On August 23, the Boone County, Missouri, medical examiner made it known that viral meningitis caused the July 12 death of University of Missouri, Columbia, football student-athlete Aaron O'Neal, who collapsed after a summer workout. Reporters quickly began raising questions as to the prevalence of such a rare disease in the sports environment.

Meningitis, an infection of the fluid surrounding the brain or spinal cord, can be due to the infection of bacteria or a virus. Although death from viral meningitis is rare, the incidence raises awareness for such disease in sports and re-emphasizes that otherwise healthy stu- dent-athletes are susceptible to disease and illnesses that can cause sudden death.

The Centers for Disease Control and Prevention (CDC) estimates that 1,400 to 2,800 cases of meningococcal disease occur annually in the USA, and 10 to 14 percent of cases are fatal. About 100 cases of bacterial meningitis occur on college campuses each year, with about five to 15 student deaths.

The risk for meningitis among U.S. college students has been reported to be similar (1.7:100,000) to that among persons the same age (1.4:100,000), but higher for those who reside in dormitories than for those residing in other types of accommodations on college campuses. Of interest, freshmen have been found to have a much higher incidence (5.1:100,000) than other students on campus.

Vaccination and antibiotics can prevent some types of bacterial meningitis from spreading and infecting other people. On February 10, 2005, the Advisory Committee on Immunization Practices (ACIP) for the CDC recommended that all incoming college freshmen living in dormitories be vaccinated against meningococcal disease. The ACIP and the American College Health Association (ACHA) also have recommended all other college students can reduce their risk for the disease by receiving a vaccine.

Currently, 31 states have adopted legislation requiring colleges to provide information on risks of meningitis to students residing on campus, and 10 states have mandated vaccination for certain students, unless a vaccination waiver is provided.

As with other types of infectious disease, students may be active carriers. Five to 20 percent of people may carry the meningococcal bacteria in the nose and throat at any given time, which is referred to as "carriage." That number may be higher during the winter and under crowded conditions (like dormitories) where germs are likely to be transmitted. Carriage is common but disease is rare.

Meningococcal disease is spread through close contact, such as living in the same home, and very close contact such as kissing, sharing cigarettes, utensils or water bottles. The bacteria do not survive outside the body and are not spread through casual contact such as sharing a classroom or on clothes or other surfaces. A decline in immune function related to intense exercise also may be a risk factor for invasive disease that is unique to athletes.

Few people who carry the bacteria develop disease, but even one case of meningitis requires an emergency public health response. Those who have had contact must be identified, evaluated, and sometimes given antibiotics.

The NCAA currently is funding a research study to estimate the meningococcal carriage rate among athletes at the University of Utah; the findings may help administrators develop vaccination policies for their institutions in states that do not already have mandatory vaccinations. Athletes spend large amounts of time with their teammates that place them at risk of close contact. Athletes in contact and collision sports routinely have close contact with teammates and opponents placing them at a higher risk for both bacterial carriage and disease.

Institutions may find more information on this topic from the CDC Web site at www.cdc.org.

Christy Porucznik, Elizabeth Joy and Robert Toth are members of the University of Utah athletics medical staff.