College-bound students appreciate opportunities to exert independence and control over their own choices. Being able to drive is one major milestone, but another is taking responsibility for medical decisions. Even if the college or university you or your child plans to attend does not require certain vaccines before arriving on campus, it is a good idea to discuss your vaccination history with your doctor. When large groups of people from diverse areas of the country gather and live in close proximity, it is common for outbreaks of infectious diseases to occur.
Even before the pandemic, college campuses experienced outbreaks of influenza, meningitis, and mumps. During outbreaks, college health centers and public health officials mobilize to provide vaccination to prevent further spread. Parents and students can review the CDC’s recommended vaccination schedule and make a decision about which vaccines to get before arriving on campus. Some may require two doses, so starting now is important if the series is to be completed before mid-August.
Several organisms such as bacteria, viruses, and fungi can cause inflammation of the membranes lining the brain and spinal cord (the meninges), resulting in the illness “meningitis.” According to the World Health Organization (WHO), bacterial meningitis can cause serious illness and death without treatment. Infants are vaccinated against Haemophilus influenzae type b (Hib) to protect them against invasive disease. Two vaccines are available for teens to provide protection against meningococcal disease: MenACWY covers four serotypes and MenB covers the most widely circulating strain on college campuses.
Although overall incidence is very low, first year college students living in dormitories have an increased risk compared to the general population. Warning signs of illness include fever, headache, rash and a stiff neck. Although incidence is low, the case fatality rate (9 per 100 cases) is more than 200 times higher than COVID-19 (0.04 per 100 cases among ages 18-49 years). For this reason, many colleges recommend vaccination against meningococcal disease or require a waiver documenting that the student understands the risks of contracting meningitis.
Most children receive two doses of the measles/mumps/rubella (MMR) vaccination by age six. Caused by a virus spread via respiratory droplets, mumps usually first appears as swelling of the salivary glands on either one side or both sides of the jaw. When the virus enters the bloodstream, in about a third of patients the virus can cause complications such as swelling of the testicles and ovaries or hearing loss and meningitis. Vaccination in early childhood with the measles/mumps/rubella (MMR) vaccine has dramatically reduced these complications.
Mumps can periodically emerge on college campuses and other settings where groups of people congregate or live together (churches, athletic teams, large parties or events, etc.). Most cases have been among fully vaccinated young adults. Research suggests several reasons for a resurgence of mumps. The effectiveness of the mumps component of the MMR vaccine appears to be lower (88%) than that of measles and rubella (97%). With widespread vaccination of young children, routine natural boosting is less likely and antibody levels are lower by young adulthood. During outbreaks, colleges may recommend those without immunity get vaccinated, and those with two doses consider getting a third dose of MMR. Students who have not yet had two doses of MMR should discuss catch-up vaccination with their doctor.
Tetanus, pertussis (whooping cough), diphtheria
Infants and children are routinely vaccinated against three tetanus, pertussis and diphtheria with 5 total doses of DTaP vaccine administered before age six. A booster with the tetanus, diphtheria and acellular pertussis vaccine (Tdap) at age 11 or 12 is recommended; if a child missed that dose then a Tdap booster is recommended at the next visit (such as before college). Tdap is also recommended with every pregnancy to provide the infant protection after delivery and before the first vaccine dose is possible at two months of age.
Caused by a bacterium, all three illnesses are covered with the Tdap vaccine. Pertussis (“whooping cough”) can affect children and adults, causing prolonged coughing for weeks and periodic coughing spasms which can be quite exhausting. Full recovery can take weeks, and subsequent respiratory infections can trigger symptoms. Although the disease is most serious for infants younger than 6 months of age, between 5% of teens and 13.8% of adults over age 20 years were hospitalized with pertussis in 2021.
Tetanus (Td) boosters should be updated every 10 years or when recommended following an injury.
Human papillomavirus (HPV)
Recommended at ages 11 to 12, the HPV vaccine prevents infection with human papillomavirus. For teens who missed the two-dose series before age 15, a three-dose series is available to provide coverage against 9 strains of HPV including the two which cause most HPV cancers. Since the introduction of the vaccine, genital warts have decreased 88% in teens and 81% in young women.
Because HPV transmission occurs via close contact and is the most common sexually transmitted infection in the US, CDC recommends that young men be vaccinated as well because HPV can remain a persistent infection—even if it does not cause symptoms—and eventually cause cancer.
The pandemic has caused parents to worry about the health of their children in unprecedented ways. One positive outcome might be a renewed appreciation for the protection offered by routine vaccinations. Hesitancy about vaccination was growing before the pandemic, and uncertainty around the risks and benefits of COVID-19 vaccination has increased the rancor around this topic.
Now perhaps more than ever it is important to help your child or young adult establish a good relationship with a trusted healthcare provider to discuss important topics such as vaccination, lifestyle choices, substance use, healthy options to manage stress and weight, the importance of sleep for repairing tissues and boosting immunity, and caution regarding supplements and vitamins.