Lab Accident at San Francisco VA Leaves Man Dead of Bacterial Meningitis

A young lab assistant at the VA Medical Center in San Francisco died on Saturday after becoming infected with a deadly strain of bacterial meningitis that he had been working with in the lab.

Officials at the VA wouldn't release the man's name, but said he was 25 years old and had been working at the lab since October, handling the bacterium Neisseria meningitidis for at least several weeks. (Update Thursday: The man has now been identified as 25-year-old Richard Din of San Francisco.)

Harry Lampiris, Chief of Infectious Disease at the San Francisco VA and a professor of medicine at UCSF, said the man began complaining of a headache and nausea on Friday evening. The next morning, his symptoms worsened, and he developed a full body rash. The man asked his friends to take him to the hospital but became unresponsive in the car and arrived at the VA around noon without a pulse. He was briefly revived, but died of a heart attack soon after. His death came just 17 hours after the first symptoms had appeared.

Had he called an ambulance and received medical attention sooner, said Lampiris, he might have survived. "I don't think anyone had any concept as to how sick he was."

Investigators still haven't determined how the man became infected with the bacteria, or when the infection occurred. The typical incubation period for meningococcus, the disease caused by the Neisseria meningitidis bacterium, is 3-5 days, but can be as long as eight days, said Lampiris. The man had been handling the bacterium all week. Typically, infection occurs through inhalation.

Lampiris said San Francisco VA lab workers were accustomed to handling the deadly bacteria, and had been doing so for 25 years. He said researchers followed standard CDC protocol, wearing gowns and gloves and working under a device known as a hood, designed to pull air – and potential contaminants – away from the researcher.

The researcher, said Lampiris, "was working in a lab that was highly experienced with dealing with these organisms."

Still it was unclear whether the lab had followed all CDC recommendations for worker safety. According to CDC spokeswoman Alison Patti, "researchers working with Neisseria meningitidis should be vaccinated with meningococcal conjugate vaccine," with revaccinations occurring every five years.

Lampiris said the VA hasn't determined whether any of the lab workers had received the vaccine, or even knew it was recommended. "I would say that people in the lab had not received information that there was a routine recommendation for vaccination," he said.

But, Lampiris added, the vaccine might not have saved the man, because this particular strain of Neisseria meningitidis, serotype B, is resistant to existing vaccines. "No vaccine would have prevented it," said Lampiris.

Neisseria meningitidis outbreaks are rare in the US. According to the CDC, 75 people died from this particular form of meningitis in 2010. Exposures from laboratories are much rarer. The authors of a 2005 research paper cited by the CDC found that only 16 cases of laboratory-acquired infection were reported worldwide between 1985-2001, including six cases in the US. Eight of those 16 cases were fatal.

Meningococcus can be prevented with antibiotics if it's caught before the bacteria take root in the body and symptoms begin to appear. According to the Lampiris, six of the man's personal contacts have received antibiotics, as well as 60 VA employees. None have shown symptoms, said Lampiris.

Lampiris says the VA lab has been closed temporarily and the case is under investigation by the Occupational Safety and Health Administration, the federal agency that oversees workplace safety issues.

At the San Francisco VA, a town hall meeting was held on Monday to inform the community about what happened, and to offer grief-counseling services. "We're devastated by the loss of one of our own researchers," said Lampiris.

Update Thursday, May 3: According to Dr. Harry Lampiris of the VA, unvaccinated researchers at the lab had been working with several strains of Neisseria meningitidis, including serotype B, the strain believed to have killed the researcher now identified as Richard Din, 25, of San Francisco.

This appears to be a violation of CDC guidelines, which specify that lab workers handling any type of Neisseria should be vaccinated, even though the vaccine is ineffective against serotype B.

Meanwhile, analysts at the CDC are working with samples from the lab as well as from the victim to confirm his disease did, indeed, stem from workplace exposure.

It is possible to catch Meningococcal disease – the form of meningitis caused by Neisseria meningitides – outside of a lab. But laboratory-acquired cases have a much higher fatality rate than cases in the general population. According to the CDC, half of lab workers who are infected with meningococcal disease generally die from it, compared to a 12-15 percent fatality rate in the general population.