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The U.S. Army medical team investigating three fatal cases of meningococcal disease in Germany left for the United States on Saturday to prepare its report on what its leader called “one of those rare events.”

What’s odd about the three cases is that they occurred within a short period of time in roughly the same geographical area, and yet are unrelated from an epidemiological standpoint, said Army Col. Bruno Petruccelli.

Petruccelli, the team chief, said medical officials were surprised at how rapidly the health of the victims deteriorated. Two of the three — Pvt. Dave Robbins, 20, and Air Force civilian Lindsey Ferris, 26 — died within hours of seeking medical care. The third, Kimberly Wesson, an Army spouse, survived for two days.

Such a rapid progression towards death “always scares doctors,” said Petruccelli, director of epidemiology and disease surveillance at the U.S. Army Center for Health Promotion and Preventive Medicine. “This is a scary disease, even for providers.”

U.S. military health officials said Friday they know of no other active cases involving U.S. personnel in Germany. The three deaths, which occurred between Jan. 28 and Feb. 3, represent the only known cases this year in Germany within the American community.

Across Germany there have been at least 66 meningococcal cases since the beginning of the year, said Wiebke Hellenbrand, an epidemiologist and leading expert at the Robert Koch Institute in Berlin. Ten of the cases were fatal, she said. The mortality rate in Germany for the disease ranges from 8 percent to 10 percent, which is comparable to the United States.

Hellenbrand said there is no known link between the disease and the military, German or American. Since December 2003, there have been four cases of the disease in the German military. None proved fatal, she said.

In her three years at the institute, Hellenbrand said “this is the first time we’ve had anything to do with the U.S. military.”

Last year, according to the European Regional Medical Command, there were four cases of meningococcal disease in the American community. From 1998 to 2004, the yearly number of cases documented by ERMC ranged from none to two. Command officials could not immediately say how many of those cases were fatal.

To contract the disease, a person usually has to be exposed to an infected individual for an extended period, typically four hours or more. Often the setting is relatively confined and crowded, such as a college dormitory or military barracks.

A meningococcal vaccine shot “is one of several immunizations given during basic training,” said Army Lt. Col. William Corr, the preventive medicine consultant for ERMC.

Wintertime is an especially active time for meningococcal bacteria.

“Actually there is a predominance of cases in the first quarter of [any] year,” said Ulrich Vogel, a professor of infectious disease at the German National Reference Laboratory for Meningococci in Würzburg, Germany.

Meningococcal disease comes in two forms: meningitis and septicaemia. Typically, meningococcal bacteria are not highly contagious. To contract meningococcal disease a person has to come in contact with the respiratory secretions of someone who is carrying the bacteria. A person can carry the bacteria, often for only a short time, and display none of the symptoms.

Symptoms associated with meningitis include fever, headaches, stiff neck and nausea, according to the Meningitis Research Foundation. In this form, bacterial toxins can cause inflammation of the brain or spinal cord, or both.

Wesson, 23, the wife of a 1st Infantry Division soldier based in Schweinfurt, died of meningitis.

Robbins and Ferris, on the other hand, were stricken with septicaemia, the deadlier form of meningococcal disease. Septicaemia occurs when bacteria in a person’s blood multiples, generating poisons that make a person feel ill and feverish. In turn, the poisons damage the walls of blood vessels, causing blood to seep out, which will shut down a person’s circulatory system.

There are vaccines for meningococcal disease, but there also are several strands of the disease, and some don’t respond to any of the inoculants on the market, medical officials have said.

None of the three Americans who died knew or had social contact with one another. And all had different strands of the disease, Petruccelli said.

Petruccelli and his team will return to the center’s headquarters at Aberdeen Proving Ground, Md., to prepare an interim summary followed by a final report that should be completed around the end of March.

“This is one of those rare events,” Petruccelli said Friday. The timing and lethality represent “a very unfortunate coincidence” of three separate cases occurring all at once.


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