Contagious on campus

Advance planning the key to preventing and managing infectious diseases on campus

A public healthcare crisis thrust Southern Methodist University into the spotlight in September when a Liberian man visiting Dallas was diagnosed with the Ebola virus.

The hospital where Thomas Eric Duncan was treated and later died—Texas Health Presbyterian—is less than four miles from SMU’s campus. It’s a facility where students are transported for emergency medical treatment and where they work in pre-med internships.

While SMU was collecting information about any possible connections to the outbreak, two graduate students reported to faculty that they had traveled on the plane from Dallas-Fort Worth to Cleveland with the Presbyterian hospital nurse who had been infected with Ebola.

Though the students had no known direct contact with her, the university—with guidance from the local health department—asked the pair to quarantine themselves in their off-campus apartments for the 21-day period during which symptoms of Ebola can develop.

“It’s one of those things that if nothing happens at the outcome, everyone thinks you did enough,” says Joanne Vogel, associate vice president for student affairs at SMU. “But if one of those students did get Ebola, then everyone would think you did too little.”

While the vast majority of colleges and universities have not had such close brushes with Ebola, schools across the country have been developing emergency plans to deal with the disease since it first became a public health threat last summer. While Ebola has moved to the forefront in campus healthcare management, college and university officials acknowledge that the most common communicable disease they must address is the flu.

In the United States, 36,000 people die from the flu each year, according to Harvard Medical School statistics. And while four people have tested positive and treated for Ebola in the U.S. since last September, more than 200,000 Americans are hospitalized each year because of the flu.

Advice for managing an infectious disease outbreak

  • Make sure your campus has an emergency preparedness plan to deal with outbreaks of a variety of communicable diseases.
  • Revise those emergency plans as new diseases arise.
  • Don’t allow campus health center staff to give advice over the phone to a student who complains of having a fever. Ask the student to visit the center for an evaluation and treatment.
  • Offer free or inexpensive flu vaccines in convenient locations throughout campus.
  • During a potential outbreak, communicate quickly and openly about new cases, even before all the details are sorted, so the campus community can take precautions.
  • In communicating, avoid glossing over risks and report what is actually happening as quickly as possible.

“We need to be prepared for Ebola, because a single case on a campus would be a huge issue,” says Dr. Sarah Van Orman, executive director of University Health Services at the University of Wisconsin-Madison and president of the American College Health Association. “But we need to put it into the context of all the other communicable diseases that we deal with on a daily basis.”

Another infectious disease that impacts colleges and universities is meningitis, an infection of the brain and spinal cord that can cause brain damage or death. First-year college students living in residence halls are at slightly increased risk for the disease, according to the Centers for Disease Control and Prevention.

Though many communicable diseases like meningitis are rare, a growing number of colleges and universities are creating emergency preparedness plans to help prevent outbreaks of such illnesses and to manage them when they do occur.

“There is always a reputational concern about any outbreak of any disease where you have a very concentrated population of college-age students who tend to mix very socially and in close quarters,” says Gary Langsdale, university risk officer at The Pennsylvania State University. “It’s not good news for a university to be associated with an outbreak of anything.”

Still, planning for disease outbreaks often involves both advance preparation and learning lessons from incidents as they occur. Here’s how institutions are dealing with the potential impacts of flu, and meningitis, and for the possibility of Ebola.

Containing influenza

While many infectious diseases such as meningitis are rare, it is not uncommon for hundreds of students at a large university to contract the flu each season. At the University of Wisconsin-Madison, for example, between 400 and 500 students are seen in the health center with a flu-like illness every year. That represents about 1 percent of the campus enrollment, says Craig Roberts, an epidemiologist with University Health Services.

Colleges and universities can help prevent outbreaks of flu by making vaccinations inexpensive and convenient for students. UW-Madison offers free flu vaccines and administers about 13,000 flu shots each year, Roberts says.

While 60 percent of the general population is vaccinated, only about 25 percent of young adults get the flu shot, Orman says. “Part of what helps with college students is to make it free and easy,” she says.

A study conducted by University at Buffalo researcher Janet Yang found that many college students did not get vaccinated in 2010—a year after the pandemic of Swine flu killed 294,000 people worldwide—because they had misinformation about both the flu and the vaccine, and they did not see the relevance of the vaccine to their health or to the health of others. The CDC estimates that the vaccination rate for college students during the H1N1 pandemic was only 10 percent.

