"Killer Disease on Campus"

PBS Airdate: September 3, 2002
Go to the companion Web site

NARRATOR: Every year at summer's end, thousands of students flock to colleges and universities across the country; and the last thing most teenagers are worried about is their health.

But there is a killer on college campuses. It targets the young, usually when their guard is down. Then it strikes with alarming speed. This threat is a common bacterium that can trigger a rare, but devastating, disease.

ADAM BUSUTTIL: If I would have ever known that you can lose fingers or limbs, I wouldn't have taken my chances. And I think a lot of people won't take any chances on that.

NARRATOR: In his sophomore year at Michigan State, Adam Busuttil's main interest was playing in the marching band. He was geared up for one of the biggest games of the season.

ADAM BUSUTTIL: I was healthy the night before. I was out with my friends. Nobody would have guessed it, I mean, that I would have come down with something like that.

NARRATOR: But when the game began Adam was missing. He was flat on his back in his dorm room with what he thought was a bad case of the flu. Dizzy and feverish, he had no idea of what was to come.

Bacteria that normally live in the throat without causing harm had broken into his bloodstream. Now deadly, these microbes would multiply explosively, quickly becoming an onslaught of millions.

DR. JOSEPH BRITTO (St. Mary's Hospital, London): The disease spreads rapidly. You can go from having a child who's slightly unwell to a child, within hours, who's in multi-system failure, whose every system in the body is failing.

NARRATOR: Meningococcal disease is often referred to as meningitis. It has long been known as an illness of early childhood, but today it is increasingly killing teens and young adults. In the 1990s, cases doubled among those age groups, striking college freshmen in particular.

DR. JAMES TURNER (University of Virginia): It's just so sad to see this happening to young people so innocently and so unnecessarily.

NARRATOR: Unnecessary because many of these lives could have been saved by a vaccine that's been available for over 20 years.

DR. JAMES TURNER: The public needs to be aware of it because it's a dreadful disease and it's preventable.

NARRATOR: Yet most universities don't require the vaccine for admission, and thousands of students and their families have never heard of it. But it's something you need to know about, because, while rare, this disease can strike at any time. And suddenly victims like Adam Busuttil are fighting for their lives.

Killer Disease on Campus up now on NOVA.

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NARRATOR: Without knowing it, many college students are harboring a killer. Inside their throats about 10 percent of healthy young adults carry a potentially deadly bacterium. When it attacked Michigan State sophomore Adam Busuttil it could have ended his life in a matter of hours.

ADAM BUSUTTIL: They took me to the hospital. And while I was in the hospital, I actually got sicker and sicker. My temperature went way up. My blood pressure just went insane. I can remember seeing the respirator and them struggling to put that in. And that's the last I can remember for probably a week or so.

DR. BRETT GIROIR (Children's Medical Center of Dallas): There's nothing more intense than the 24 hours when a patient comes in with meningococcal sepsis—the battle between life and death. They literally hang on the edge of a cliff just waiting to fall over.

NARRATOR: Adam's heart was barely able to pump. It was nearly paralyzed by the bacteria surging through his bloodstream. As they multiplied, the bacteria released a poison that ravaged his body and left permanent damage.

ADAM BUSUTTIL: I lost some fingertips, a few toes, and I have some skin grafts. It's major, but it's very minor to what could have happened.

NARRATOR: Adam has recovered, but one in 10 of the patients struck down by this bacterium, called "meningococcus," will die. While it affects only a few thousand people in the U.S. each year, meningococcal disease has one of the highest death rates of any infection.

DR. BRETT GIROIR: Right now we have a relatively low level of cases, but 3,000 cases is still 3,000 cases of disease. That's a lot of disease and a lot of death and a lot of heartache. And there certainly is no reason why the outbreak could not be significantly worse than it is right now.

NARRATOR: One way to fight this illness is understanding the culprit itself, meningococcal bacteria, and how they inflict damage on the human body. Once the bacteria are in the bloodstream they can cause two life-threatening conditions: meningitis and sepsis. In meningitis, the bacteria attack the lining around the brain called the meninges. They break through to infect the fluid running into the spinal cord. One clear early symptom is a stiff, sore neck. The meninges and brain start to swell, putting pressure on essential nerves. Fewer than one in 50 victims of meningococcal meningitis will die, but survivors are often left deaf or with permanent brain damage.

The other type of infection is much more deadly, killing roughly 20 percent of its victims. It's a severe blood poisoning called meningococcal sepsis that affects the entire body. The bacterial toxins rupture blood vessels and can rapidly shut down vital organs.

DR. JAMES TURNER: It's the only infectious disease that I'm aware of that can take an otherwise healthy individual, and within four or five hours they're hospitalized, in an intensive care unit, in shock, on a ventilator, clinging to life.

