When Jenna Dunn died of a disease related to bacterial meningitis in 1999, the vaccines available at the time weren't recommended for broad use.

That has changed over the past decade with the development of better vaccines, yet at least 30 percent of adolescents last year in Minnesota hadn't received the shot.

And that's a gap that Dunn's father finds troubling.

James Dunn, 66, of Inver Grove Heights watched his 26-year-old daughter -- then a graduate student at the University of St. Thomas in St. Paul -- succumb to the disease in less than a day's time.

"Not a day goes by, not an hour that you don't think about her," said Dunn. "You ache for one more hug, one more minute."

In Minnesota and a growing number of other states, public health officials are pushing to require all children to be vaccinated for meningitis before entering seventh grade.

The effort comes at a curious time in the natural history of meningitis, epidemiologists say, because deaths and illnesses from the disease have dropped to historic lows in the United States. No one seems to know what's driving the decline, but health officials are pushing for broader use of the vaccine, nonetheless, because cases of meningococcal disease can be so severe.

"Even though it's a rare disease at this point, the consequences are devastating," said Kris Ehresmann, director of infectious disease epidemiology at the Minnesota Department of Health.


Meningitis can result from viral and bacterial infections, but the vaccines approved for use in the United States protect against meningococcal diseases caused by a bacterium known as Neisseria meningitides. The bacteria can infect the lining that surrounds the brain and spinal cord and cause meningitis, or it can cause a dangerous bloodstream infection like the one that killed Jenna Dunn.

The illnesses prevented by the vaccine are different from the current outbreak of fungal meningitis that's been linked to injected steroid medications from a compounding pharmacy in New England.

Even with appropriate antibiotics and intensive care, up to 15 percent of people who develop meningococcal disease die. An additional 10 percent to 20 percent suffer complications such as brain damage and loss of limb or hearing.

"If your child gets sick in the morning, they can be dead the very next day," said Melinda Thomas, a school nurse at Falcon Ridge Middle School in Apple Valley who is part of a vaccine awareness campaign funded by the drug company Sanofi-Pasteur.

Neither Sanofi-Pasteur -- which makes one of the vaccines available in the United States -- nor the National Association of School Nurses would say how much money is being spent on the awareness effort. During the first half of 2012, the drug company reported about $205 million in worldwide sales of its meningitis vaccine.

Retail clinics charge about $180 for the vaccine, but the cost of the shot typically is covered by health insurance plans.

"I think sometimes unless the vaccines are required, parents go: 'Well, we don't really need that,' " Thomas said. "That's what this campaign is about -- to educate parents about the need for this vaccine."

The Minnesota Department of Health is seeking a change to the state's immunization law that would require a child enrolling in a secondary school to have a meningococcal vaccination beginning in the seventh grade. Exceptions would be made if parents or guardians take a medical or conscientious exemption for the vaccine.

The health department started the process of changing the law through rulemaking on April 30, with the first in a series of steps that typically take a year to 18 months to complete, said Ehresmann, the health department official.

At least 14 states require proof of meningitis vaccination or a waiver, according to the St. Paul-based Immunization Action Coalition.

About 70 percent of U.S. adolescents ages 13-17 had received the meningitis vaccine last year, according to estimates from the federal Centers for Disease Control and Prevention. In Minnesota, the estimated vaccination rate is between 56 percent and 70 percent.

"There is a consistent trend since 2008 of Minnesota's point estimate being lower than the national point estimate, which gives credence to the position that our true rate probably is somewhat lower than the national true rate," Ehresmann said.

"One reason could be that some states require meningococcal vaccination for school entry at, (for example), seventh grade. Those states are likely to have higher rates and pull up the national average relative to states that don't."

Currently, the meningitis vaccine is recommended for adolescents, preferably at age 11 or 12, with a booster dose at 16. In 2003, a Minnesota law required colleges to provide information on the meningococcal vaccine, but the state hasn't required vaccination itself.

(Wisconsin does not require the meningococcal vaccine, but colleges and universities must distribute information annually to all students about meningococcal disease.)

College students living in dormitories and military personnel are at increased risk for meningococcal meningitis because they reside in community settings where the bacteria can spread more quickly.

It's unclear why meningococcal diseases have become less common, Ehresmann said. In Minnesota, there were nine cases in 2010 -- down from 56 cases in 1999, according to the health department. The decline is the key reason, Ehresmann said, that infectious disease professionals haven't pushed for immunizing infants and toddlers.

Currently, there are about 1,000 cases of meningococcal diseases annually in the U.S. and 150 deaths, said Jessica MacNeil, a CDC epidemiologist. Previously, there would have been a few thousand cases per year, she said.

She said the decline in cases occurred before 2005, when the government licensed the first long-lasting meningitis vaccine.

"Meningococcal disease definitely has a cyclical nature to it, and we don't really know why that is," MacNeil said. "It's at an all-time low, but this is really a devastating illness. That's why we think it's really important that adolescents get vaccinated."

James Dunn underscores that point.

His daughter was working on her master's degree in English at the time of her death. The course of study fit with Jenna's love of reading and writing, Dunn said.

When she went to an emergency room early on the morning on June 28, 1999, doctors failed to diagnose the illness fast enough to treat it, Dunn said.

In the first few years after her death, Dunn and his former wife pushed for procedures that would enable doctors and hospitals to more quickly recognize the symptoms of meningococcal disease. Now, he's happy to support the cause of boosting vaccinations.

Meningitis cases aren't that common, Dunn said, so the vaccination issue can fly under the radar for parents.

"We all think it can't happen to us, but it can. And when it does, it's devastating," he said. "If it takes a little bit of effort to prevent (this) ... by all means do it."
