Page 8Information about Meningococcal Disease and VaccinationInformation about Meningococcal and Disease and VaccinationWaiver for Students at Residential and Schools and <strong>College</strong>sWaiver for Students at Residential Schools and <strong>College</strong>sMassachusetts requires all newly enrolled full-time students attending a secondary school (e.g., boarding schools) orpostsecondaryMassachusettsinstitutionrequires(e.g.,all newlycolleges)enrolledwhofull-timewill bestudentsliving inattendinga dormitorya secondaryor other congregateschool (e.g.,housingboardinglicensedschools)ororapprovedby the postsecondary secondary school institution or institution (e.g., colleges) to: who will be living in a dormitory or other congregate housing licensed or approvedby 1. the receive secondary meningococcal school or institution vaccine; or to:2. fall 1. receive within one meningococcal of the exemptions vaccine; in or the law, which are discussed on the reverse side of this sheet.2. fall within one of the exemptions in the law, which are discussed on the reverse side of this sheet.The law provides an exemption for students signing a waiver that reviews the dangers of meningococcal disease andindicates The law that provides the vaccination an exemption has for been students declined. signing To qualify a waiver for that this reviews exemption, the dangers you are of required meningococcal to review disease the information andbelow indicates and sign that the waiver vaccination at the has end been of this declined. document. To qualify Please for note, this exemption, if a student you is under are required 18 years to review of age, the a parent informationlegalguardian below must and sign be given the waiver a copy at the of this end document of this document. and must Please sign note, the waiver. if a student is under 18 years of age, a parent or legalguardian must be given a copy of this document and must sign the waiver.What is meningococcal disease?Meningococcal What is meningococcal disease is caused disease? by infection with bacteria called Neisseria meningitidis. These bacteria can infect thetissue Meningococcal that surrounds disease the brain is caused and spinal by infection cord called with bacteria the “meninges” called Neisseria and cause meningitidis. meningitis, These or they bacteria can can infect infect the the blood orother tissue body that organs. surrounds In the the US, brain about and 1,000-3,000 spinal cord called people the get “meninges” meningococcal and cause disease meningitis, each year or they and can 10-15% infect the die blood despite orreceivingother bodyantibioticorgans.treatment.In the US,Ofaboutthose1,000-3,000who live, anotherpeople11-19%get meningococcallose their armsdiseaseor legs,eachbecomeyear anddeaf,10-15%havedieproblemsdespitewiththeirreceivingnervousantibioticsystems,treatment.become mentallyOf those whoretarded,live, anotheror suffer11-19%seizuresloseortheirstrokes.arms or legs, become deaf, have problems withtheir nervous systems, become mentally retarded, or suffer seizures or strokes.How is meningococcal disease spread?How is meningococcal disease spread?TheseThesebacteriabacteriaarearepassedpassedfromfromperson-to-personperson-to-personthroughthroughsalivasaliva(spit).(spit). YouYoumustmustbebeinincloseclosecontactcontactwithwithananinfectedinfectedperson’s person’s saliva saliva in order in order for for the the bacteria bacteria to to spread. spread. Close Close contact contact includes includes activities activities such such as as kissing, kissing, sharing sharing water water bottles, bottles,sharing sharing eating/drinking eating/drinking utensils utensils or or sharing sharing cigarettes cigarettes with with someone who is infected; or or being being within within 3-6 3-6 feet feet of of someone someone who whois infected is infected and and is coughing is coughing or or sneezing. sneezing.Who Who is at is most at most risk risk for for getting meningococcal disease?High-risk High-risk groups groups include include anyone with with a a damaged spleen or whose spleen has been removed, those with with persistentcomplement component deficiency (an (an inherited immune disorder), HIV infection, those traveling to to countries wheremeningococcal disease is very is very common, microbiologists and people who may have been exposed to to meningococcaldisease disease during during an an outbreak. People who who live live in in certain settings such as college freshmen living in in dormitories and and militaryrecruits recruits are are also also at greater risk risk of of disease.Are Are some some students students in in college college and and secondary schools at at risk for meningococcal disease?<strong>College</strong> <strong>College</strong> freshmen freshmen living living in in residence halls halls or or dormitories are at at an increased risk for for meningococcal disease disease as as compared comparedto individuals to individuals of the of the same same age age not not attending attending college. college. The The setting, combined with risk risk behaviors (such (such as as alcohol alcoholconsumption,consumption,exposureexposuretotocigarettecigarettesmoke,smoke,sharingsharingfoodfoodororbeverages, and activitiesinvolvinginvolvingthetheexchangeexchangeofofsaliva),saliva),maymaybe whatbe whatputsputscollegecollegestudentsstudentsatata greatera greaterriskriskforforinfection.infection.ThereThereisisinsufficientinsufficient informationinformationaboutaboutwhetherwhethernewnewstudentsstudentsininother congregate living situations (e.g., residential schools) may also be at increased risk for meningococcal disease. But,other congregate living situations (e.g., residential schools) may also be at increased risk for meningococcal disease. But,the similarity in their environments and some behaviors may increase their risk.the similarity in their environments and some behaviors may increase their risk.The risk of meningococcal disease for other college students, in particular older students and students who do not live inThe congregate risk of meningococcal housing, is not disease increased. for other However, college meningococcal students, in particular vaccine is older safe students and efficacious and students way to reduce who do their not live risk in ofcongregate contracting housing, this disease.not increased. However, meningococcal vaccine is a safe and efficacious way to reduce their risk ofcontracting this disease.Is there a vaccine against meningococcal disease?Is there Yes, there a vaccine are currently against 2 meningococcal types of vaccines disease? available that protect against 4 of the most common of the 13 serogroupsYes, (subgroups) there are currently of N. meningitidis 2 types of that vaccines cause serious available disease. that protect