NARRATOR: Fortunately, fewer than one in a hundred thousand adults in the U.S. will suffer from meningococcal disease.

DR. JAMES TURNER: Most of us, by the time we reach the age of 25 or 30, have likely already been exposed to the bacteria and have developed a natural immunity. And we have antibodies. And that's why adults tend to get the disease less frequently than younger people.

NARRATOR: Children under four are more susceptible because their weak immune systems can't keep the bacteria in check. And infants are still the group most at risk for developing and dying from meningococcal disease in the U.S.

But in the 1990s, there was a surprising rise in cases among another group, teens and young adults age 15 to 24. Annual cases surged from 300 to over 600. Exactly what caused this alarming increase is unclear.

DR. JAMES TURNER: One possibility is perhaps a different strain of the bacteria has been introduced into the population. Now, this may be a strain that simply has new characteristics that people's immune systems simply have never seen before. Or maybe it's a strain that is particularly virulent or powerful. It's not really clear.

NARRATOR: What is certain is that more could be done in this country to protect those most at risk.

In Great Britain, meningococcal disease is being treated as a national emergency. In the 1990s, incidents of the disease reached a level twice as high as in the U.S. But now cases and deaths have been dramatically reduced, thanks in part to the work of doctors and researchers at this hospital: St. Mary's in London.

St. Mary's is a world leader in the clinical care of meningococcal disease, which in Britain, as in the U.S., mainly affects infants and young adults. Since its pediatric intensive care unit opened in 1992, there has been a five-fold increase in the survival rate of patients here. One crucial part of St. Mary's strategy is a rapid response team.

DR. IVAN DILLON (St. Mary's Hospital, London): We go out as quick as we can to get intensive care to these children as quick as possible to give them the best chance of survival, because without proper treatment, a lot of these children would die.

NURSE: Has she got a rash?

DR. IVAN DILLON: Yeah, she's got quite a severe rash.

NARRATOR: Dr. Ivan Dillon and his team form a mobile intensive care unit. Dispatched from St. Mary's, they are rushing to a hospital 30 miles from London to aid a critically ill teenaged girl. They plan to stabilize her and then bring her back to St. Mary's.

NURSE IN BACKGROUND: The time is 16:14—just under half an hour.

DR. IVAN DILLON: Hello. Hi. I'm Ivan, the doctor. Hi. You're Mum? How do you do Mum? I'm one of the doctors. What I'm going to do is just have a quick look, see what's going on, to get the story, then I'll come and have a chat with you.

NARRATOR: Sixteen-year-old Pauline Upton has been sedated.

LOCAL DOCTOR (High Wicombe Hospital): She's been quite well until two days ago, when she developed a runny nose, sore throat.

NARRATOR: The early signs of Pauline's illness—fever, aching limbs, cold hands and feet—could easily have been mistaken for flu. By the time her symptoms became severe, the bacteria had multiplied and were threatening her life.

DR. IVAN DILLON: Right. Has the rash extended at all since then?

LOCAL DOCTOR: I thought possibly the rash over the ankle was expressed, but basically it seemed to be static.

NARRATOR: Pauline has one of the clearest signs of meningococcal disease, a purple rash on her skin.

DR. IVAN DILLON: The rash is a little bruise caused by the blood leaking out of these small blood vessels in the skin that are being damaged by the disease process. But it's happening throughout the whole body, in every organ and every tissue base in the body.

NARRATOR: The local doctors recognized Pauline's symptoms and responded quickly, giving her penicillin to kill the bacteria.

DR. IVAN DILLON: Any delay in getting effective treatment gives the bacteria a chance just to take hold, and that can invariably be fatal.

NARRATOR: It's vital for Dr. Dillon to pinpoint what form of meningococcal disease Pauline has: the severe blood poisoning called sepsis, the brain swelling of meningitis or a combination of the two.

DR. IVAN DILLON: Can you just relax for me? What I'm doing is looking at the back of the eye, any swelling around that, which will give us an indication if there's any swelling in the brain.

No. And it's nice and clear.

NARRATOR: Pauline's brain is free of infection, but she still has the deadly blood poisoning, sepsis. Pauline's parents, Aileen and David, know that she is in critical condition and fear she may get worse.

DR. IVAN DILLON: I'm one of the doctors from St Mary's, okay? Right. Now, I just wanted to come and introduce myself and just have a little chat about what we think's going on and what our plans will be from here. Okay, just a few questions first of all. Pauline's 16, I believe. Is that right? And apart from the few coughs and colds in the last couple of months, she's otherwise fit and well?

AILEEN UPTON (Meningococcal Sepsis Patient's Mother): This has just started Sunday evening. She had a runny nose. Monday she woke up, she was shivering and she had a headache.

