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.     

Epidemic Potential of Measles and Rubella

Abstract

Although there have been major declines in the incidence of measles and rubella in the United States since licensure of vaccines, the incidence of disease in adolescents and young adults has not declined nearly as markedly as that in younger children. As a result, an increasing proportion of cases have occurred in adolescents and young adults. In 1978, 26% of all reported measles cases in which age was known occurred in those 15 years of age and older, and 76% reported rubella cases occurred in this age group. Outbreaks of both diseases have been reported from high schools, military bases, colleges, and universities. During a recent outbreak of measles involving a university, a 22-year-old university employee contracted measles and died of measles encephalitis. In addition to the direct effects of these diseases, the implications of the current pattern of occurrence of two infections known to have adverse effects on the developing fetus are obvious.

Improvements in immunization levels and declines in disease incidence have been brought about effectively by the enactment and enforcement of immunization requirements for school-age children and military recruits. Colleges and universities should also institute immunization requirements as a condition of enrollment.     

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.     

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.     

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.)     

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.     

US college and university student health screening requirements for tuberculosis and vaccine-preventable diseases, 2012

ABSTRACT

Objective: Colleges are at risk for communicable disease outbreaks because of the high degree of person-to-person interactions and relatively crowded dormitory settings. This report describes the US college student health screening requirements among US resident and international students for tuberculosis (TB) and vaccine-preventable diseases (VPDs) as they relate to the American College Health Association (ACHA) guidelines. Methods/Participants: In April 2012, US college health administrators (N = 2,858) were sent online surveys to assess their respective school's TB screening and immunization requirements. Results: Surveys were completed by 308 (11%) schools. Most schools were aware of the ACHA immunization (78%) and TB screening (76%) guidelines. Schools reported having policies related to immunization screening (80.4%), immunization compliance (93%), TB screening (55%), and TB compliance (87%). Conclusion: Most colleges were following ACHA guidelines. However, there are opportunities for improvement to fully utilize the recommendations and prevent outbreaks of communicable diseases among students in colleges.     

Immunization documentation practices and vaccine-preventable disease surveillance capacity among institutions of higher education in Indiana

Objective: Complete and accurate documentation of immunization records and surveillance of disease transmission are critical to the public health response to outbreaks of communicable disease in institutions of higher education (IHEs). This study aims to describe immunization documentation practices and disease surveillance capacity among IHEs in Indiana in order to inform public health action. Methods: IHEs in Indiana were identified and included in the study if they offered on-campus housing and had a dedicated student health center. Phone surveys were administered in September 2015 to each institution, inquiring about current immunization documentation policies and practices, disease surveillance capacity, and use of statewide electronic reporting systems. Additionally, IHE websites were searched to identify immunization documentation requirements for matriculating students. Results: Surveys were completed for 33 of 38 eligible IHEs. Twenty-three (70%) IHEs reported that student immunization records are entered into an accessible electronic system or database. Matriculating student immunization requirements were identified for 32 institutions. Of these, 22 (69%) required a physician-signed proof of immunization. No IHEs reported documenting historical immunizations in the statewide electronic immunization system and three IHEs (9%) reported utilizing the state electronic disease surveillance program. Conclusions: Immunization documentation practices vary among IHEs in Indiana and use of statewide immunization and disease reporting systems is minimal. Robust utilization of immunization and disease surveillance systems has been shown to improve public health response to communicable disease outbreaks. Improving mutual understanding of policy and practice between health departments and IHEs could improve the ability to respond to public health challenges.     

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.     

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.     

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.     

Intimate partner violence,trauma, and mental health need among female community college students

ABSTRACT

Objective: The impact of interpersonal violence on college students has received considerable attention, yet no studies have been conducted among community college students, who comprise 40% of all American college students, and have unique risk factors and needs. Community College students are more likely to be women, people of color, working, parenting, and first generation college students. Participants: Data were collected from a simple random sample from four community colleges (n=435). Methods: A cross-sectional quantitative survey was used to assess the extent of intimate partner violence, trauma exposure, sexual violence, and associated mental health consequences among female students. Results: Over 27% of participants reported IPV in the past year, while 25% reported sexual assault and 34% reported other uncomfortable sexual experiences in their lifetime. Nearly 20%of participants were currently reporting PTSD symptoms. Conclusions: Community Colleges should work with service providers to build their capacity to respond to students' needs.     

