Vaccine Preventable Disease on Campus

Abstract

Vaccine preventable diseases (VPD) have declined as a cause of morbidity and mortality in the United States. From more than 500,000 cases of measles reported annually in the prevaccine era, there were only 1,436 cases reported in 1983 (38% on college campuses); from more than 12.5 million reported cases of acquired rubella and 20,000 cases of congenital rubella syndrome (CRS) reported in 1964, there were only 954 reported cases of rubella (an unknown number occurred on campuses) and 4 cases of CRS reported in 1983. Only 6 cases of diphtheria (1 occurred on a campus), 8 cases of paralytic polio, and 75 cases of tetanus were reported in 1983 in the United States.

While these declines have been dramatic, significant morbidity from these VPDs persist. Up to 25% of college age adults remain susceptible to measles and rubella. Most students would be eligible for their first booster (10 years after preschool dose) at the time of college entrance, 62% of young adults (18–39 years of age) are estimated to be susceptible to diphtheria, and 11% are estimated to be susceptible to tetanus. Fewer than 5% of young adults are believed to be susceptible to polio.

Measles and rubella continue to be associated with college outbreaks. All cases of measles and rubella should be reported to local health departments. College and universities have the opportunity to ensure the protection of their students, faculty, and employees by establishing and enforcing immunization requirements for measles, rubella, diphtheria, tetanus, and polio as a condition of matriculation, registration, or unemployment.     

Measles and Rubella on College Campuses: The Need to Act

Abstract

The lack of immunization requirements at the nation's colleges and universities threatens the maintenance of the interruption of indigenous measles in the United States. The high susceptibility rates in some college populations coupled with the high mobility of college students who may travel to countries where measles is endemic or epidemic increases the potential for measles outbreaks.

Preventing measles in college-age populations is particularly important because the disease can be more serious in adults. In view of the importance of preventing measles in college students, the Immunization Practices Advisory Committee (ACIP) of the U.S. Public Health Service has recommended that officials strongly consider immunization requirements for college entry.

The ultimate goal of rubella immunization is the protection of a future fetus against damage from intrauterine infection. Although rubella cases are reported routinely on college campuses, most colleges make no effort at controlling these outbreaks or instituting immunization requirements. The ACIP strongly urges educational institutions to require proof of immunity to rubella for registration or employment.     

Using Nursing Students to Enhance One College's Immunization Program

Abstract

In New York State, all college students who were born on or after January 1, 1957, are required to show proof of immunity against measles, mumps, and rubella (MMR) before the 1st day of classes. Colleges have established immunization programs so that those students who do not have the required proof can be given the necessary injections. Often, our health service office does not have enough staff to administer the MMR shots during the registration period, resulting in long lines of students waiting to be immunized. In this article, the authors describe how one college used nursing students to assist with and enhance its immunization program. The 45 nursing students who participated in this project administered 694 injections over a 5-day period, They received credit from the nursing department for clinical time and all of the participants agree that the project was a success.     

Rubella Susceptibility and Immunization in a University Population: Experience,Strategy, and Policy

Abstract

Despite the availability of a safe and effective vaccine, rubella continues to occur in the United States. In recent years 70% of all cases have occurred in college aged individuals. Since 1978 the University of Rochester has required all entering students to have either rubella immunization or rubella serology. Compliance with this requirement has been excellent and has resulted in an increase in the rubella immunization rate from 52% to 71 %. Of those obtaining serology, the overall susceptibility rate (HI titer < 1:16) was 18%. Less than half of susceptible women accepted immunization, and few susceptible men sought immunization. College entry is a logical time to define an individual's rubella status.     

Connotative Meanings Assigned to Contraceptive Options

Abstract

The authors surveyed a stratified sample of 880 colleges and universities in the United States to assess the status and characteristics of their prematriculation immunization requirements (PIRs). On the basis of a 90% return (796 responses), they estimated that 55% of US colleges and universities had implemented a PIR at the time of the survey. Among schools with PIRs, measles vaccine was almost universally required, with 74% requiring two doses, mumps vaccine was required by 70%, and rubella vaccine by 92%. Hepatitis B vaccine was rarely required and was usually recommended only for students in health-profession programs. The strongest determinant of having a PIR was the presence of a state law or regents' policy. PIRs implemented under the aegis of a state law were, on average, less comprehensive but better enforced. Other factors associated with the implementation of a PIR included membership in the American College Health Association (ACHA), the presence of a student health clinic, and availability of record-keeping personnel.     