DR. IVAN DILLON: And then you noticed the rash today?

AILEEN UPTON: Yes, this morning when she woke up.

DR. IVAN DILLON: Recognition of the disease and treating it effectively and quickly is the most important prognostic factor. Most important of all is that Mum recognized that there was a rash and realized that this was something significant.

It is a serious condition, okay? And that's why we're here. And we're only going to go into the ambulance when I'm happy that she's in the best condition.

NARRATOR: Once Pauline is stable, the rapid response team transports her to the hospital in London. Five hours after the team went out, Pauline is wheeled into St Mary's intensive care unit.

DR. IVAN DILLON: We've corrected the amount of fluid they've given, based on her weight, which—we actually measured her at 70...

NARRATOR: Here, Ivan Dillon transfers care of Pauline to pediatrician Joseph Britto.

DR. JOSEPH BRITTO: Nice one. All the best for this one.

NARRATOR: She remains in a precarious state, because the bacteria are so effective at spreading poison throughout her body.

Every meningococcal bacterium is surrounded by a slimy outer coat that contains a poisonous chemical called an endotoxin. As the bacteria multiply and move through the bloodstream, they shed bubbles that contain concentrated amounts of toxin. They also act as decoys, confusing the body's immune system. The endotoxin targets the heart, affecting its ability to pump, and also causes blood vessels throughout the body to leak. As every vessel starts to hemorrhage, major organs like the lungs and kidneys are damaged and eventually destroyed.

As soon as doctors suspect meningococcal disease, patients are given a large dose of antibiotic, usually penicillin. Penicillin flowing through the bloodstream rapidly kills the bacteria, but it cannot penetrate the bubbles that contain the endotoxin. In fact, as the bacteria are killed, they release even more toxin.

It takes up to two days for the poison to be cleared from the body and the siege to end.

DR. JOSEPH BRITTO: What we're going to have to do, unfortunately, is to battle the effects of endotoxin and just wait till the effects of endotoxin wear off. What this child needs, basically, is the support of every organ system in the body. With antibiotics and time it'll finally be the body that will have to do the last lap and, in a sense, repair itself. But I'm optimistic. We've seen children much sicker than this come through.

I guess as her family you're going to ask me, "Is she likely to come through? And if she does come through is she likely to have problems like deafness and brain damage?," because the disease can do that. Let me say at the outset that, fortunately, Pauline has so far a mild version of meningococcal disease.

DAVID UPTON (Meningococcal Sepsis Patient's Father): Once you've got the rash, it's not too late then?

DR. JOSEPH BRITTO: Ninety-three percent of all children with meningococcal disease have the rash. And sometimes if the rash is severe it can compromise blood supply to the hands and feet. But that isn't the case with her.

AILEEN UPTON: No, she just had two places.

DR. JOSEPH BRITTO: I saw that. I've had a look at her rash, and, fortunately, she doesn't have a very severe form of the rash, which again, augers well for her. Okay, so hang in there.

DAVID UPTON: Will do. Thank you very much.

NARRATOR: Treating the disease is a marathon struggle for doctors and nurses, families and patients. But with early recognition and aggressive treatment, more than 95 percent of victims can be saved.

Pauline Upton was well enough to go home from the hospital after four days. But not all victims of the disease are so fortunate.

With meningococcal cases on the rise, the British government decided to mount a powerful defense: universal vaccination.

DR. JOSEPH BRITTO: I've had recently four children, two of them teenagers, who died from meningococcal disease. And I feel it's going to be particularly hard for the parents to live with the fact that if their children had perhaps the benefit of the vaccine, which is, as we speak, being introduced across the country, then the outcome might have been quite different.

NARRATOR: In clinics throughout Great Britain, children and young adults are now being vaccinated against one of the most common types of meningococcal disease.

NURSE GIVING VACCINATION: Okay, can you just sit back in the chair.

GIRL BEING GIVEN VACCINATION: Does it really hurt?

NURSE GIVING VACCINATION: It's only a little pinprick and you've had your ears done. So it's nothing like that.

Was it as bad as having your ears pierced?

NARRATOR: The campaign has already saved hundreds, perhaps thousands, of lives.

GIRL BEING GIVEN VACCINATION: No, not at all.

NARRATOR: The vaccine will eliminate the bacteria from the throats of these teens, preventing them from spreading the germ to others.

Before this campaign as many as a third of all adolescents were carrying meningococcal bacteria. The bacteria commonly live in the human throat without causing harm, but sometimes they break through the lining of the throat and enter the bloodstream. The reasons why and how are only now being unraveled.

