Outbreak forces review of college vaccination mandates

Many states not requiring immunizations for college students

Recent campus outbreaks of easily spread but preventable diseases have forced administrators across the nation to review their institutions’ immunization policies.

Immunization policy on potentially deadly illnesses—including measles, meningitis, rubella and mumps—has a rather dense structure that varies by state (and often, by university or system). And these policies are becoming ever more important to clarify, define and enforce on campus.

A December 2014 measles outbreak, which began in California’s Disneyland and has now spread to 14 states, brought national attention to the University of California system’s policy that requires vaccination only against hepatitis B.

The university system announced that, starting in 2017, it will require all students to receive vaccination against measles, mumps, rubella, chickenpox, meningococcus, tetanus and whooping cough. Still, many other university systems and other states do not require students to be vaccinated before entering college.

All states now have requirements for school-age children.

A discredited 1998 study by British researcher Andrew Wakefield stating that the measles, mumps, rubella (MMR) vaccine causes autism in children created a panic among parents and inspired an anti-vaccination movement. The children of this movement have now reached college age, and institutions cannot assume that their students are fully protected.

Besides the MMR, a significant number of families opt out of other vaccines, including those for human papillomavirus (HPV), meningococcal diseases and chicken pox (varicella)—due mainly to concerns about side effects, immune system disorder risks and vaccines containing live viruses.

Colleges with vaccination requirements should make sure they cover all possible threats, says Sharon McMullen, past chair of the Emerging Public Health Threats & Emergency Response Coalition with the American College Health Association (ACHA).

And many schools may have to strengthen guidelines for incoming students.

“Over the years, as anti-vaccine sentiment increased, some schools’ vaccine exemption practices may have become overly permissive. With all of the media hype and increasing pressure from some parents, that’s easy to understand,” says McMullen, who is also director of university health services at the University of Notre Dame. “I hope that this measles outbreak, as unfortunate as it is, will serve as a wake-up call.”

Institutions crafting new policies can consult the ACHA’s recommendations, which align with the Centers for Disease Control and Prevention guidelines, says Susan Even, chair of ACHA’s Vaccine Preventable Diseases Advisory Committee and director of the University of Missouri in Columbia’s Student Health Center.

The education of incoming domestic and international students, and their families, is vital to a successful immunization program, says Even.

The message can be spread through e-blasts and links on school websites, and also by providing immunization opportunities during summer orientation. Students also can be prevented from registering until they can prove they are properly immunized, Even says.

As with many major changes in policy, a strict vaccination rules will require more staff to document that students have complied. To that end, the University of Missouri charges a health fee for students enrolled in six credits or more, with funds going directly toward the salaries of health staff.


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