Meningococcal against 4 polysaccharide of the most common vaccine of is the approved 13 serogroups for use in(subgroups) those 2 years of N. of meningitidis age and older. that There cause are serious 2 licensed disease. meningococcal Meningococcal conjugate polysaccharide vaccines. Menactra® vaccine is is approved for use inthose those 2 years 9 months of age – 55 and years older. of There age and are Menveo® 2 licensed is approved meningococcal for use conjugate in those 2-55 vaccines. years of Menactra® age. Both the is approved polysaccharide for use inthose and 9 conjugate months – vaccines 55 years provide of age and protection Menveo® against is approved four serogroups for use of in the those bacteria, 2-55 called years groups of age. A, Both C, Y the and polysaccharideW-135. Theseand four conjugate serogroups vaccines account provide for approximately protection against two-thirds four of serogroups the cases that of the occur bacteria, in the U.S. called each groups year. A, Most C, Y of and the remaining W-135. Thesefour one-third serogroups of the account cases are for approximately caused by serogroup two-thirds B, which of the is cases not contained that occur in either in the vaccine. U.S. each Meningococcal year. Most of vaccines the remaining areone-third thought of to the provide cases protection are caused for by approximately serogroup B, 5 years. which Currently, is not contained students in are either only vaccine. required Meningococcal to have a dose of vaccines arethought polysaccharide to provide vaccine protection within for the approximately last 5 years 5 or years. a dose Currently, of conjugate students vaccine are at only any time required in the to past have (or a fall dose within of one ofpolysaccharide the exemptions vaccine allowed within by law). the last 5 years or a dose of conjugate vaccine at any time in the past (See(or reverse fall within side) one ofthe exemptions allowed by law).(See reverse side)
Page 9However, please be aware that in October 2010 the Advisory Committee on Immunization Practices (ACIP) recommendedbooster doses of meningococcal conjugate vaccine for healthy adolescents 16-18 years of age. Persons up to 21 years ofage entering college are recommended to have documentation of a dose of meningococcal conjugate vaccine no more than5 years before enrollment, particularly if they are new residential students.Is the meningococcal vaccine safe?A vaccine, like any medicine, is capable of causing serious problems such as severe allergic reactions. Gettingmeningococcal vaccine is much safer than getting the disease. Some people who get meningococcal vaccine have mildside effects, such as redness or pain where the shot was given. These symptoms usually last for 1-2 days. A smallpercentage of people who receive the vaccine develop a fever. The vaccine can be given to pregnant women. Anyone whohas ever had Guillain-Barré Syndrome should talk with their provider before getting meningococcal conjugate vaccine.Is it mandatory for students to receive meningococcal vaccine for entry into secondary schools or colleges thatprovide or license housing?Massachusetts law (MGL Ch. 76, s.15D) requires newly enrolled full-time students attending a secondary school (thoseschools with grades 9-12) or postsecondary institution (e.g., colleges) who will be living in a dormitory or other congregatehousing licensed or approved by the secondary school or institution to receive meningococcal vaccine. At affectedsecondary schools, the requirements apply to all new full-time residential students, regardless of grade (including gradespre-K through 8) and year of study. All students covered by the regulations must provide documentation of having receiveda dose of meningococcal polysaccharide vaccine within the last 5 years (or a dose of meningococcal conjugate vaccine atany time in the past), unless they qualify for one of the exemptions allowed by the law. Whenever possible, immunizationsshould be obtained prior to enrollment or registration. However, students may be enrolled or registered provided that therequired immunizations are obtained within 30 days of registration.Students may begin classes without a certificate of immunization against meningococcal disease if: 1) the student has aletter from a physician stating that there is a medical reason why he/she can’t receive the vaccine; 2) the student (or thestudent’s parent or legal guardian, if the student is a minor) presents a statement in writing that such vaccination is againsthis/her sincere religious belief; or 3) the student (or the student’s parent or legal guardian, if the student is a minor) signsthe waiver below stating that the student has received information about the dangers of meningococcal disease, reviewedthe information provided and elected to decline the vaccine.Where can a student get vaccinated?Students and their parents should contact their healthcare provider and make an appointment to discuss meningococcaldisease, the benefits and risks of vaccination, and the availability of this vaccine. Schools and college health services arenot required to provide you with this vaccine.Where can I get more information? Your healthcare provider The Massachusetts Department of Public <strong>Health</strong>, Division of Epidemiology and Immunization at (617) 983-6800or www.mass.gov/dph/imm and www.mass.gov/dph/epi Your local health department (listed in the phone book under government)Waiver for Meningococcal Vaccination RequirementI have received and reviewed the information provided on the risks of meningococcal disease and the risks and benefits ofmeningococcal vaccine. I understand that Massachusetts’ law requires newly enrolled full-time students at secondaryschools, colleges and universities who are living in a dormitory or congregate living arrangement licensed or approved bythe secondary school or postsecondary institution to receive meningococcal vaccinations, unless the students provide asigned waiver of the vaccination or otherwise qualify for one of the exemptions specified in the law.□After reviewing the materials above on the dangers of meningococcal disease, I choose to waive receipt ofmeningococcal vaccine.Student Name: ____________________________________________ Date of Birth: _________________Student ID or SSN: ________________________________________________________________________Signature: __________________________________________________ Date: _________________(Student or parent/legal guardian, if student is under 18 years of age)Provided by: Massachusetts Department of Public <strong>Health</strong> / Division of Epidemiology and Immunization / 617-983-6800MDPH Meningococcal Information and Waiver <strong>Form</strong> Reviewed March 2013
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