Damage to the throat from flu and other infections could be a factor. Whether the bacteria then take hold and multiply depends on the ability of the immune system to ward off an attack.

DR. MARTIN MAIDEN (Wellcome Trust Centre, Oxford): It's a professional living in the backs of our throats, and part of that professionalism is to avoid our immune system. We have still got a way to go to really understand how the organism evades the immune system, and we have to catch up.

NARRATOR: Teens and young adults are at greater risk of getting the disease than any group other than infants, in both Britain and the U.S. This survey aims to find out if there's something in the teenage lifestyle that makes them vulnerable.

BOY TAKING HEALTH SURVEY: ...stuff about our household and where we live.

FIRST GIRL TAKING HEALTH SURVEY: "How many people live in your household and what's the total number of rooms in your house?"

SECOND GIRL TAKING HEALTH SURVEY: "How many days in the last week have you visited a pub or a nightclub." And the last one asked, "How many people have you kissed in the last week?"

DR. MARTIN MAIDEN: Obviously one of the questions that gets a lot of interest from the teenagers is when you ask them how many people they've kissed. But kissing is thought possibly to be one way in which the bacteria can be transmitted among groups.

NARRATOR: It hardly seems like life-threatening behavior. And the lifestyle that puts British teens at risk is equally at play among American college students. Late nights with little sleep, alcohol, and smoking all wear down immunities. Smoke and binge drinking also irritate the lining of the throat, making it easier for bacteria to invade the bloodstream.

It can't survive long outside the human body, but the bacterium can easily spread through kissing, coughing or simply sharing a drink.

And even students who don't smoke or drink at all are vulnerable. As students come together from far afield they bring with them different strains of meningococcal bacteria, increasing the odds that they'll catch a bug to which they aren't immune.

Freshmen living in campus dorms are roughly seven times more likely than other students to get meningococcal disease. Tight quarters and shared bathrooms help the bacteria spread.

With such risks, why aren't all incoming freshman routinely vaccinated here, as they are in Great Britain?

DR. JAMES TURNER: When governments and health agencies recommend universal vaccination, they've done an analysis that demonstrates that the cost of vaccinating the population is less than the cost of the disease burden to society. When you apply that analysis to meningococcal disease, because it is so rare, it is not cost-effective to society to vaccinate all of these individuals.

NARRATOR: According to the Centers for Disease Control, vaccinating all college freshmen would cost roughly 130 million dollars, prevent 40 to 70 cases, and save two to four lives each year. The CDC has concluded that it's just not worth the public health dollars.

DR. JAMES TURNER: We don't have universal vaccination for this disease. Government turns over the responsibility of making the decision to the individual. I don't think individuals should have to go out and search out information about the disease and the vaccine. I really think it's up to healthcare providers, the family physicians, the colleges, the universities and the health departments to provide the information.

NARRATOR: More than a dozen states now require schools to notify students about the disease. But most colleges across the country don't require vaccination. And thousands of students remain unaware that a safe vaccine, costing less than a pair of running shoes, could save their lives.

ADAM BUSUTTIL: Any of my friends would say, "I'd spend 65 dollars." I think that's what the vaccine costs here...is 65 dollars. And I'd rather spend 65 dollars than not have any more fingertips or not have any more toes.

NARRATOR: Adam Busuttil was one of many who didn't know about the vaccine, even though he was far from the first Michigan State student to fall victim to the disease.

Like Adam, 20-year-old Jeffrey Paga, a star hockey player, was healthy and thriving before the unimaginable struck. At home on Thanksgiving break, he and his parents spent a carefree day skating on their frozen pond.

JUDY PAGA (Mother of Meningococcal Disease Victim): I can shut my eyes and just see him now. He went around and he just...he was so graceful and powerful. And I watched him. And he went up to the house and I said to Jerry, "What an athlete, what a picture of health."

JERRY PAGA (Father of Meningococcal Disease Victim): We're hockey fanatics, and he was a very good hockey player from the time he was a little kid. He never had given us any trouble, not one day in his life. For us he was a perfect son. We couldn't have asked God to give us a better son.

NARRATOR: Back at school, Jeffrey stopped in at the university health service complaining of flu-like symptoms. He was given Tylenol and sent back to his dorm to sleep.

JERRY PAGA: We got a call from one of his roommates that night about midnight saying that he still wasn't feeling good and that he had a fever. And our response was basically, "Jeez, you know, I think he needs to sleep it off. And if he's not any better in the morning, well, we'll drive up to school and take him in to the doctor."

JUDY PAGA: I was going to go up in the morning. I was going to do a mother thing and make soup and just kind of be there with him.

NARRATOR: But the next morning was too late.

JERRY PAGA: My wife called in the morning and the police answered the phone. And they explained that Jeffrey had died.

