After seeing a "20/20" television broadcast a few weeks ago, my daughter has asked me if she needs a meningitis shot. She is a student in San Diego, California. I would like your opinion on this subject.

A.D.

I did not see the show on "20/20," but I just read the entire transcript. This report was about an unfortunate woman who developed meningococcal meningitis. Meningitis (infection of the covering of the brain and spinal cord) causes fever, a sore and stiff neck and various neurologic problems such as confusion. Many microbes cause meningitis, including the bacterium Neisseria meningitidis. The meningococcus, as this organism is known, can also invade the bloodstream to cause severe widespread infection. The hallmark of the disease is a rash that looks like little red dots on the skin. Bruises and bleeding can occur as well. This form of the disease carries a fatality rate of over 25 percent even with treatment. Meningitis without bloodstream infection has a fatality rate of less than 10 percent.

Meningococcal meningitis is relatively uncommon in the United States, but it causes epidemics in other countries. When it occurs in sporadic cases in the United States, the infection generally affects infants and young children. Small outbreaks can also occur. The people most at risk from outbreaks are those who live in close quarters such as military barracks or college dormitories -- typically older children and young adults. Meningococcal meningitis is not the most common type of meningitis in any age group, but when it occurs, it gets a lot of press attention because it has been associated with outbreaks and because the disease can be so deadly.

Meningococcal disease can be prevented. For example, if a person develops the infection, close contacts should receive a short course of antibiotics to prevent their becoming ill as well. Such treatment is very effective.

Another way to prevent the disease is by vaccination. However, the vaccine can only prevent infection with four of the five strains (varieties) of meningococcus. Unfortunately, there is no effective vaccine to prevent the most common strain, called type B, which causes most of the epidemics and probably half of all disease in the United States. In addition, the vaccine isn't very effective in children under two, and it is only effective for a few years.

The U.S. Centers for Disease Control (CDC) in Atlanta recommend against routine vaccination of civilians for the following reasons: "(1) The risk of infection in the United States is low; (2) a vaccine against serogroup B, the major cause of meningococcal disease in the United States, is not yet available; and (3) much of the meningococcal disease in the United States occurs among children too young to benefit from the vaccine."

Shows such as the one that aired on "20/20" are designed to provoke a response, and everyone is upset to hear about a young woman who develops a devastating illness. However, the producers of such shows may not always understand the ramifications of some of their suggestions, particularly when they imply that everyone should get the meningococcal vaccine. For the reasons the CDC list, it is probably not a wise use of health-care resources to vaccinate everyone. (Furthermore, in reading the "20/20" transcript, I could not find any reference to the strain of meningococcus the young woman had. If it was type B, then no vaccine could have prevented her disease.) Since the vaccine is safe, I see no reason not to vaccinate your daughter, but I don't think everyone needs it.