Delivery of Care

Promoting public health in a time of fear

Rapid response to meningitis threat at Providence College showcases the strength, value of Rhode Island’s public health infrastructure

Photo courtesy of CDC website

A young adult is vaccinated against meningitis.

By Richard Asinof
Posted 2/16/15
Amid the hue and cry of the measles outbreak and controversy surrounding vaccines, the quick response by the R.I. Department of Health to ramp up a series of vaccine clinics to protect students at Providence College from a meningitis outbreak after two students were reported to have contracted the disease is a testament to Rhode Island’s strong public health infrastructure.
What kinds of new investments might the state consider in its public health infrastructure to continue the excellent work being done by the R.I. Department of Health, whose spending has been managed under budget? What kinds of lessons could be learned from the Department of Health’s capability to buy vaccines at reduced prices and then applied to the management of pharmaceutical purchases by the state for its managed Medicaid population? When will CommerceRI consider investment in the state’s biomedical industry sector as a priority of economic development?
The continued efforts by the Republican majority in the U.S. House of Representatives to vote to repeal the Affordable Care Act, known as Obamacare, in many cases voicing a strong political and philosophical rejection of the role of government in managing health care, runs smack dab into a big paradox when confronted with the public health threat of measles, Ebola or flu. Few politicians argue with the right of government to act to defend the public’s health and well-being. Infectious diseases do not discriminate by class but by vaccination rates.
A similar paradox may confront efforts by R.I. General Assembly leaders to cut Medicaid services. The old chestnut that Rhode Island is more generous with its benefits has been debunked; the latest argument is that Rhode Island’s benefits exceed those of its neighbors. The answer is obvious: if 21 percent of Rhode Island’s children are living in poverty, the highest rate in New England, it stands to reason that the need for benefits will be higher.
A competent financial analysis will show the benefits of increased Medicaid spending – in job creation, in leveraging federal dollars, in reducing charity care by hospitals, in sustained economic purchasing power, in workplace attendance, in school attendance, and in improved health outcomes. The question is: can members of the legislature overcome their own political biases.

PROVIDENCE – With the aftershocks of the measles outbreak that began at Disneyland in California still reverberating across the nation, the rapid response by the R.I. Department of Health to a potential outbreak of meningococcal meningitis at Providence College shone a bright light on the agency’s strong public health efforts.

It was an “under-reported” story. For those that may have missed it, having been buried under the weight of consecutive snowstorms or still celebrating the New England Patriots winning the Super Bowl, the story first broke with a news release on Feb. 2 from the R.I. Department of Health.

It confirmed the report of a case of meningococcal meningitis in a vaccinated Providence College student, who had been admitted to a Boston-area hospital and was improving.

Working in collaboration with the Providence College Health Services, the agency said that it had identified those in close contact with the student and had provided them with preventive antibiotics, according to the release.

“Meningitis does not spread through the air or through casual exposure, so the risk of contracting this disease is low for Providence College students and staff,” said Dr. Michael Fine, the director of the R.I. Department of Health, in the news release. “Still, meningitis is a dangerous disease,” he continued, saying that the agency took even a single case seriously and worked hard to prevent any spread.

The news release went on to describe meningococcal meningitis as a bacterial infection of the lining that surrounds the brain and spinal cord, spread through through direct secretions from the nose or mouth through activities such as kissing, sharing food, drinks, water bottles, toothbrushes, eating utensils, or cigarettes.

The disease can be treated with antibiotics, the news release said, but quick medical attention is extremely important, adding that about 92 percent of Rhode Islanders from 13 to 17 years of age have received at least one dose of meningococcal vaccine.

A second case
Three days later, on Feb. 5, when a second probable case of meningitis was reported at Providence College, with the student admitted to a hospital in Rhode Island, the R.I. Department of Health shared that information in a news release.

As a result, on Feb. 6, the R.I. Department of Health, in coordination with the Centers for Disease Control and Prevention and Providence College, moved quickly to hold a series of vaccination clinics at Providence College. Thousands of students received the first dose of meningitis B vaccine on Feb. 8 and Feb. 11, which was recommended for the college’s 3,800 undergraduate students, graduate students living on campus, staff that were under 25 years old and/or who may have had a suppressed immune system.

“The spread of meningococcal disease can be stopped by good public health practices,” Fine said, in a follow-up news release, calling the rapid action vaccination clinics an important step to kept the Providence College community healthy.

Indeed, Providence College went ahead with its planned “Alumni and Family Weekend,” scheduled for Feb. 13-15, without a hitch, save for the fourth major snowstorm in four weeks.

There was no pushback from parents, college officials or critics about the need for vaccinations – or about the necessary role of government in promoting and protecting public health.

Potential breakthrough in human immune system diseases
In another under-reported story, the effectiveness of this year’s flu vaccine against the current strain of flu has proven to be problematic, as what the Centers for Disease Control and Prevention calls “mismatched” H3N2 flu viruses are continuing to spread across the country, hitting older people hard, according to the agency.

As of Feb. 6, the flu-associated hospitalization rate among people 65 or older was the highest rate recorded since the CDC began tracking that data 10 years ago in 2005. Overall, nearly 60 percent of the flu-associated hospitalizations have been among people 65 years and older.

The predominant strain of the flu virus this year is H3N2, but the virus mutated enough since the vaccine went into production that it is not a complete match, according to health experts.

Ongoing work by Dr. Anne S. De Groot and her team at EpiVax may lead to the production of more highly effective flu vaccines, focused on research on what they term “immune camouflage.” In a paper published online on Feb. 10 in the journal Human Vaccines & Immunotherapeutics, research by De Groot and her team showed how pathogens may be actively suppressing protective immunity by exploiting what are known as “ignorance and tolerance” mechanisms.

Through the use of EpiVax’s new JanusMatrix technology tool, the researchers were able to identify several such “camouflaged” tolerizing epitopes that are present in the viral genomes of diseases such as H7N9 influenza.

Translated, it means that researchers, by identifying and removing these immune camouflage agents in viral, bacterial and parasitic diseases, may be able “to develop more effective vaccines and immumotherapeutics in the future.”

The cutting-edge research appears to be very much congruent with President Obama’s $215 million new personalized medicine initiative.


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