NARRATOR: Jeffrey's roommates had found him covered with a purple rash. Meningococcal disease had taken his life overnight.

Health officials at Michigan State recommended that anyone in recent contact with Jeffrey take antibiotics, a temporary measure that, unlike a vaccine, doesn't offer long-term protection.

Two months later, one of Jeffrey's close friends, Brian Anderson, came down with the disease, and after a harrowing week in the hospital, Brian died.

The next month, following yet a third case, the university was spurred into action, offering vaccine to everyone on campus.

Michigan State now has a policy of mailing information about the disease to all incoming freshmen. But, like most universities, it doesn't require vaccination. And nationwide, vaccination is still not a high priority for most students.

DR. JAMES TURNER: Freshmen, when they're going off to school, the last thing they're thinking about is getting a shot. The battle to inform is never-ending. It happens every single year.

NARRATOR: The vaccine used in the U.S., called "Menomune," carries no serious side effects, but it is not perfect. It's relatively ineffective in children under two, and in older children and adults, immunity lasts only three to five years. But its most significant limitation is that it doesn't guard against all types of meningococcal bacteria.

There are five types that cause disease, each defined by its unique outer coat. In the U.S., three subgroups, B, C and Y, account for most cases. But different subgroups cause disease in other parts of the world.

In Africa, Group A is a huge public health problem, triggering mass epidemics. Roughly 50,000 cases a year regularly occur in the so-called "meningitis belt" of sub-Saharan Africa. In 1996, there were over 150 thousand cases and nearly 16,000 deaths. Here, routine vaccination could prevent such catastrophe because existing vaccines like Menomune protect against Group A and three other types.

But there is no vaccine to prevent the Group B bacteria that plague the U.S. and Great Britain. Group B is responsible for a third of all American cases, and in Great Britain it causes the vast majority of cases, particularly among infants.

Six-month-old Faye Schrier is in critical condition with sepsis triggered by Group B bacteria.

DR. PARVIZ HABIBI: Now you said she was a bit groggy on Sunday?

MOTHER: Yeah. And then about, what was it? About six, about six o'clock we noticed a bit of a rash that came up.

DR. PARVIZ HABIBI: What did you think about that?

FATHER: Worrying. Her mum said, "Just get her straight to the hospital."

DR. PARVIZ HABIBI: Very lucky for her that you recognized this for what it is because she is one of the illest patients that we've ever treated.

NARRATOR: Only recently have doctors deciphered the chain of events that makes children like Faye so sick. As soon as the bacteria enter the bloodstream, unleashing poisonous endotoxin, the body responds. White blood cells, the hunter-killers of the immune system, lock on to the bacteria. They engulf the bacteria, coming into contact with the endotoxin. The poison causes the white cells to release chemicals that make the blood vessel walls sticky. The white cells then become trapped on the walls, leaving a trail of damage.

Gradually, the lining of the blood vessels is stripped away. And as the damage increases, the vessel walls break up, and pieces fall off. The blood's repair cells, called platelets, rush to plug up the damaged areas. Dangerous clots begin to form. The proteins that normally prevent clotting have all been destroyed.

Within minutes the small blood vessels of the body are completely blocked. The damaged blood vessels disintegrate, and blood and other fluids hemorrhage into the surrounding tissue. It is this cascade of events that causes the distinctive rash that appears beneath the skin, and kills tissue throughout the body.

DR. PARVIZ HABIBI: Her trunk is not affected too badly but, unfortunately, her extremities have been affected.

NARRATOR: Faye is likely to lose some of her fingers and all her toes.

DR. PARVIZ HABIBI: And the best thing for us to do is leave those areas well alone and not to interfere with them, because the rest of her body is getting better. Her organs are mending one by one. The heart's improved, the lungs have improved and in most cases, if the patient survives, they survive and do well and they're not brain damaged. So I think for the first time I can give you some news that is making you smile. But we've got a long way to go.

NARRATOR: Doctors are trying to find a way to stop the chain of events that causes such suffering. St Mary's in London is collaborating on a major research project that started thousands of miles away in Dallas, Texas.

DR. BRETT GIROIR: We had a very severe outbreak of disease here in the North Texas area. We were getting often several patients a day with fullmanent meningococcal sepsis into our ICU. And of course we, like everyone else, did the best we could with conventional care. But that only got us so far.

NARRATOR: By the time eight-year-old Waneshia Taylor reached the hospital, the bacterial endotoxin had already inflicted serious damage.

FIRST NURSE: (Children's Medical Center of Dallas): Do you remember where that is?

WANESHIA TAYLOR (Meningococcal Disease Patient): I know what that is.

FIRST NURSE: Oh. You're so smart.

