New York State Public Health Law requires that post-secondary institutions inform all students about Meningococcal disease, make them aware of being vaccinated, and allow those students to choose their actions.

The institution must have either a record of immunization or a signed statement from the student indicating that they had been made aware of the vaccine and choose not to, or to notify the school if they plan on acquiring the vaccine within the next 30 days.

Therefore, after reviewing the information below on meningococcal disease you must make a decision regarding the vaccine. Indicate on this form whether you 1) choose not to be vaccinated or 2) plan on being vaccinated in the next 30 days:

Meningococcal disease is a potentially fatal bacterial infection commonly referred to as meningitis. Meningococcal disease is rare, however its initial flu-like symptoms make diagnosis difficult. If not treated early, the disease can lead to brain damage, vital organ failure, permanent disability and even death. Cases of meningococcal disease among teens and young adults 15 to 24 years of age have more than doubled since 1991. Recent studies indicate that college students living in dormitories and particularly freshmen dormitory residents are at increased risk of infection. An estimated 100 to 125 cases of meningococcal disease occur on college campuses each year. Of those students infected as many as 15 may die.

The meningococcal vaccine protects against four of the five strains of the bacteria which causes meningococcal disease (strains A, C, Y, and W-135). It is estimated that vaccination would prevent approximately two-thirds of all cases of meningococcal disease in college students and up to 88% of deaths. The vaccine is considered safe and is well tolerated with the most common side effect being soreness at the injection site. It provides protection against meningococcal disease for three to five years. The Haemophilus influenza type b (Hib) vaccine given to infants and young children is often referred to as a “meningitis vaccine”. The Hib vaccine does not protect against meningococcal disease and does not meet the vaccination requirement.

Additional information can be obtained on the Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/health/diseases.htm (select meningococcal disease) or the American College Health Association website at http://www.acha.org .