Last year, the student health center at the University of Missouri in Columbia began a two-prong strategy to boost the vaccination rate: The school included the cost of the flu shot in the students’ health fee of $100 per semester, and offered the vaccine at the library, bookstore, student health center and other campus locations. Due to those changes, the campus broke its own record by administering 5,127 vaccines as of the end of November, says Dr. Susan Even, executive director of the MU’s Student Health Center.

Students who suspect they have the flu are not always treated medically. “If they call and they report symptoms consistent with influenza and they don’t have any other complicating factors, we’ll give them recommendations—if you have fever over 100 and a cough, you need to stay home until those symptoms are under control,” Even says.

At Adelphi University on Long Island, New York, the health services staff gives the students medication and a mask to wear in residence hall bathrooms and other common areas. “We ask them to self-isolate,” says Jacqueline Cartabuke, director of health services at the university where about 16 percent of students live in residence halls. “If they live off campus, we send them home.”

Managing meningitis

In January 2008, an outbreak of bacterial meningitis began at Ohio University in Athens. Over a nearly two-year period, eight students contracted the disease, including a freshman who died. The university recently agreed to the pay that student’s family $1 million to settle a lawsuit filed by the parents.

What made the outbreak difficult to manage was that the strain of meningitis belonged to serogroup B. Though common in Europe, the strain had not been seen in the United States before and is not covered by the current meningitis vaccine.

Five years later, outbreaks of strain B bacterial meningitis occurred at Princeton University and the University of California, Santa Barbara. In November 2013, Princeton received approval from the Food and Drug Administration to offer a serogroup B vaccine used in Europe. That vaccine has since been approved by the FDA for general distribution in the U.S. and, at press time, was expected to be available at some point early this year.

Though Ohio University did not have an emergency plan for handling infectious diseases in place when the outbreak occurred, officials began developing one as the meningitis crisis unfolded. Even without a plan to follow, university leaders say the open communication policy employed during the outbreak helped save lives.

“We would often communicate before we had lots of details,” says Ryan Lombardi, vice president of student affairs, adding that confirmation of meningitis could take up to a day. “We would often blast emails if it looked like a suspected case. We were very quick to realize that and err on the side of caution.”

Another change stemming from the outbreak is that any student who calls the university health center complaining of a fever is now advised to come in for an evaluation or seek treatment at a local hospital. The student who died from meningitis never visited the health center but had called and received advice over the phone, Lombardi says.

Tackling Ebola

While the likelihood of an Ebola case emerging on a college campus is extremely low, the internationalization of American universities has drawn students from the West African countries where the disease has festered: Guinea, Liberia and Sierra Leone. Creating policies on travel to those countries has become the focus of campus Ebola planning.

“We have a population that is highly international and highly mobile, so universities need to take it seriously,” says Langsdale of Penn State, which has four students from Guinea, Liberia and Sierra Leone enrolled this year.

Last fall, colleges and universities restricted education-related travel to those three African countries, following the CDC guidelines that also warn people to protect themselves while visiting Mali. By the end of the semester, however, schools faced a different issue: How to arrange the return to campus of students who planned to travel home to those countries over the holiday break.

Most schools that enroll students from Guinea, Liberia and Sierra Leone who returned home for vacation were working with their local health departments to implement CDC guidelines and ask the students to self-monitor themselves for 21 days after their return.

As emergency plans for Ebola are developed, officials should keep in mind the need to communicate the information immediately to their campus community. Vogel, who helped plan the communication strategy at SMU during the Ebola crisis in Dallas, says one lesson she learned is that parents want as much detailed information as the university can provide—as quickly as possible.

“They really see right through a nice message,” she says. “They really want more about what’s happening.”

Providing transparency in communication is also the best way to protect the university’s reputation, says Anita Ingram, assistant vice president and chief risk officer at the University of Cincinnati. “It’s important to put that information out there and to communicate what the actual facts are,” she says. “In that way you mitigate your risk and minimize the rumors and the bad information.”

Sherrie Negrea is a writer based in Ithaca, N.Y.

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