SECOND NURSE: (Children's Medical Center of Dallas): Oooohhh! That's why you always need to look where you're going.

WANESHIA TAYLOR: I look where I'm going.

FIRST NURSE: Did it fit?

WANESHIA TAYLOR: Yeah.

FIRST NURSE : Very good.

NARRATOR: The Dallas team, like doctors elsewhere, found that early treatment could save lives, but the disease often still had a brutal outcome.

DR. BRETT GIROIR: We've always had the dilemma: How could a disease be so bad and kill so many children and adults, and leave many children and adults maimed? How can it be so bad when we know that the bacteria that causes it is so very susceptible to antibiotics?

And really my research is focused on answering that question: "Why can it be so bad despite the fact that it's so easy to kill the bacteria?"

NARRATOR: While many bacteria release endotoxin, the levels produced by meningococcal bacteria are a hundred to a thousand times greater than normal.

Brett Giroir's research has focused on the direct effects of endotoxin on the body. This rat's heart, kept artificially alive, reveals one way that endotoxin causes damage.

DR. BRETT GIROIR: We're infusing the heart with endotoxin in just about the quantities that a patient with meningococcal sepsis would have, and we're able to see the ability of that heart to beat is actually tremendously reduced.

And this is exactly what we see in children with meningococcal sepsis, that not only does fluid leak out of their blood vessels, not only do they have clots within their blood vessels, but their heart does not function very well—and actually their heart fails. And this is a main contributor to some of the death we see early with meningococcal sepsis.

NARRATOR: If doctors could block the release of endotoxin it would be a major breakthrough that would limit the most devastating effects of the disease. Brett spent years searching for a drug that might do this. He turned to the body's own defense mechanisms for the answer.

DR. BRETT GIROIR: What we became interested in is a compound called "BPI." This is not some artificial substance produced somewhere in someone's laboratory. This is an exact copy of a normal, natural protein found in your white blood cells, your infection fighting cells. Not only does BPI kill bacteria but it completely binds and neutralizes endotoxin, the primary toxin that we think is the bad player.

NARRATOR: BPI was used experimentally for the first time on a child on the brink of death.

DR. BRETT GIROIR: We gave it to a girl, a nine-year-old girl from east Texas, who actually had to have CPR and be revived twice before she actually came to our hospital. And she had a magnificent, wonderful outcome after treatment with BPI and all the care we gave her.

NARRATOR: In a major trial for FDA approval, BPI seemed to reduce the number of limb amputations like Waneshia's by 68 percent, and increase survival by 25 percent.

But many children died before they could experience the benefits of the drug.

DR. BRETT GIROIR: It's easy to do a trial if you have a million people with heart disease on any given day. But it's very difficult to do a trial in a rapidly progressive disease like meningococcal disease, that by the time you get the patients many of them are dead, in a disease that's so rare, and in a disease where, I think, the rules are different.

NARRATOR: In the end, the results of the study were not considered statistically significant, and further trials to get the drug to market may take another three to five years.

DR. BRETT GIROIR: Right now the study is over and BPI is not yet approved. So if one of my children came into the hospital today with meningococcal sepsis, they couldn't get BPI, even though I know it works. There's no way to supply it.

NARRATOR: But Brett Giroir and his fellow researchers aren't giving up hope that one day the drug will be approved.

DR. BRETT GIROIR: We're going to make a difference in this disease. It may take a few years to do it because it's very complex, but this is the right point in time with the right amount of science—everything pointing in the direction that we're going to impact it. We're going to change it and—I'm sure we are.

NARRATOR: Until the status of BPI changes, doctors at St Mary's in London have to treat patients like Faye Schrier as best they can.

FATHER: There was a time when I did honestly think she weren't going to make it. I looked at her, and the marks on her body and how bad she was, and I just didn't think she would.

NARRATOR: A month has passed since Faye was admitted to intensive care.

FATHER: She's pulled right through the worst stage of it, the meningococcal, and she's off all the machines, as you can see. But she's still on the morphine because she's finding it hard to do without. So they've got to wean her off of that. What they're saying is that, at the moment, they can save her thumb here. They've also said that any fingers that have got the scabbing down one side, they'll remove that and then they'll take skin from her thigh and make the rest of the finger up with it. So, hopefully she's not gonna lose all of them, but definitely, she's gonna lose some of them.

Sometimes I think about her future and boyfriends and things like that, but I don't want to let it bother me because there's too much going on now.

NARRATOR: The disease maims and kills so quickly that the effectiveness of any new treatment may be limited. What's needed is a vaccine for meningococcal B to prevent the onset of the illness in the first place, like the vaccines that are currently available for other types of meningococcal disease.