Social Norms of Alcohol,Smoking, and Marijuana Use Within a Canadian University Setting

Abstract

Objective: To study actual and perceived substance use in Canadian university students and to compare these rates with US peers. Participants: Students (N = 1,203) from a large Canadian university. Methods: Participants were surveyed using items from the National College Health (NCHA) Assessment of the American College Health Association questionnaire. Results: Alcohol was the most common substance used (65.8%), followed by marijuana (13.5%) and cigarettes (13.5%). Substance use and norms were significantly less than the NCHA US data. Overall, respondents generally perceived the typical Canadian student to have used all 3 substances. Perceived norms significantly predicted use, with students more likely to use alcohol, cigarettes, or marijuana if they perceived the typical student to use these substances. Conclusions: Similar to their US peers, Canadian university students have inaccurate perceptions of peer substance use. These misperceptions may have potentially negative influences on actual substance use and could be a target for intervention. Further research examining the cross-cultural differences for substance abuse is warranted.     

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.     

Prevalence and predictors of suicidal ideation,plan, and attempts,in first-year college students with ADHD

Abstract

Objective. The present study evaluated the prevalence of past suicidal ideation (SI), plan, and attempt in college students with ADHD (N?=?102) compared to a matched control (N?=?102). Predictors of SI, plan, and attempts, were examined. Participants. Study participants were first year college students at a large Southeastern university who completed measures during August or September of 2014 or January of 2015. Methods. Measures were completed by first year students via an online survey. Results. Prevalence rates for SI and related behaviors were higher among the ADHD group than the matched control, with suicide attempts rates four times higher in the ADHD group (13.7% vs. 2.9%). Results showed that ADHD predicted rates of SI and suicide attempt accounting for depression and key demographic variables. Conclusions. Findings have implications for suicide risk assessments conducted with college students with ADHD.     

Reducing Firearm-Related Violence on College Campuses—Police Chiefs' Perceptions and Practices

Abstract

Context: Firearms are used in the majority of college aged suicides and homicides. With recent efforts by various gun lobbying groups to have firearms more accessible to college students on campuses, there is the potential for more firearm-related morbidity and mortality. Objective: This study assessed university police chiefs’ perceptions and practices concerning selected issues of firearm violence and its reduction on college campuses. Participants: The Directory of the International Association for College Law Enforcement Administrators was used to identify a national random sample of campus police chiefs (n = 600). The respondents were predominantly males (89%), 40 to 59 years of age (71%), Caucasian (85%), and worked for 21or more years in law enforcement (75%). Methods: In the fall of 2008, a 2-wave mailing procedure was used to ensure an adequate response rate to a valid and reliable questionnaire. Results: A total of 417 (70%) questionnaires were returned. A firearm incident had occurred in the past year on 25% of campuses and on 35% of campuses within the past 5 years. The majority of campuses (57%) had a plan in place for longer than a year to deal with an “active shooter” on campus. Virtually all (97%) of the campuses had a policy in place that prohibited firearms on campus. The primary barrier (46%) to a highly visible campus plan for preventing firearms violence was the perception that firearms violence was not a problem on their campus. Conclusions: A greater awareness of the importance of a highly visible campus firearm policy and its potential for reducing firearm trauma on college campuses is needed.     

Truth® ads,receptivity, and motivation to use or quit tobacco among college students

Abstract

Objective: Examine receptivity and motivation to use/quit tobacco among college students after viewing Truth ads. Participants: Random sample of 10,000 college students invited to complete online survey February 2016 (8.5% response rate). Methods: Quasi-experimental. Participants (N?=?854) watched four ads and answered survey items for each ad. Results: Students rated ad receptivity and decreased motivation to use tobacco higher for the Catmageddon ad than the others. Regardless of ad, men and current cigarette smokers reported lower receptivity. Younger age was associated with lower motivation to use tobacco for all ads. Tobacco users reported greater motivation to quit with the Catmageddon ad. Conclusions: College students were receptive to the Truth ads, and many indicated lower motivation to use tobacco. Men, older college students, and current cigarette smokers were less receptive to the ads, reinforcing the need to develop tailored campaigns to reach these subgroups.     

Flourishing,Substance Use,and Engagement in Students Entering College: A Preliminary Study

Abstract

Objective: The purpose of this study was to identify the health topics students received information about, how students obtained health-related information, and perceived believability of those sources. Participants and Methods: Students (N = 1202) were surveyed using the National College Health Assessment (NCHA) of the American College Health Association. Results: Nearly half (46%) of the sample reported not receiving any information, whereas only 0.5% received information on all health topics. The Internet was the most common source of health-related information, but, conversely, was perceived as the least believable source. Health center medical staff and university health educators were perceived to be the most believable sources. Conclusions: Future practice at the university setting should focus on delivering health information through believable messengers utilizing the most commonly reported sources of information. This may have implications towards how students shape their health-related social cognitions and subsequent behaviors.     

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.