What starts out as a headache and stiff neck could end in death.

That is, if the stiff neck, a result of swelling around the brain and spinal cord, is caused by meningococcal meningitis. Meningitis is one of the most serious diseases that college students living in dormitories are at risk for, because of the close living quarters. The disease can be viral or bacterial, though the bacterial form is more serious. Left untreated, bacterial meningitis can result in amputations, neurological damage and death.

The symptoms of meningitis include respiratory problems, headache, stiff neck, fatigue, fever, nausea and sensitivity to light. These symptoms can be easily mistaken for other common diseases, such as the stomach flu. It is not until later on in the rapidly progressing disease that the more tell-tale signs appear, such as confusion, severe headaches and small bruise-like dots on the body.

"Sometimes people are trying to do the self-care thing at home, and then all of a sudden, they're so sick that they aren't even capable of making rational decisions about going to the doctor," said Brenda Higgins, Student Health Center director. "They just feel so bad that they want to curl up in bed."

One way Higgins said she can tell if a person might have meningitis is to test for nucchal rigidity, or a lack of neck flexibility. Nucchal rigidity is caused by irritation to the spinal cord, and a person with it might be unable to bend his or her neck.

The treatment for bacterial meningitis is antibiotics and other needed supportive care, or treatment of symptoms, such as headache relief or even amputation of limbs that lose circulation. With viral meningitis, which is less deadly and eventually will go away on its own, not much can be done except supportive care.

Students can prevent the two forms of meningitis several ways. For both forms, avoiding sharing drinks and cigarettes, not kissing sick people and frequent hand-washing can help. There is a vaccine for bacterial meningitis the University recommends all on-campus residents receive.

The University administration advocates getting vaccinated, and the health center nurses provide them at different points in the year, most notably during move-in days, for $90.

This year, no student was given the key to his or her room without proof of vaccination or signing a waiver saying they were given information by the University and chose not to.

"We didn't get a great number during [move-in day]," Higgins said. "I hope that that's because we did a lot of pre-publicity about the vaccination requirement and a lot of people chose to get it at home before they came to school."

While the current vaccine creates a 3- to 5-year immunity, a new meningitis vaccine called Menactra recently has come out on the market. Higgins said Menactra possibly will have life-long immunity.

Sophomore Stephen Barnes, however, chose not to get a vaccination.

"Before I was born, my parents did a lot of research on immunizations and whether or not they were a good thing," Barnes said "After a lot of thought, they came to the conclusion that they really weren't any better for people, so I haven't had my meningitis shot, nor any other shot."

In the past seven years that Higgins has been with the University, she said there only has been two known cases of meningitis on campus.

"We heard rumor of a student who had viral meningitis this year, but we did not see that student," Higgins said. "The viral kind is not generally life-threatening."

There are 2,500 cases of meningitis annually, 10 to 15 percent of which results in death, according to the American College Health Association. Of those cases, 100 to 125 occur on college campuses, and an estimated 5 to 15 result in death.

The health center employees occasionally see other serious conditions, including students with mononucleosis, sports injuries, appendicitis and rarely schizophrenia.

"Sexually transmitted diseases are the conditions which effect the 18-22 age group most, in my estimation," said Ray Juneau, communicable disease surveillance manager for the Missouri Department of Health. "[This age group] is one of the healthiest age groups, however. We have not seen a cluster of meningitis in the state of Missouri on college campuses in two years."

More commonly, however, sare respiratory diseases, such as ear infection, bronchitis, strep throat. Higgins said at least 70 percent of cases in the health center are this type of disease.

Other non-serious issues the health center frequently sees are reproductive concerns, sports injuries and dermatological problems.