Of the five major groups of meningococcal bacteria, only Group B has truly eluded scientists. Until a vaccine is developed, Group B will continue to be a formidable threat in Europe and the United States.

But nowhere is the need for a vaccine more urgent than in New Zealand. The country has the highest rate of Group B disease in the developed world. In the last ten years, there has been a twelve-fold increase in cases.

DR. WENDY WALKER (Middlemore Hospital, Auckland): Children are dying. Children are going through terrible illnesses. This is an incredibly significant epidemic for us.

NARRATOR: Most of the victims are under five years old and are Maori and Pacific Island children living in South Auckland. At first it was a mystery why these children in particular were suffering. The sudden rise in cases took the New Zealand health authorities by surprise.

Wendy Walker is head of the children's unit at the Middlemore hospital in South Auckland. People who live in this area are five times more likely to get the disease than other New Zealanders.

DR. WENDY WALKER: So we don't really know what's causing this. Malu, the name's Malu?

COLLEAGUE (Middlemore Hospital, Auckland): Yes.

NARRATOR: Jane Peri's daughter Malu was brought in with breathing difficulties and a rash.

DR. WENDY WALKER: When it's really bad in our peak season, in the middle of winter, we're getting about three to four a week perhaps. And we've got one very famous hour, when we had three cases in one hour.

Definitely non-blanching.

When I was working at the old children's hospital, I didn't ever see a case of this disease. So, it really is something that we have had to develop an expertise over—in a fairly short period of time.

NARRATOR: Jane Peri is worried because both of her older children have had meningococcal disease. But her baby, for now, is more fortunate.

DR. WENDY WALKER: This is a viral thing, okay? And I think that's why she's got the ulcers and the spots. She does not have meningitis.

JANE PERI (Mother of Sick Child): That's good.

DR. WENDY WALKER: Okay. So she doesn't have the meningococcal bug in her blood.

We've had some children who have actually come in looking really well and then just deteriorate and crash out in front of our eyes. That's devastating for a family because they think that when they get to a hospital that everything's going to be okay and that everything's going to be done. And then to have a child deteriorate in hospital is devastating for families and staff.

NARRATOR: Doctors have struggled to understand why the epidemic is hitting the Maori and Pacific Island populations. The cause does not appear to be genetic. On the Pacific Islands, the disease is almost unheard of, but here it's a very different story.

DR. DIANA LENNON (University of Auckland, New Zealand): A Pacific Island child born in Auckland has a one in a hundred chance of contracting meningococcal disease in his or her first year of life. And that's extraordinary.

NARRATOR: Researchers found that nearly all cases came from the most densely populated suburbs of Auckland, where economic pressures force many Maori and Pacific Island families to share houses.

DR. WENDY WALKER: In the early `90s there was a significant change in housing policy which resulted in a number of families moving in together—gross overcrowding—so 12, 15 people in a two- to three-bedroom house.

DR. DIANA LENNON: Although it's difficult to say cause and effect, it seems very likely that people crowded together have shared the infectious organism.

NARRATOR: Bringing large numbers of people together in cramped quarters is a formula for spreading disease. It happens in university student dorms as well as in army camps. In fact, outbreaks of Group C disease in U.S. Army boot camps in the late 1960s spurred researchers to develop the first effective meningococcal vaccine.

Vaccines for most types of the disease are made from the bacteria's outer coat, a routine way of triggering the body's immune response. But the B type has evolved a unique outer coat that makes this approach impossible.

PROFESSOR MICHAEL LEVIN (St. Mary's Hospital, London): The coating of the Group B meningococcus is identical in its structure to the coating of some of the cells within the human brain. And this has been really an extremely clever strategy of the meningococcus. By covering itself in molecules which are identical to molecules within the human body, the immune system is fooled into not recognizing the bacteria. It's almost the Trojan horse sort of strategy.

NARRATOR: Any vaccine produced from this outer coat wouldn't work. The immune system would either ignore it or start attacking the body's own cells. And there's a further problem. There are hundreds of strains of Type B, and it will be difficult to devise a vaccine that works for all of the strains. But scientists are searching for a component of the B bacteria that is common to all strains, which could then be used to make the elusive universal vaccine.

At St Mary's in London, doctors have turned to the survivors of the disease, believing they may hold the key to the problem.

DR. SIMON NADEL (St. Mary's Hospital, London): How do you feel, generally?

AMY MANSELL (Meningococcal Disease Survivor): I feel better. I'm more energetic now. I can get up in the morning. I do get tired, a little bit.

NARRATOR: Seventeen-year-old Amy Mansell had Type B meningococcal disease just eight months ago. She's come for a check-up with Dr. Simon Nadel and will give blood for a new research project.

DR. SIMON NADEL: And this finger?

