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Outbreaks of Meningitis, Measles Strike Districts

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Outbreaks of bacterial meningitis and measles have struck several school districts in recent weeks, disrupting activities and killing at least two students.

The swift spread of disease through a school or district quickly strains the resources of administrators suddenly faced with angry and confused parents, seriously ill students, and a host of health-related concerns.

In Mankato, Minn., officials scrambled to vaccinate more than 7,000 students, employees, and family members after a meningitis outbreak killed one student and sent several people to the hospital.

A 15-year-old Mankato West High School sophomore died Feb. 3 after becoming infected with the bacteria that causes meningoccal meningitis, an inflammation of the brain and spinal cord. After his death, health officials placed all Mankato West students and their families on an antibiotic, rifampin, that kills the bacteria.

A similar outbreak last month killed a student at Episcopal High School, a private boarding school in Alexandria, Va. A second student from a Norfolk, Va., school who attended a track meet at Episcopal has been hospitalized.

Confronted with sudden serious illnesses, educators must make some quick decisions.

"You need to get the key players in your community together--and fast," said John Barnett, the principal at Mankato West High. That means school administrators, municipal officials, and public-health authorities, he said.

On the advice of the state epidemiologist, Mankato officials decided not to close the school. Students "probably have closer contact out of school than they do in school," Mr. Barnett said last week.

Following the student's death, attendance plummeted to about 30 percent, Mr. Barnett said, but climbed steadily thereafter. Though they kept school open, Mankato West officials suspended the attendance policy and offered make-up assignments.

Taking a different tack, a tiny one-school district in central Texas last month bowed to worries over five meningitis cases and shut its doors for eight school days.

The disease felled three students, a parent volunteer, and the superintendent in the 240-student Jonesboro district, said Tom Rhea, the principal of Jonesboro School. The adults and one of the students had been on the same field trip to Fort Worth.

"Parents were keeping their kids home in droves," he said.

Quick Responses

Once initial decisions are made, school officials then must worry about containing the disease.

During the forced break, Jonesboro School held a vaccination clinic that drew 650 people from in and around the 500-resident farming and ranching community west of Waco.

In Alexandria, Episcopal High School administrators decided to go beyond the recommendation of the local health department and offer rifampin to all faculty members and 400 students.

The actions a school should take during a meningitis outbreak depend on working with public-health officials to identify what strain of the disease is at work and who is likely to be at risk, said Dr. Jay Wenger, the chief of the childhood- and respiratory-diseases branch of the federal Centers for Disease Control and Prevention in Atlanta.

The C.D.C. does not recommend closing school for meningococcal meningitis, he said.

In Grand Junction, Colo., officials administered about 8,000 immunizations after a bout with 50 cases of measles among students and teachers, said Merritt Vanderhoofven, a co-director of pupil services for the Mesa County Valley School District #51.

Since the outbreak in December and January, district officials are considering changing their immunization policy. Colorado law requires students to have had their first measles-mumps-rubella immunization before they enter kindergarten, and the second shot is not required until entry into 7th grade.

But during the epidemic, the students who came down with measles were those who had had the first but not the second measles shot.

During the crisis, students were told to stay away from a district high school if they had not had the second measles shot. And a handful of students who for religious reasons would not get the shot took their lessons home.

"What we had was an epidemic," Mr. Vanderhoofven said. "Parents recognized this as not only a matter of protecting [their] own children, but protecting other children."

Parental Concerns

Keeping parents informed is crucial in such emergencies, officials said.

"You've got to be candid with people," said Mr. Barnett of Mankato West High. "If there's any sense among the public that you're not telling the truth, they'll eat you alive."

At two community meetings held at Mankato West--the second of which drew 1,500 people following the student's death--parents expressed concern about keeping school open.

In Jonesboro, one reason officials there closed school was because they believed the community needed a "cooling off" period, Mr. Rhea said. "There just wasn't enough information out there to allay the fears."

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