Antibiotics Expert

More than a quarter of the University of Pennsylvania’s undergraduates have been issued antibiotics as a precaution against a bacterial infection that has hospitalized three students, officials said yesterday.

No new cases of meningococcal disease have been confirmed since Friday, and a city public health official said two other students who had been hospitalized with flu-like symptoms probably did not have the more serious illness.

The three students with confirmed Neisseria meningitidis were in fair or good condition yesterday at the Hospital of the University of Pennsylvania, a positive sign with a disease that is fatal in 10 to 15 percent of cases and causes permanent serious disability in an additional 10 to 15 percent.

Getting three cases at once is very unusual, and Esther Chernak, the city Health Department’s head of acute communicable disease, said the university had mounted an aggressive response.

Health-care workers quickly determined that all three infected students had been part of the Greek party scene on the same night, Chernak said. Some people can carry the bacterium with no ill effects, she said, and a carrier without symptoms might have attended a party.

“At a frat party, there is lots of kissing, drinking, smoking,” she said – perfect conditions for an infection that is spread through oral or respiratory secretions.

Why did those three students get sick when others did not? “That’s the Nobel Prize-winning question,” Chernak said.

City and Penn officials determined that with students typically moving from party to party on any given night, thousands could have been exposed. Symptoms usually show up in two to four days but can take up to two weeks.

Late last week, the university temporarily canceled all Greek events and asked any students who had attended fraternity or sorority parties since Feb. 2 to visit special health clinics. Certain secondary sources of contact – dorms, sports teams where water bottles were shared – were identified as well.

In an e-mail to the university community yesterday evening, Penn President Amy Gutmann wrote that while “it is too early to say with absolute confidence that there is no more danger,” the improved condition of the three infected students, lack of new cases, and the distribution of preventive antibiotics offered “every reason to be optimistic.”

More than 3,000 of Penn’s 10,000 undergraduates had been given antibiotics through yesterday, said Phyllis Holtzman, associate vice president for university communications. Most would have gotten a single dose of Ciproflaxin, a broad-spectrum antibiotic that can provide short-term protection against N. meningitidis.

“They are casting a pretty broad net,” said Todd Barton, an assistant professor of clinical medicine at the Penn School of Medicine who is not involved with the investigation.

Barton, an infectious-disease specialist, was consulted on all three cases when the students came into the hospital, although he said other physicians already had made the tentative diagnosis.

He said the first student was admitted to a general-medicine unit early last week with symptoms, such as fever and bad headache, that could indicate various ailments. But he said a particular kind of skin rash, often on the legs, suggested meningococcal disease.

The other two students were admitted directly to an intensive-care unit, he said.

It takes about 24 hours for initial confirmation from a culture, Barton said, and two or three days for the cause to be determined with certainty. In the meantime, a patient would be put on antibiotics.

The death of a Penn sophomore in September 2007 prompted a lawsuit alleging that among other things, the hospital had failed to begin drug treatment while awaiting test results. The suit is pending.

About 1,100 cases of N. meningitidis were reported last year, according to the U.S. Centers for Disease Control and Prevention, a significant decline from a decade or so ago.

Much of that drop is attributed to vaccines. Pennsylvania state law requires all incoming college students to be vaccinated and the University of Pennsylvania is particularly vigilant about it, said the Health Department’s Chernak, who is leading the city’s part of the response.

The newest and most common vaccine, which is known as MCV4 and is manufactured by Sanofi Pasteur Inc. in Swiftwater, Pa., is recommended by the CDC for all children and adolescents ages 11 through 18, as well as for certain other risk groups, including college freshmen living in dorms.

The vaccine covers four of the five major strains of N. meningitidis. Barton said all three of the infected students had been vaccinated.

The vaccine does not cover a strain known as serotype B, which Chernak said caused about a quarter to a third of cases of meningococcal disease.

She said this outbreak had been identified as serotype B.