AMY MANSELL: That one, it seems to be going back on its own. But they're going to encourage it and just cut it. Yeah, he's going to, yeah, release that, and then he's going to extend this thumb, there.

DR. SIMON NADEL: So you can use it?

AMY MANSELL: Yeah, just a bit of a grip.

I was very upset. And I was worried about the way I looked because my hands...they are...I think they were the first things I noticed. I thought I'd been in a fire accident and I'd burnt my hands.

That was the worst. It's just that bone there. This one's, I think, the best out of the two. I've still got, like, stitches, just two there.

DR. SIMON NADEL: They look like they're healing up really well.

AMY MANSELL: They're a little bit hairy. I'm embarrassed.

DR. SIMON NADEL: Put your socks back on.

NARRATOR: Amy has developed antibodies that should protect her from ever getting the same strain of B disease again. But the research team wants to know if she could also be immune to other strains.

MICHAEL LEVIN: This research which is nearing completion has, I think, given us a definite answer. And that answer is that a child who has had the disease—even if they're less than a year of age—will develop a change in immunity against, not only the strain of the bacteria which caused their disease, but against many other different strains of meningococcus.

NARRATOR: Perhaps there is one molecule, common to many different Group B bacteria that could trigger protective antibodies if included in a vaccine.

Survivors like Amy are eager to help, to spare others the fate they have suffered.

DR. SIMON NADEL: It's devastating. It's absolutely devastating. I mean, you know, she's got very good spirits, but her life has been torn apart, basically.

AMY MANSELL: Just follow me with the wheelchair.

(Mother of Amy Mansell): You just be careful.

NARRATOR: Most doctors fear that a vaccine that protects against all types of meningococcal disease could be at least five to ten years away. But researchers and survivors will not give up hope that one day, through their efforts, this terrible disease will be eradicated.

NURSE: I've got to give you a massive hug.

Ahhhh! Excellent! Fantastic!

INTERVIEWER: How long have you had them?

AMY MANSELL: Since yesterday.

HOSPITAL STAFF: No way!

Hey! Hooray!

Fantastic, absolutely fantastic.

Oh, well done. Well done.

On NOVA's Website, meet other survivors, find out what it was like to film this documentary and get more information on meningitis. At PBS.org or America Online, Keyword PBS.

To order this show, or any other NOVA Program, for $19.95 plus shipping and handling, call WGBH Boston Video at 1-800-255-9424.

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PRODUCTION CREDITS

Killer Disease on Campus

Produced by
Emma Bowman
Susan K. Lewis

Directed by
Jeremy Llewellyn-Jones

Edited by
Stephanie Munroe
Michael Flynn

Associate Producers
Jennifer Lorenz
Bindu Mathur

Narrated by
Will Lyman

Camera
Chris Morphet
Stephen McCarthy

Sound Recordists
Keith Desmond
Andrew Ennever

Music
Ray Loring
Neil Arthur

Animation
Bernard Heyes Design

Additional Graphics
David Eells

Additional Field Production
Stephen Sweigart

Post Production Services
Medallion/PFA Film & Video

Online Editor
Ed Ham

Colorist
Mark Kueper

Audio Mix
Richard Bock

Research
Jennie MacDiarmid

Production Administration
Fiona Reid
Susan Harvard

Production Manager
Jacqui Loton

Executive Producer for Windfall Films
David Dugan

Archival Material
AB Dowsett/Science Photo Library
ABC News
Aventis-Pasteur
Cells Alive!
Getty Images
Photo Researchers Inc.
Sekani
UNICEF

Special Thanks
Centre for Applied Microbiology & Research
Imperial College of Medicine
The Paga Family
Adam Busuttil
Melanie Benz
Cooney Waters Group

NOVA Series Graphics
National Ministry of Design

NOVA Theme
Mason Daring
Martin Brody
Michael Whalen

Post Production Online Editor
Mark Steele

Closed Captioning
The Caption Center

Production Secretaries
Queene Coyne
Linda Callahan

Publicity
Jonathan Renes
Diane Buxton
Katie Kemple

Senior Researcher
Ethan Herberman

Unit Managers
Holly Archibald
Denise Drago

Paralegal
Nancy Marshall

Legal Counsel
Susan Rosen Shishko

Post Production Assistant
Patrick Carey

Associate Producer, Post Production
Nathan Gunner

Post Production Supervisor
Regina O'Toole

Post Production Editor
Rebecca Nieto

Coordinating Producer
Laurie Cahalane

Supervising Producer
Lisa D'Angelo

Senior Science Editor
Evan Hadingham

Senior Series Producer
Melanie Wallace

Managing Director
Alan Ritsko

Executive Producer
Paula S. Apsell

A Windfall Films production for NOVA/WGBH and Channel 4

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