Meningococcal Disease: A Parent s Perspective

2. Meningococcal Disease: A Parent�s Perspective Mike Kepferle National Meningitis Association, Founding Board Member

3. Susan Marley, RN, BSN, PNP, NCSNNASN Board Member, Meningococcal Disease Task Force

4. Role of School Nurse School nurses play integral role Responsible for health and well-being of students Instrumental in educating about preventive measures

5. Meningococcal Disease: Not Just College Students Meningococcal disease a health threat for teens, as well as college students NASN at the forefront of meningococcal disease prevention

6. NASN Member Survey Distributed to members in November 2004 Web-based survey Nearly 1,000 members participated Survey focused on adolescent meningococcal disease, including: Disease prevention Potential new immunization recommendations

7. Do you advise parents about adolescent immunization? Through the survey we were able to confirm that the vast majority of school nurses surveyed � 86 percent � already advise parents in general about immunizations for adolescents. This reinforces the role of the school nurse in helping to implement the new CDC meningococcal immunization recommendations. You already are a key player in adolescent immunization, so broadening that to include meningococcal disease is a natural next step. Through the survey we were able to confirm that the vast majority of school nurses surveyed � 86 percent � already advise parents in general about immunizations for adolescents. This reinforces the role of the school nurse in helping to implement the new CDC meningococcal immunization recommendations. You already are a key player in adolescent immunization, so broadening that to include meningococcal disease is a natural next step.

8. Rate your awareness of adolescent meningococcal disease

9. Rate your knowledge of meningococcal immunization Most respondents indicated they were familiar with meningococcal immunization Very High = 6% High = 17.9 % Average = 50.2% Low = 22.5% Very Low = 3.4%

10. Knowledge of CDC Immunization Recommendations At the time of the survey, the CDC, along with the American College Health Association recommended that college students, especially freshmen living in dormitories, be educated about meningococcal disease and immunization. As you can see, a large majority of members surveyed were aware of the college recommendations. And while members surveyed knew that younger adolescents, in addition to college students, also are at risk for meningococcal disease, most did not know the CDC was considering recommendations targeting younger adolescents, which at the time of the survey, were still under review by the CDC�s Advisory Committee on Immunization Practices. In late-May, the CDC approved meningococcal immunization recommendations specifically targeting younger adolescents and college students, which we will detail later in today�s presentation. Given the new recommendations, now is the time to begin educating parents and students about this devastating disease and importance of immunization. At the time of the survey, the CDC, along with the American College Health Association recommended that college students, especially freshmen living in dormitories, be educated about meningococcal disease and immunization. As you can see, a large majority of members surveyed were aware of the college recommendations. And while members surveyed knew that younger adolescents, in addition to college students, also are at risk for meningococcal disease, most did not know the CDC was considering recommendations targeting younger adolescents, which at the time of the survey, were still under review by the CDC�s Advisory Committee on Immunization Practices. In late-May, the CDC approved meningococcal immunization recommendations specifically targeting younger adolescents and college students, which we will detail later in today�s presentation. Given the new recommendations, now is the time to begin educating parents and students about this devastating disease and importance of immunization.

11. What You Need to Educate Parents, Students

12. SAFER � HEALTHIER � PEOPLE

13. SAFER � HEALTHIER � PEOPLE

14. SAFER � HEALTHIER � PEOPLE Meningococcal Disease Is A Challenge Persistent global health problem Causes endemic and epidemic disease Early disease can be easily misdiagnosed Variable clinical manifestations Hard to distinguish from common viral illness Displays rapid onset and progression High morbidity and mortality Effective therapy

15. SAFER � HEALTHIER � PEOPLE Overview: Meningococcal Disease Bacterial infection causes by the bacterium Neisseria meningitidis Attacks membranes surrounding the brain and spinal cord (meningitis) or poisons the blood (meningococcemia)

16. SAFER � HEALTHIER � PEOPLE Most Common Clinical Presentations of Meningococcal Disease Meningococcemia Rash Vascular damage Disseminated intravascular coagulation Multi-organ failure Shock Death can occur within 24 hours ~5% to 20% of cases Meningitis Fever and headache Flu-like symptoms Stiff neck Nausea Altered mental status Seizures ~50% of cases

