Waiver Form For Students At Residential Schools And Colleges printable pdf download

Information about Meningococcal Disease and Vaccination

and

Waiver for Students at Residential Schools and Colleges

Massachusetts requires all newly enrolled full-time students attending a secondary school (e.g., boarding schools) or

postsecondary institution (e.g., colleges) who will be living in a dormitory or other congregate housing licensed or approved

by the secondary school or institution to:

1. receive meningococcal vaccine; or

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 and

indicates that the vaccination has been declined. To qualify for this exemption, you are required to review the information

below and sign the waiver at the end of this document. Please note, if a student is under 18 years of age, a parent or legal

guardian must be given a copy of this document and must sign the waiver.

What is meningococcal disease?

Meningococcal disease is caused by infection with bacteria called Neisseria meningitidis. These bacteria can infect the

tissue that surrounds the brain and spinal cord called the “meninges” and cause meningitis, or they can infect the blood or

other body organs. In the US, about 1,000-3,000 people get meningococcal disease each year and 10-15% die despite

receiving antibiotic treatment. Of those who live, another 11-19% lose their arms or legs, become deaf, have problems with

their nervous systems, become mentally retarded, or suffer seizures or strokes.

How is meningococcal disease spread?

These bacteria are passed from person-to-person through saliva (spit). You must be in close contact with an infected

person’s saliva in order for the bacteria to spread. Close contact includes activities such as kissing, sharing water bottles,

sharing eating/drinking utensils or sharing cigarettes with someone who is infected; or being within 3-6 feet of someone who

is infected and is coughing or sneezing.

Who is at most risk for getting meningococcal disease?

High-risk groups include anyone with a damaged spleen or whose spleen has been removed, those with persistent

complement component deficiency (an inherited immune disorder), HIV infection, those traveling to countries where

meningococcal disease is very common, microbiologists and people who may have been exposed to meningococcal

disease during an outbreak. People who live in certain settings such as college freshmen living in dormitories and military

recruits are also at greater risk of disease.

Are some students in college and secondary schools at risk for meningococcal disease?

College freshmen living in residence halls or dormitories are at an increased risk for meningococcal disease as compared

to individuals of the same age not attending college. The setting, combined with risk behaviors (such as alcohol

consumption, exposure to cigarette smoke, sharing food or beverages, and activities involving the exchange of saliva), may

be what puts college students at a greater risk for infection. There is insufficient information about whether new students in

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 risk of meningococcal disease for other college students, in particular older students and students who do not live in

congregate housing, is not increased. However, meningococcal vaccine is a safe and efficacious way to reduce their risk of

contracting this disease.

Is there a vaccine against meningococcal disease?

Yes, there are currently 2 types of vaccines available that protect against 4 of the most common of the 13 serogroups

(subgroups) of N. meningitidis that cause serious disease. Meningococcal polysaccharide vaccine is approved for use in

those 2 years of age and older. There are 2 licensed meningococcal conjugate vaccines. Menactra® is approved for use in

those 9 months – 55 years of age and Menveo® is approved for use in those 2-55 years of age. Both the polysaccharide

and conjugate vaccines provide protection against four serogroups of the bacteria, called groups A, C, Y and W-135. These

four serogroups account for approximately two-thirds of the cases that occur in the U.S. each year. Most of the remaining

one-third of the cases are caused by serogroup B, which is not contained in either vaccine. Meningococcal vaccines are

thought to provide protection for approximately 5 years. Currently, students are only required to have a dose of

polysaccharide vaccine within the last 5 years or a dose of conjugate vaccine at any time in the past (or fall within one of

the exemptions allowed by law).

(See reverse side)

Waiver Form For Students At Residential Schools And Colleges

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