By Kara Shire
Valley Times

April 21, 2001

LIVERMORE — It's a rare but bold bacteria. When it attacks, it does so violently, often killing its victims within hours.

So why, when the meningitis-related bacteria was first found in the body of a 15-year-old Livermore boy on March 30, did it take 19 days for a community health clinic to get off the ground?

Why, some are asking, did it take two more cases and the death of 16-year-old Michael Gordon to get widespread antibiotic treatment for Livermore students?

"I think they should have taken care of it early," said sophomore Levente Nagy while waiting for his dose of the meningitis-fighting drug, called Cipro, at a health clinic at Livermore High School.

But physicians and health experts say treating meningococcal meningitis or its cousin, meningococcemia, is not that simple. And when it comes to doling out antibiotics to an entire school, health officials say they face a long list of worries.

"As a parent, your first reaction is 'boom, inoculate everybody, protect everyone,'" said Carla Newby, general manager of the Indianapolis-based Meningitis Foundation of America whose 6-year-old son died of meningitis in 1998.

"But health officials have to listen to their head a little bit more than their heart."

There are two primary reasons why health workers don't race in and medicate an entire community when the first sign of meningitis pops up, Newby said.

"Number one is supply," she said. "Number two is, you don't want to give somebody medicine and have them immune to (the antibiotic) and then be exposed to (the disease) again three or five years later."

Local health officials also point to protocol, which rarely calls for the kind of broad-scale treatment of meningitis that Livermore teens have seen this week.

"The normal procedure is once we've diagnosed a case, we interview the person to see who they've been in close contact with, and we treat the close contacts," said Dr. Barbara Allen, director of the Alameda County Department of Public Health Division of AIDS and Communicable Diseases.

"So we did that with the first two cases. What makes this last case different is unfortunately, he did not survive, so we can't interview him."

Instead, the county health department has handed out some 1,700 pills over two days to Livermore students, parents and teachers of a pill that will protect them from the meningococcal germ for at least a few weeks.

"Normally, we wouldn't do this," Allan said.

And the reason, said Dr. Jon Rosenberg , is because meningitis almost always strikes a community once and then simply disappears.

Until this year, California schools hadn't seen a "cluster" of meningitis since 1993, said Rosenberg, an epidemiologist with the California Department of Health Services.

"Every year we have 40 to 80 cases (in the 10- to 19-year-old age group), and for eight years in a row those were single cases," Rosenberg said.

"So let's say there's 50 cases in one year. To treat an entire high school you're talking 1,000 to 2,000 students. That alone_that's a staggering number of doses of antibiotics for which you would not have stopped another case."

Still, health officials say they understand the kind deep-rooted fear something like meningitis stirs in a community.

"I absolutely understand," said Alameda County Department of Public Health spokeswoman Sherri Willis. "That's why we're holding this clinic."

Although there is a meningitis vaccination, it is only effective on some strains. The Livermore strain has not been identified.

Last year, there were 20 meningitis cases in Alameda County, 21 in 1999. There were 28 in Contra Costa last year, 10 in 1999.