Meningitis B Vaccine: College Requirements and Recommendations

As young adults prepare for college, ensuring their health and well-being is paramount. One crucial aspect of this preparation involves understanding and adhering to immunization requirements, particularly concerning meningococcal disease. Meningitis, an infection of the brain and spinal cord, poses a significant threat, especially to college students living in close quarters. This article delves into the specifics of meningitis B vaccination, college requirements, and important recommendations to safeguard students' health.

Understanding Meningococcal Disease

Meningococcal disease is a serious bacterial illness that can lead to meningitis (infection of the brain and spinal cord), bacteremia (blood infection), and septic arthritis (joint infection). While anyone can contract the disease, college students, especially first-year students residing in dormitories or participating in fraternities and sororities, face an elevated risk.

In the United States, between 200 and 400 individuals are affected by meningococcal disease annually, with a mortality rate of 10 to 15 percent. Among survivors, up to 20 percent experience permanent disabilities, including deafness, brain damage, loss of limbs, or seizures. The disease can progress rapidly, necessitating prompt medical intervention.

Symptoms of Meningitis and Bacteremia

The most common symptoms of meningitis include:

High fever
Headache
Stiff neck
Nausea
Vomiting
Sensitivity to light
Confusion
Extreme tiredness

Symptoms of meningococcal blood infections (bacteremia) include:

Fever
Extreme tiredness
Chills
Cold hands and feet
Severe aches or pain
Rash
Joint pain and swelling (in case of joint infection)

It is crucial to seek immediate medical attention if any of these symptoms are present.

How Meningococcal Disease Spreads

Meningococcal bacteria spread through the exchange of respiratory and throat secretions during close contact, such as:

Kissing
Sharing silverware
Drinking from the same container
Sharing a cigarette or lipstick
Living in the same household

Prevention Strategies

Vaccination stands as one of the most effective methods to prevent meningococcal disease. Additionally, practicing good hygiene, such as washing hands, covering coughs, and staying home when sick, can help reduce the risk of transmission.

Meningococcal Vaccines: Types and Recommendations

The United States utilizes three types of meningococcal vaccines to combat the disease.

Meningococcal Conjugate Vaccine (MenACWY): This vaccine protects against four strains of the meningococcal bacteria (A, C, W, and Y). It is recommended for all 11- to 12-year-olds, with a booster dose at age 16. First-year college students living in residential housing are advised to receive MenACWY if they did not receive a dose on or after their 16th birthday.
Meningococcal B Vaccine (MenB): This vaccine protects against the meningococcal B strain. It is not routinely recommended for all college students but is available for individuals aged 16-23 years. MenB vaccination is also recommended for people over age 10 years with certain high-risk conditions. Some colleges and universities may require MenB vaccination for incoming students.
Meningococcal ABCWY Vaccine: Approved by the FDA in October 2023, this pentavalent vaccine combines protection against both MenACWY and MenB strains into a single shot. It can be administered to individuals 10 years and older who are eligible for both vaccines on the same day.

The Advisory Committee on Immunization Practices (ACIP) provides recommendations on vaccine schedules and eligibility.

Specific Recommendations for College Students

MenACWY: First-year college students living in dormitories or participating in sororities or fraternities are recommended to receive the MenACWY vaccine. If a dose was received before age 16, a booster is recommended before starting college.
MenB: While not routinely recommended, students aged 16 to 23 should discuss the MenB vaccine with their healthcare provider, especially if the college they plan to attend requires it.
Boosters: Individuals with prolonged increased risk for serogroup A, C, W, or Y and B meningococcal disease need regular boosters. The recommended interval between doses varies by age and vaccine type. People who were previously vaccinated may need additional protection if they're part of a population at increased risk during an outbreak.

College Requirements and Policies

California

California State law mandates that Universities of California (UC) with on-campus housing inform students about meningococcal disease and the vaccine. UC's must also document students’ receipt of information and whether they choose to get immunized (Health and Safety Code Sections 120395-120399).

The University of California (UC) system requires ALL incoming students to follow the recommendations of the California Department of Public Health Immunization Branch for immunizations and screening for tuberculosis prior to beginning their studies at any of the UC campuses. All students on UC campuses are required to document that immunization and TB screening requirements have been met.

The California State University (CSU) system recommends that students are current for the immunizations listed in the table above. A CSU campus and/or campus-sponsored program whose participants may have increased exposure risk are authorized to require documentation of recommended immunizations in accordance with California Department of Public Health (CDPH) guidelines.

Texas

Per Texas Education Code 51.933, Health and Human Services may write rules requiring students enrolled in health-related courses to receive certain vaccines. The following information is summarized from Title 25, Texas Administrative Code §97.64.

Institutions that provide on-campus housing must inform students about meningococcal disease and vaccine. Public institutions must document receipt of information and whether they choose to be immunized (Health and Safety Code, Sections 120395-120399).

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General Considerations

Requirements for school-age children and young adults entering college can change yearly. It is essential to ensure that students have the proper immunizations for the upcoming school year. Students in the health care or veterinary field may have specific vaccine requirements due to their coursework, which may expose them to viruses and bacteria at a higher risk.

Exemptions

Students may be granted medical exemptions from required immunizations if they can provide a signed statement from a physician documenting either:

a) the student has a physical condition or medical circumstance that contraindicates vaccination.

Duration of exemption (permanent or temporary with end date) should be specified.

Accessing Meningococcal Vaccines

Cost and Availability

If you don't have insurance or your insurance does not cover the cost of the meningococcal vaccines, you may be able to find free or low-cost meningococcal shots. Note that there may still be an administration fee of up to $21.22 per shot.

For individuals 18 years old or younger: Check with your doctor or clinic to see if they participate in the Minnesota Vaccines for Children Program.
For individuals 19 years old or older: Visit Vaccination Clinics Serving Uninsured and Underinsured Adults to search for a clinic near you that offers low-cost vaccines for eligible adults.
Contact your city or county health department. They may be able to provide low-cost meningococcal shots.

Documentation

Using an immunization registry to look up vaccine history is highly recommended. All immunizations in California are required to be entered into a California registry (see California Immunization Registry for more information). The completed immunization record, exemption documentation, tuberculosis risk questionnaire and any action indicated (e.g., TB test [yes or no]), results of any TB test (e.g., type and date of test and skin test reading (in mm) or IGRA results), and evaluation for active TB should be documented and submitted to school prior to attendance. This information should be maintained in each student’s health or academic file in paper or electronic form.

Additional Immunization Recommendations

In addition to meningococcal vaccines, college students should consider the following immunizations:

Completion of primary tetanus, diphtheria, pertussis series; Tdap or Td booster every 10 years after initial series.
Hepatitis A vaccine (if student desires protection)
Poliovirus vaccine (if did not complete series as a child for persons under age 18 years)
Vaccines for international travel, based on destination
Students with certain medical conditions (e.g., diabetes mellitus) or certain risk factors may need additional immunizations.

All incoming students should also be assessed for their risk of developing TB. Students with identified risk factors for TB, such as birth in a country with an elevated TB rate (includes countries other than the United States, Canada, Australia, New Zealand, or Western and North European countries), should have a tuberculin skin test (TST) or Interferon-gamma release blood test (IGRA).

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