CONCORD, N.H. -- An 18-year-old woman was in critical condition with bacterial meningitis yesterday, one of three teenagers from southwestern New Hampshire hospitalized with the potentially fatal disease.
State health officials said a fourth teenager, a 14-year-old boy from the Concord area, was suspected of having the disease and was in serious condition.
Authorities said they are searching for links between the four.
"Our number one priority is to make sure that those in close contact with the confirmed cases are contacted and we get antibiotics into their mouths," said Dr. Jesse Greenblatt, the state epidemiologist. "It's quite important for the success of our efforts to have as many people come out as possible."
Officials announced Wednesday that two 15-year-old sophomores at Monadnock Regional High School had been diagnosed with the illness. Health officials offered antibiotics to the school's 1,300 students and staff yesterday.
The diagnoses of the woman, who is from Hillsborough County, and 14-year-old boy were announced yesterday.
All four were being treated at Dartmouth-Hitchcock Medical Center. The stricken 15-year-olds, Brady Ells and Louis Gilman, were in fair condition and improving, a hospital spokeswoman said.
Greenblatt urged parents and health care providers to be on the lookout for the disease.
The woman is not a student; officials would not say what school the 14-year-old attends. Greenblatt said there were no plans to offer antibiotics to a wider group of students in the Concord area, as was being done in the Monadnock area.
Greenblatt said available vaccines would not have protected Ells and Gilman from the strain of bacteria that infected them. The same strain is suspected in the case of the woman. Greenblatt said it was not clear which strain sickened the 14-year-old boy.
Bacterial meningitis is an infection of the membranes surrounding the spinal cord and the brain. Symptoms include severe headache, fever, nausea, stiff neck, and sometimes a rash. The incubation period is generally two to six days.
There are typically 15 to 25 cases of meningitis annually in New Hampshire. Typically, there are one or two deaths, Greenblatt said.
The disease is fatal in about 12 percent of cases, Greenblatt said.
Greenblatt said the 15-year-old boys likely were exposed to the bacteria at the school, with one boy spreading it to the other. About 40 people, including household members and teammates involved in a karate class one of the boys takes, had taken antibiotics as a preventive measure, officials said.
Students in grades seven to 12 attend Monadnock Regional High School. They come from Swanzey and seven smaller towns in the region.
Meningitis is spread by "fairly intimate contact" such as sharing utensils, water bottles or cigarettes, kissing or mouth-to-mouth contact in cardiopulmonary resuscitation drills, according to health officials. It is not easily transmitted through sneezing and coughing.
Officials in neighboring states have not reported clusters of meningitis similar to that in New Hampshire, Greenblatt said.