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Meningitis (bacterial and viral) among college age students is on the rise in college campuses due to the closeness of college students in residence halls. The causes can be viral or bacterial in origin. Bacterial meningitis is fast-moving, causing debilitating amputations, hearing loss and kidney damage and it can be fatal (CDC, 2019). Viral meningitis has similar symptoms to bacterial meningitis but is not as debilitating or as deadly as bacterial meningitis (National Meningitis Association, 2019). Three organisms mainly cause bacterial meningitis:
Meningitis can also be caused by other microorganisms like fungi or parasites, as well as being caused by injury, cancer, or certain drugs (CDC, 2019). It should be noted, also, that Kwang (2018) states that Escherichia Coli (E. Coli) is the most common bacillary organism bacteria causing meningitis.
The symptoms of meningitis infecting the spinal cord and brain are sensitivity to bright light, seizures, high fever, confusion, delirium, sleepy, vacant, vomiting and the hallmark symptoms of severe headache and stiff neck (CDC, 2019).
Other late symptoms of meningitis are a pink or purplish skin rash, positive Kernig’s sign, positive Brudzinski’s sign, and turbid cerebrospinal fluid upon spinal tap (Badru, 2019). Mode of transmission is the exchange of respiratory secretions during close contact such as kissing or coughing on someone. Complications can be deadly or can lead to hearing loss, brain or kidney damage, or limb amputations (NMA, 2019). Treatment after diagnosis via lumbar puncture to culture cerebrospinal fluid must be swift as death and serious complications can occur within hours (Badru, 2018).
Treatment consists of antibiotics given right away to help reduce the risk of dying (CDC, 2019).
Dickinson & Perez (2005) cite the World Health Organization estimation of 1.2 million bacterial meningitis (BM) cases worldwide and of those 135,000 deaths. Mbaeyi, Joseph, Blain, Hariri, & MacNeil (2019) state that freshman college students in particular are at increased risk for meningococcal disease. Among college students age 18-24 years old, in the period from year 2014 to 2016, the incidence of meningitis was 1.74 per 100,000 for those living in dormitories vs. 0.96/100,000 for those students living off campus (Mbaeyi, et al., (2019). In the period of 1990-1991 and 1991-1992 school years, cases of meningococcal disease occurred 9-23 times more frequently in students residing in dormitories. Comparatively, university students living in catered hall accommodations (the UK term for dorms) in the United Kingdom also had an increased incidence of 13.2 per 100,000 versus 5.5 per 100,000 for those university students not living in catered hall accommodations (Dickinson & Perez, 2005). The prevalence of meningococcal disease (meningitis) among adolescents and young adults is higher in the 16-23 year old age group (CDC, 2019). Meningococcal disease is seasonal with peak number of cases in January, February, March.
Artiga & Hinton (2018) identify the social determinants of health as socioeconomic status, education, neighborhood, physical environment, employment, social support networks and access to health care. In college aged students, the social determinants of health in the area of physical environment and neighborhood contribute to the increased prevalence and incidence of meningitis. Dickinson & Perez (2005) state that the physical environment of sleeping in overcrowded dormitories contributes to the high incidence of meningitis in college age students. The incidence of meningococcal disease among US college students is low but college students are at increased risk for meningococcal disease compared with noncollege students aged 18-24 years as a higher incidence of meningococcal (Type B) disease accounts for three-fourths of all the cases in this group (Mbaeyi, et al, 2019).
The epidemiological triad consists of the host, environmental factors, and the agent (the bacteria or virus causing the disease). In the host (the college student with a common cold), the pharyngeal and respiratory epithelium act as barriers to pathogens (NMA, 2019). When this mucosa is irritated by a respiratory illness (such as the common cold) the barrier is broken down or irritated allowing more invasive disease such as the Neisseria meningitidis bacterium (agent) to enter the bloodstream causing bacteremia which in turn allows bacterium entry into the human brain microvascular endothelial cell (NMA, 2019). Meningitis-causing bacteria such as N meningitidis or, specifically, E Coli can invade the tight blood brain barrier (Kwang, 2018).
Environmental factors consist of socio-economic elements and physical elements. Socio-economic elements are overcrowding, access to health services, and unsanitary conditions (Kwang, 2018). Physical elements characteristics are climate, geology, fauna, flora, ecosystem, and geographic areas (Kwang, 2018).
The ideal physical conditions for meningitis to proliferate among college students is the time of year, ecosystem, and geography. It should be noted that meningococcal bacteria commonly exist in the throat and nasal areas without being sick (AANP, 2019). January, February, and March (winter months) are peak times for meningitis contagion. College students are indoors studying in overcrowded dorms and study areas during these cold winter months. The ecosystem is cold weather not allowing for fresh air circulation indoors. The geography is northern climates where most remain indoors during inclement weather.
College students are prone to dating (spending lots of time with each other) and often share bodily fluids (knowingly or unknowingly) by kissing, sharing utensils, food or drinking cups and the organism is easily transmissible due to these college student habits (NMA, 2019).
To promote quality healthcare and improve clinical outcomes, NP’s participate in health care forums, participate in nursing research and apply evidence-based practice to clinical practice (AANP, 2019). Nurse practitioners have an enormous role to prevent and treat meningitis.
Surveillance activities by FNP’s involve mandatory reporting of meningococcal disease to local and state health departments (CDC, 2019). The Council of State and Territorial Epidemiologists (CSTE) classify meningococcal disease as 1) suspected (clinical purpura in the absence of a + blood culture); 2) probable (detection of Neisseria meningitidis); 3) confirmed (detection of Neisseria meningitidis via lab test or isolation of Neisseria meningitidis from sterile body sites (such as blood or cerebrospinal fluid) (CDC, 2019).
Primary prevention practices are educating students and their parents on the existence, causes, signs and symptoms (beyond a head cold), prevention of meningitis, personal and environmental hygiene and how meningitis is spread (Badru, 2018). Nurse practitioners can disseminate culturally-sensitive information via churches, mosques, markets, and areas where college students gather (coffeeshops, vegan/smoothie shops) (Badru, 2019). Additionally, The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control recommends that the MenB vaccine be given to adolescents entering high school (prior to entrance to colleges with dormitories) and to college freshmen living in dormitories (Banzhoff, 2017).
Secondary prevention involves treating family and friends in close contact with meningitis patients with antibiotic prophylaxis (Badru, 2018). Also, the FNP screens college students for potential exposure to meningitis bacteria asking questions about overcrowded living arrangements and sanitation and hygienic practices (CDC, 2019).
Tertiary prevention by APN’s involves Badru’s (2018) recommendation to report to the hospital as early as possible to curtail the infection. After successful treatment with antibiotics, tertiary prevention involves hearing tests to detect and treat the degree of hearing loss from hearing loss complications (Mbaeyi, et al, 2019). Amputation after infection can be attended to by referrals for physical therapy and occupational therapy (Mbaeyi, et al, 2019). Kidney disease can be followed by referrals for nephrology care and follow-up primary care (Mbaeyi, 2019).
Hale, Harper, & Dawson (1996) developed a model of practice for advanced practice nursing primary care of college students at George Mason University Student Health Center (SHC). The SHC is staffed by faculty who are practicing nurse practitioners implementing evidence-based practice for primary care. They are applying these evidence-based practices to the care of college students on campus. By providing comprehensive primary care to students on campus, the focus of care is managing current health care needs by emphasizing prevention, wellness, and quality of life (Hale, et al, 1996).
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