mother. "But I have never blamed anybody for Elizabeth's death, nor have I felt much anger -only the devastation of losing her. I know that the warden of her hall of residence felt very concerned as she had been begging him to let her have a room of her own because the one she was sharing was tiny."

What Mrs Harries does wish is that the vaccination programme launched this year by the government in a bid to protect students against meningitis "had been done years ago".

Everybody knows that drinking too much alcohol can make you sick, give you a headache that lasts a day or a lethargy that lasts a week. But not everyone knows that the characteristics of a hangover are uncannily similar to the initial stages of meningitis.

Both these conditions are prevalent among first-year university students, particularly during the first few weeks of term when the risk of meningitis is highest. Students are exposed to the cauldron-like effects of communal living for the first time and mix freely with other young people - one in four of whom, statisticians say, naturally carry the dormant bacteria that can quickly develop into full-blown meningitis in others.

For this reason, the government and the National Meningitis Trust have turned their attention to this year's student first-years, pledging to immunise them against C-strain meningitis. Although the C-type accounts for around 30 per cent of cases among university students, B-type meningitis is more common. As yet, however, there is no vaccination for it.

Cardiff University introduced its freshers' immunisation programme in 1998, a year before the government's recent recommendations, in the light of the university's unhappy history of meningitis outbreaks. There were seven cases in 1997, including three fatalities. A few cases have occurred each year since, none claiming any victims.

Sandra Jones, from Cardiff University's health service, praises the university for its commitment to protecting its students. "It may seem quite pro-active to have acted like this, but we feel very strongly about the issue. Very few students have refused to have the vaccine." Any student accepting a place at Cardiff was told by letter or email that an immunisation session would take place during freshers' week. Although students were free to ask their GPs for the single injection, the university acquired sufficient supplies of the vaccination to inoculate every first-year, or returning student, living in halls of residence.

Attempts the previous year to encourage Cardiff University students to approach their doctors for meningitis vaccinations before leaving home were largely unsuccessful. According to Meirion Evans, a consultant in communicable disease control to Bro Taf, the health authority that covers Cardiff and Glamorgan universities, GPs were reluctant to administer the vaccination in 1997 because it was not national policy.

"We decided to run our own immunisation sessions for students as soon as they arrived in Cardiff, to ensure that we got to them immediately," says Evans. This year, a team of 20 medical staff immunised approximately 3,500 students over a three-day period, accounting for around 85 per cent of the first-year residential population.

Cardiff experienced many of the problems suffered by health services across the country, in that getting its share of the 900,000 vaccinations released by the department of health proved tricky. "We were given to understand by the government that sufficient supplies existed," says Evans. "But what was not made clear was that the stock was not readily available. Much of it was in bottles of 50 doses, which have to be used in a matter of hours. It is fine if you are immunising thousands of students at one time, but quite unsuitable for occasional use in a surgery."

No special immunisation arrangements were made for nearby Glamorgan University's first-year students because, as Evans explains, Glamorgan has not experienced any problems with meningitis in the past. Cardiff University, on the other hand, has a fairly clear pattern of outbreaks.

"There is some evidence that the older, established universities have a much higher incidence rate than the new universities," he says.

Research carried out by Keith Neal, at Nottingham University's department of public health medicine and epidemiology, shows that students living in catered halls of residence are 2.8 times more at risk of contracting meningitis. The study also shows that students are on average 2.4 times more likely to suffer from meningitis than non-students of the same age and geographical region.

"This kind of research underlies the government's attempts to get students immunised before they leave home," Evans says. "Students starting at university will be mixing with people from all over the country. There will inevitably be a lot of close contact during the first few weeks of term, but that is all part of the university experience."

The current vaccination takes 14 days to take effect, lasts for three to four years and is only 80 per cent effective. A new vaccination, destined for children, teenagers and other vulnerable parts of the population, will be available shortly. Providing near life-long protection, it is hoped that by the beginning of the next academic year, every potential student will have been immunised.

This year's intake is being encouraged to find a medium between complacency and paranoia. Sarah Williams, spokeswoman for the Health Education Authority, says that the message accompanying the government's immunisation programme is two-pronged. "Everybody still needs to be cautious. Students need to get to know the signs and symptoms of the disease because early recognition and action can save lives," she says. "It's all about looking out for your mates."