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Fatal Infection Puts Pot on the Spot

Passing around marijuana joint caused meningitis outbreak

WEDNESDAY, May 9 (HealthScout) -- The next time you're passing a joint around, ponder this: You might be a sitting duck for meningitis.

Smoking pot was the smoking gun that killed one person and made eight others sick with meningitis during a two-month outbreak that started in December of 1998, say public health officials in Florida. Finding out who the victims came into contact with turned out to be tricky and meant thousands had to be vaccinated, but it was essential in getting to those who really needed antibiotics.

Unusual social networks define who is risking meningitis, they add. The moral here for the public officials was that they needed to dig deeper and use those networks to track down and stop the spread of the virulent disease.

"This outbreak of meningitis was a lot more concentrated than any other outbreak we had seen before," says Dr. Steven Wiersma, deputy state epidemiologist with the Florida Department of Health in Tallahassee. Most of the cases occurred in the months of December [1998] and January of 1999, and then it was basically over."

Florida health officials moved quickly to contain the outbreak, Wiersma says.

"We have guidelines published by the Centers for Disease Control and Prevention that basically outline a strategy for preventing and controlling meningitis. This outbreak occurred in a fairly small community, and all the victims were school-age people, but they did not all go to the same school.

"We decided young people were probably more at risk and made a decision that anyone age 2 to 22 should be vaccinated. Over the Christmas holidays, the health department vaccinated 13,500 people."

Meningitis, an infection of the brain lining, comes in two forms, viral and bacterial. The bacterial form, which is what the kids had, is rarer -- and deadlier. Neisseria meningitis is a species of five deadly meningitis bacteria that affect approximately 2,600 people a year in the United States. The organism attacks the blood and meninges (the membranes around the brain and spinal cord), killing 5 percent to 15 percent of the patients it infects. The germ is particularly hard on young children and the elderly. A quarter of those who survive meningococcal disease suffer brain damage.

In the Florida case, investigators questioned all nine patients on their habits and friends to make sure that everyone they had come in contact with got an antibiotic shot to prevent the disease. "We asked who was your boyfriend, your girlfriend; whom did you share drinks with," Wiersma says.

Marijuana proved to be the link. And the information was not easy to come by.

"They were hesitant to tell about their social networks because they were involved in illicit behavior," he says. Persistence, sensitivity and keeping the information confidential were the keys to finding the root cause, he adds.

So how was marijuana implicated in the spread of the disease?

"Either it was passing around a marijuana joint itself, or the group of young people hung around a lot together and therefore become at higher risk," Wiersma says.

The findings were published in the May Southern Medical Journal.

The Meningitis Foundation of America says that sharing a joint puts you at high risk for the disease.

"They could have caught the disease from smoking a joint, because it's direct contact with saliva," says Carla Newby, executive director of the foundation, based in Indianapolis, Ind. "One of the ways of getting meningitis is direct contact through kissing, sharing of utensils or sharing the same glass."

Using social networks is essential, she adds. "If you have an outbreak situation, and they are all smoking pot together, then to track them down you have to find anyone who was sharing that joint. They are all at risk."

What To Do

For more information on meningitis, visit the Meningitis Foundation of America or the National Institute of Neurological Disorders and Stroke.

And don't forget these previous HealthScout stories on meningitis

SOURCES: Interviews with Steven Wiersma, M.D., MPH, deputy state epidemiologist, Florida Department of Health, Tallahassee; and Carla Newby, executive director, Meningitis Foundation of America, Indianapolis, Ind.; May 2001 Southern Medical Journal
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