The Cost Effectiveness of Hepatitis Immunization for US College Students

Abstract

Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to consider infection risks and disease progression and then compared the cost of vaccination with economic, longevity, and quality of life benefits. Immunization of 100,000 students would prevent 1,403 acute cases of hepatitis A, 929 cases of hepatitis B, and 144 cases of chronic hepatitis B. Hepatitis B vaccination would cost the health system $7,600 per quality-adjusted life year (QALY) gained but would reduce societal costs by 6%. Hepatitis A/B vaccination would cost the health system $8,500 per QALY but would reduce societal costs by 12%. Until childhood and adolescent vaccination can produce immune cohorts of young adults, college-based hepatitis immunization can reduce disease transmission in a cost-effective manner.     

Look Again: Research,Uncertainty, and Understanding

Abstract

An outbreak of measles (rubeola) occurred on the Bloomington campus of Indiana University in February 1983, resulting in 179 clinically diagnosed cases. An aggressive, voluntary immunization program followed by the possibility of sanctions against nonimmunized students returning to campus after spring break resulted in 23,000 vaccinations, with other students submitting verifications of previous history of disease or live-vaccine immunization.

The factors that may have contributed to the outbreak were less natural immunity in this age group, absence of school legislation when these individuals were entering school, and use of killed vaccine which did not provide immunity.     

To Screen or to Vaccinate? A Decision Analysis for Rubella Prevention on Campus

Abstract

Rubella is common among young adults. The most important consequences of rubella are fetal anomalies resulting from maternal rubella infection in early pregnancy. Health officials strongly advocate a mandatory rubella immunization policy for college students, leaving school officials the dilemma of deciding how to implement it.

To effectively prevent a rubella outbreak, a herd immunity of ≥ 95% is needed. This can be accomplished either by: 1) screening all students who do not provide a valid rubella immunization certificate and giving the vaccine to those with negative titers, or 2) vaccinating all of them without prior testing.

At the Medical College of Virginia (MCV), we have shifted our approach of rubella prevention from “screening first” to “vaccinating without prior testing.” We analyzed data from the past 6 years of our rubella prevention program and found that the latter approach was safe and simpler to administer. Decision analysis reveals that this approach can achieve an identical herd immunity of 99.45%, with a 45% cost savings compared to the “screening” approach. Threshold analysis indicates that unless the cost of the lab test is less than that of the vaccine, or the incidence of adverse reactions and associated treatment costs escalates 23 fold, the decision to vaccinate every student is still favored. We conclude that our decision to vaccinate without prior testing is a sound decision based on available data

“Intra-Blood-Brain-Barrier Synthesis of HTLV-III-Specific IgG in Patients with Neurologic Symptoms Associated with AIDS or AIDS-Related Complex,” LIONEL RESNICK, et al. Intra-blood-brain-barrier production of virus-specific antibody is good evidence of infection within the blood-brain barrier. Patients with the acquired immunodeficiency syndrome (AIDS) have an increased incidence of neurologic abnormalities—i.e., unexplained, diffuse encephalopathy manifested clinically as chronic progressive dementia. To define the role of human T-cell lymphotropic virus Type III (HTLV-III), the etiologic agent of AIDS, in the pathogenesis of neurologic dysfunction, we compared cerebrospinal fluid and serum from patients with neurologic symptoms associated with AIDS and the AIDS-related complex for the presence of antibodies directed agains HTLV-III. Antibodies directed against HTLV-III antigens were detected by four immunologic tests: a fixed-cell immunofluorescence assay, an enzyme-linked immunosorbent assay, immunoblots of viral lysates, and immunoprecipitation of cellular lysates. All patients were seropositive, and 22 of 23 (96 per cent) had HTLV-III-specific antibodies in their cerebrospinal fluid. Unique oligoclonal IgG synthesis within the blood-brain barrier was elevated. In eight of nine patients tested, the enzyme-linked immunosorbent assay showed that the percentage of HTLV-III-specific IgG in cerebrospinal fluid was higher than in serum, suggesting that HTLV-III infection of neurologic tissue occurs in the majority of patients with neurologic disease associated with AIDS or its related complex. (New England Journal of Medicine 1985;313:1498–504.)     

