AT PAS 2017

SAN FRANCISCO (FRONTLINE MEDICAL NEWS) A survey of public and private colleges and universities throughout the United States has revealed marked variation in the requirements for vaccination in the enrollment process and vaccine availability through on-campus student health.

The policies of the institutions usually reflected the policies of the particular state or district.

“It was a bit depressing to see less than 15% of the schools required vaccination for meningococcal disease,” said Kristen A. Feemster, MD , director of research for the Vaccine Education Center at the Children’s Hospital of Philadelphia, adding that learning more of the reasoning behind the decision-making for required vaccinations is a priority.

The cross-sectional study surveyed two private and two publicly-funded 4-year degree-granting colleges or universities in each state and the District of Columbia – 216 institutions in total. The institutions were randomly selected to reflect the diversities in size, religious affiliations, and type of institution. The institutions’ websites were scrutinized for information on immunization requirements, vaccinations needed prior to enrollment, vaccination options available on-campus, and consequence of failure to obtain the necessary vaccinations.

Of the institutions, 52% were private, about 80% had an enrollment exceeding 5,000, and one-third had an enrollment of over 20,000 students. About 18% of the schools were located in states with no vaccine requirements for college/university students.

A wide variation in vaccine requirements and on-campus availability was evident. MMR vaccination was an admission requirement of about 82% of the schools surveyed. Vaccination was best done prior to arrival on campus, as only 42% of the surveyed colleges and universities offered the vaccine through student health. Vaccination for hepatitis B was required by only 31% of colleges/universities, with 44% offering the vaccine through student health. Vaccination for hepatitis A was required by only about 1% of the surveyed institutions, although the vaccine was available on one-third of the campuses, Dr. Feemster said at the Pediatric Academic Societies annual meeting.

Meningococcal B (MenB) vaccination was required by 25 schools, of which 6 (24%) had experienced MenB illness outbreaks. Of the 191 schools that did not have a requirement for MenB vaccination, only 4 (2.0%) had experienced a MenB outbreak.

Of contemporary concern, vaccination for human papillomavirus was offered by one-third of the colleges/universities, but this vaccination was not a requirement for admission to any of the surveyed institutions. Vaccination for influenza, another disease with a high propensity to spread, also was not required by any school, with only 37% having influenza vaccination available as part of student health care.

Compliance with immunization requirements was enforced by 67% of the schools, with course registration not finalized until the necessary vaccinations had been received and documented. Of the 17% of schools that did not have an enforcement policy, 61% cited the vaccine requirements of their particular state, the assumption being that the incoming students from that state would have received the necessary vaccinations, reflecting a more reactive than proactive stance, according to Dr. Feemster. There was no difference in enforcement strategy between the public or private institutions.

Of the surveyed vaccines, at least some were available at just over 91% of the public institutions and at 76% of the private institutions

“The variation in requirements and enforcement suggest inconsistent vaccine uptake. Next steps include a mixed-methods study to measure attitudes, beliefs, and behaviors related to school vaccine policy among a national sample of college students and to identify facilitators and barriers to school vaccine policy implementation among school health administrators and providers,” said Dr. Feemster.

“The ultimate goal is to identify the best practices for implementation of college vaccine policies to optimize vaccine uptake and increase positive attitudes, beliefs, and future intentions about vaccines,” she added.

The sponsor of study was the Children’s Hospital of Philadelphia. The study was not funded. Dr. Feemster had no conflicts to disclose.