Med+Proctor Immunization Blog

Immunization Practices and Policies in Colleges and Universities in Washington State

M. Patricia deHart, ScD Ros Aarthun, MA Tom Kimsey   Background and Significance: Outbreaks of vaccine-preventable diseases (VPDs) on college campuses have serious health and economic consequences. In 1995 in Washington State, a large measles outbreak occurred on a college campus, which cost over $400,000 to the Department of Health, the county in which the university was located, and the institution. The following year, a measles outbreak in another Washington County also involved students at a college. In 1997, a potential measles outbreak, due to the direct exposure of two athletic teams at another university, was averted, most likely due to high vaccination levels and the quick response by university and county health personnel. Mumps and rubella outbreaks have also occurred on many college campuses and these diseases can have very serious side effects, particularly in persons who have the potential for child-bearing. In addition, nationwide surveillance has also shown that college students who live in dormitories are at increased risk of developing meningococcal disease (ACHA 1999). Meningitis is a bacterial or viral infection which can lead to permanent brain damage, hearing failure, amputation, kidney failure, and, in approximately 13 % of cases, death. In an effort to ensure high levels of immunity to vaccine-preventable diseases, the Advisory Committee on Immunization Practices (ACIP), in 1980 recommended that colleges and universities establish policies requiring all students to have documentation of immunity to measles, mumps and rubella (Rodgers, 1992). Taking this a step further, the American College Health Association (ACHA) in 1984 issued a resolution that all colleges and universities should institute a prematriculation immunization requirement (PIR) including documentation of immunity to diphtheria and tetanus in addition to measles, mumps and rubella, and polio for those younger than 18 years of age (Rodgers, 1992). Although several states have state laws or regents’ policies requiring PIRs, Washington State has no such policy in place. Furthermore, local health jurisdictions (LHJs) and the Washington State Vaccine Advisory Committee expressed an interest and need to be familiar with what immunization requirements, practices and services were in place within the college communities in Washington. In response to this need, the Immunization Program of the Washington State Department of Health, in 2003, conducted a statewide survey of colleges and universities. The purpose of this survey was to describe, understand and evaluate immunization admission requirements and vaccination practices and services currently in place in colleges and universities in Washington State. Findings from this survey will be used by the Department of Health for policy and program development to promote adequate immunization and decrease the risk of vaccine-preventable disease among the college student and staff populations. Findings may also be used to consider whether the development of immunization requirements or recommendations for admission to institutions of higher learning is needed. Summary and Discussion: Overall less than 40% of Washington colleges and universities have prematriculation immunization requirements. Of the institutions with PIRs more than 60% accept exemptions for medical, religious and/or philosophical reasons. Almost 75% of colleges with PIRs impose sanctions for noncompliance, mostly restriction from registration, clinical placements or class attendance. While over 90% of colleges with PIRs require measles vaccination or proof of immunity, less than 40% have PIRs which leaves a potentially undervaccinated population for this highly contagious disease. This could present a particular problem with international students and students taking educational trips or semesters abroad since almost all of measles disease in the United States has origins in foreign countries. This risk is also present for the other vaccine-preventable diseases with higher prevalence in other countries even though they may have lower communicability. In addition, while approximately 65% have immunization/immunity requirements for health/medical students and 55% for health/medical staff, only 20% reported having workplace restrictions for exposed susceptible employees. Another concern is that less than 60% of colleges maintain immunization or/immunity information for health/medical students. The record maintenance is even lower for medical/health staff (35%) and for all students (<25%). This could potentially make it difficult to institute infection control methods in cases of vaccine preventable disease outbreaks. Although this survey was conducted before enactment of the law requiring dissemination of information about meningococcal disease and vaccination, several institutions had already begun sending information, recommending or requiring vaccination and having educational materials available. Strengths and Limitations: This is the first large statewide survey of colleges and universities in Washington State designed to estimate the presence of prematriculation immunization requirements as well as what immunization practices and services exist at these institutions. This survey also provides information on the availability of college immunization/immunity records for use in outbreak situations. Findings from this project may also be used to contribute to the effort to prevent and control outbreaks of vaccine-preventable diseases that occur among college and university populations and to the effort to address and eliminate health disparities within the State. Colleges and universities were asked only about current practices and services available and immunization information for individual students was not collected. Therefore, we were unable to estimate coverage levels for individual institutions or for the overall college population in the state. Furthermore, because only colleges and universities listed in the 2002-2003 edition of the Washington Education Directory were included, it is possible that some alternative or newly formed institutions were missed. Future Directions: The findings from this project indicate the need for immunization education/information targeted at colleges and universities. There is also the need for dissemination of information about the new meningococcal and pertussis vaccines and other vaccines and recommendations as they become available. The findings may also be used to inform ongoing evaluations and discussions about the need for and usefulness of statewide immunization recommendations and/or requirements for the college setting. Additionally, findings from this survey may direct future studies to evaluate whether immunization coverage rates among college and university populations are associated with the presence or types of immunization requirements and services available to students and staff. Furthermore, it may be possible, should outbreaks of vaccine-preventable diseases occur on college campuses within the State, to investigate whether these outbreaks are associated with institutional immunization policies and practices.   References: American College Health Association (ACHA). Online, Meningococcal meningitis: News release. American College Health Association Online, 1999. American College Health Association (ACHA). Online, Meningococcal meningitis: Overview of the disease. American College Health Association Online, 1999. Centers for Disease Control and Prevention. Meningococcal Disease and College Students -Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. June 30, 2000; 49(RR07);11-20. Revised Code of Washington (RCW), Title 70, Chapter 70.54, Section 70.54.370. Meningococcal Disease – Students to receive informational materials. 2003 c 398 §1, 2. Rodgers DV, Currents status of college and university prematriculation immunization requirements. 26th National Immunization Conference Proceedings, St. Louis, June 1992.

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