2009–2010 Seasonal Influenza Vaccination Coverage Among College Students From 8 Universities in North Carolina

Abstract

Objective: The authors sought to describe the 2009–2010 seasonal influenza vaccine coverage of college students. Participants: A total of 4,090 college students from 8 North Carolina universities participated in a confidential, Web-based survey in October–November 2009. Methods: Associations between self-reported 2009–2010 seasonal influenza vaccination and demographic characteristics, campus activities, parental education, and e-mail usage were assessed by bivariate analyses and by a mixed-effects model adjusting for clustering by university. Results: Overall, 20% of students (range 14%–30% by university) reported receiving 2009–2010 seasonal influenza vaccine. Being a freshman, attending a private university, having a college-educated parent, and participating in academic clubs/honor societies predicted receipt of influenza vaccine in the mixed-effects model. Conclusions: The self-reported 2009–2010 influenza vaccine coverage was one-quarter of the 2020 Healthy People goal (80%) for healthy persons 18 to 64 years of age. College campuses have the opportunity to enhance influenza vaccine coverage among its diverse student populations.     

Cost of Including Males in a University Rubella Immunization Program: A Recommendation to Change a Discriminatory Policy

Abstract

Twenty-seven University of Rochester students developed clinical manifestations of rubella during 1976–77. Twenty-five were male and had not been immunized against this disease; 18 required infirmary care costing $4,876. On the basis of data for freshman males, a cost analysis demonstrates the feasibility of changing the university policy which encourages immunization only of females to encouragement of either selective or mass immunization of all males as well. Immunization during childhood with combined MMR vaccine is least expensive and should be encouraged. In certain circumstances, selective immunization of susceptible males may be less expensive than the present selective policy, which leaves males at risk.     

Impediments to Health Care for the Foreign Student

Abstract

Today's college students occupy a “window” between older adults, whose need for hepatitis B vaccination is minimal, and younger people who receive the vaccine as part of their childhood immunization series. However, because of the high-risk activities that are often part of student behavior, college students are among the individuals who are at the highest risk for this disease; 75% of all reported hepatitis B cases occur in persons between the ages of 15 and 39 years. It is therefore imperative that college health professionals take seriously their responsibility to educate students about issues related to hepatitis B and make available programs that enable the students to receive immunizations. This article briefly describes a successful hepatitis B education and immunization program at an institution that has no mandatory prematriculation immunization requirements.     

The Effect of Gender on Sex-Role Attitudes

Abstract

An examination of the contradiction between college student studies and national public opinion polls.

The evidence concerning the existence and magnitude of gender differences in sex-role attitudes is contradictory. A large number of studies, based primarily on college samples, have reported significant gender differences in the sex-role attitudes of young adults; males have been found to be more traditional than females. However, studies based on national samples including all age and educational groups have not found consistent gender differences. In order to investigate this contradiction, NORC General Social Survey was aggregated from the years 1974 through 1978 to create a data set that included a large number of young adults who were currently attending or who had recently attended college. Both age and education were found to be significant predictors of sex-role attitudes, but for most of the items examined gender differences were not found to be larger for young adults than for older adults. For both age groups larger gender differences were found in items pertaining to caring for children than for items pertaining to women's roles in the public sphere.     

Gender Preference toward Providers of Genital Examinations and Frequency of Genital Self-Examination among College Students

Abstract

Both male and female students who utilize Brandeis University Health Services for primary care were assessed regarding their preference as to the gender of providers of genital examinations, together with the frequency with which each sex and academic class performs genital self-examinations, during a two-month period of the 1981 Spring Semester, using a brief self-administered questionnaire.

Among 234 undergraduate and graduate student men and women who returned questionnaires, women and men preferred to be examinated by same-sex examiners; less than half of the women and nearly none of the men would want a chaperone present during the examination, even when the examiner is not the same gender. An increasing percentage of these young women perform breast examinations as they get older, but there is no comparable rise in testicular self-examinations with increasing age among the men. It is important for physicians who care for adolescents and young adults in university health services to provide access to same-gender health care providers when genital exams are done. It is also important to educate men about testicular examinations, just as women are educated about breast examinations.     