17. SAFER � HEALTHIER � PEOPLE Serious Outcomes of Meningococcal Disease Meningococcemia Skin scars from necrosis Limb loss from gangrene Renal failure Septic arthritis Pneumonia Epiglottitis Pericarditis Up to 40% fatality rate Meningitis Spastic quadriplegia Hearing loss Cerebral infarction Cortical venous thrombophlebitis Cerebral edema Cranial nerve palsies Mental retardation Hemiparesis 3% to 10% fatality rate

18. SAFER � HEALTHIER � PEOPLE Purpura

19. SAFER � HEALTHIER � PEOPLE Gangrene Caused by N. meningitidis Infection

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21. SAFER � HEALTHIER � PEOPLE A Peak of Meningococcal Disease Incidence Occurs in 15- to 19-Year-Olds

22. SAFER � HEALTHIER � PEOPLE Rates of Meningococcal Disease (A/C/Y/W-135) by Age, 11-30 yo, U.S., 1991-2002

23. SAFER � HEALTHIER � PEOPLE Most Cases in Adolescents and Young Adults Are Potentially Vaccine-Preventable*

24. SAFER � HEALTHIER � PEOPLE Meningococcal Vaccines Meningococcal Polysaccharide vaccine (MPSV4) Licensed in 1981 as a single dose Good short term (3-5years) protection in 85% in older children and adults Antibody decrease markedly after 2-3 years Revaccination every 3-5 years Meningococcal Conjugated Vaccine (MCV4) Licensed in 2005 for single dose intramuscularly Covers Serogroups A,C,Y, and W-135 Expected efficacy similar to MPSV4 Need for revaccination not yet known but given studies to date we assume MCV4 will provide protection of >8 yrs

25. SAFER � HEALTHIER � PEOPLE

26. SAFER � HEALTHIER � PEOPLE CDC Recommendations for Routine Vaccination of Adolescents with MCV4 Vaccination recommended for - Preadolescent visit (11-12 years) and high school entry (about age 15) College freshmen living in dormitories Other groups at high risk

27. SAFER � HEALTHIER � PEOPLE CDC Recommendations for Routine Vaccination of Adolescents with MCV4 Catch-up campaigns not recommended Other individuals can chose to be vaccinated In 11-55 of age, MCV4 preferred but MPSV4 acceptable

28. SAFER � HEALTHIER � PEOPLE

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30. SAFER � HEALTHIER � PEOPLE Revaccination

31. SAFER � HEALTHIER � PEOPLE Contraindications Vaccination should be deferred for persons with moderate or severe acute illness until the person�s condition improves MCV4 or MPSV4 is contraindicated among persons known to have a severe allergic reaction to any component of the vaccine, including diphtheria toxoid (for MCV4), or to dry natural rubber latex. Any adverse effect suspected to be associated with MCV4 or MPSV4 vaccine should be reported to the Vaccine Adverse Event Reporting System (1-800-822-7967)

32. SAFER � HEALTHIER � PEOPLE Support for Recommendations American Academy of Pediatrics American Academy of Family Physicians American College Health Association Society for Adolescent Medicine

33. SAFER � HEALTHIER � PEOPLE Acknowledgements National Association of School Nurses Castle Rock, Colorado Nancy Rosenstein, MD National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention Rich Besser, MD National Center for Infectious Diseases Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention Lisa Bridges National Center for Infectious Diseases Office of Health Communication, Centers for Disease Control and Prevention Danielle Castellani Cooney/Waters, New York City, N.Y.

34. Donnese Kern, RN-CS, MSN, NCSN, NP NASN Board Member, Meningococcal Disease Task Force Thank you Bobbie, as you have all seen, meningococcal disease is quite serious. NASN feels strongly about providing members with tools to address current health issues. These efforts have allowed NASN to develop this online resource kit and provide to members timely information on the topic. Thank you Bobbie, as you have all seen, meningococcal disease is quite serious. NASN feels strongly about providing members with tools to address current health issues. These efforts have allowed NASN to develop this online resource kit and provide to members timely information on the topic.

35. NASN Resource KitGet S.M.A.R.T About Meningitis! Provide tools to confidently advise and educate community Results of member survey used to identify materials Materials are in template format and can be customized for use within your school

36. Get S.M.A.R.T About Meningitis! Online Resource Kit Materials to create/support education programs Education materials for distribution to variety audiences

37. Get S.M.A.R.T About Meningitis! Online Resource Kit Download resource kit via NASN Web site: