Evaluating Variability in Immunization Requirements and Policy Among U.S. Colleges and Universities

To evaluate variation in vaccine requirements, recommendations, and enforcement strategies among U.S. four-year colleges and universities. We conducted a cross-sectional study abstracting information from Web sites among a sample of 216 four-year colleges and universities from all 50 states and District of Columbia. Our primary outcomes of interest included: type and number of vaccines required for school entry, vaccines recommended by schools for students, and vaccines supplied through student health services. Covariates of interest included: school type, region, school size, mention of American College Health Association recommendations, presence of an accredited health center, mention of state requirements, presence of an enforcement strategy, and exemption stringency of the state in which the school was located. Almost all (94%) schools required at least one vaccine for school entry, and 48% required three or more vaccines. The most commonly required vaccines were measles, mumps, and rubella (88.4%) and meningococcal vaccine (51.9%). All schools required the same vaccines included in state requirements but 65% also required additional vaccines. Most schools (67.1%) used registration hold to enforce requirements, while 14.8% restricted students from campus housing and 2.8% dismissed noncompliant students. Seventeen percent of schools had no published enforcement strategies. A higher proportion of private compared to public universities required three or more vaccines (57% vs. 37.3%, p = .014). While most schools have immunization requirements, there is significant variation in number and type of vaccines required. This suggests potential inconsistent uptake of recommended vaccines for college students and underlies the need to characterize facilitators and barriers to immunization program implementation on college campuses.