Judgments about Risk and Perceived Invulnerability in Adolescents and Young Adults

This study examined age differences in risk judgments and perceptions of invulnerability, by surveying 577 adolescents (grades 5, 7, and 9) and young adults (ages 20 to 30 years) for their judgments concerning natural hazards and behavior–linked risks. Adolescents were less likely than were young adults to see themselves as invulnerable, and only a small minority of adolescents evidenced such perceptions. Moreover, individuals’ perceptions about the magnitude of their personal risk for experiencing negative outcomes showed an inverse relation to age. Most participants were inaccurate and significantly overestimated risks; this was especially true of adolescents. These patterns of age differences were consistent across different types of risks and sociodemographic configurations. The results pose a challenge to conventional wisdom concerning adolescents’ perceptions of risk and have important implications for theory, programs, and policies related to adolescents.     

Adolescents' Need to Talk About Sex and Sexuality in an Urban Mental Health Setting

Summary

For many adults, adolescent sexuality is problematic. For adolescents, it may be problematic, powerfully alluring, or simply a part of becoming an adult. Either way, and irrespective of whether they have ever had sex, young persons seeking mental health counseling in an urban mental health clinic express a strong desire to talk about sex and sexuality. Significant gender and age differences are noted in desire to talk about sexuality and mediated by involvement in sexual risk behaviors. Having experienced forced sex is directly related to desire for counseling about sex and sexuality. The findings presented in this article compel clinicians to engage all adolescents in meaningful dialogue about sex and sexuality.     

Suicidal Ideation and Comorbid Disorders in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Population at Risk

ABSTRACT

The purpose of this study was to examine the level of suicidal ideation and comorbid disorders (major depressive disorder, generalized anxiety disorder) among adolescents and young adults with diagnosed Asperger's syndrome (AS). A cross-sectional study using a self-administrated mail questionnaire and a Web-based questionnaire were used. Two samples were selected for this study. The first sample used snowball sampling, starting with parents of adolescents and young adults with diagnosed AS who participated in a qualitative study conducted in 2002. The second sample consisted of a volunteer sample of parents who visited Web sites for parents and individuals with diagnosed autism spectrum disorder. The sample included 10 adolescents and young adults with diagnosed AS. Fifty percent of the sample had a clinically significant level of suicidal ideation, 20% met criteria for a diagnosis of major depressive disorder, and 30% met criteria for generalized anxiety disorder.     

Bullying in children and adolescents: a healthcare perspective

Abstract

Bullying is a well-known problem among children, adolescents and young adults in USA. It has been associated with subsequent development of violent behaviors. In this article we are reviewing the medical and clinical aspects of bullying in children and adolescents, as well as providing recommendations to minimize its impact.     

Using nursing students to enhance one college's immunization program.

In New York State, all college students who were born on or after January 1, 1957, are required to show proof of immunity against measles, mumps, and rubella (MMR) before the 1st day of classes. Colleges have established immunization programs so that those students who do not have the required proof can be given the necessary injections. Often, our health service office does not have enough staff to administer the MMR shots during the registration period, resulting in long lines of students waiting to be immunized. In this article, the authors describe how one college used nursing students to assist with and enhance its immunization program. The 45 nursing students who participated in this project administered 694 injections over a 5-day period, They received credit from the nursing department for clinical time and all of the participants agree that the project was a success.     

Briefly Noted

Last week, the federal Centers for Disease Control (CDC) issues a warning about a cluster of pulmonary illnesses possibly linked to vaping. The cases have primarily been among adolescents and young adults. In some cases the young people had also used cannabis.     

Positive Consequences of Parental Divorce Among Israeli Young Adults

Abstract

Within the framework of cognitive theories that define crisis as a challenge to self-development, this study explored the positive long-term outcomes of coping with parental divorce in young adults. Data were collected from self-reports of 158 Israeli young adults whose parents divorced when they were adolescents. Together with painful feelings, almost half the participants reported “more positive than negative outcomes” and less than a quarter thought that the divorce had “more negative than positive outcomes.” The various positive outcomes were found to form three constructs reflecting maturity and growth: empowerment, empathy, and relationship-savvy. Coping styles used by the participants proved strongly connected to long-term outcomes. Reciprocal support was the main coping style used by the young adults and their significant others, and was connected to positive long-term outcomes. Based on multiple regression analyses, the study proposes a sequential model that charts a developmental sequence that enhances long-term positive outcomes. These and other results are discussed within the framework of posttraumatic growth perspective.