Meningitis Form printable pdf download

Important Meningitis

Information

St. John’s University is in compliance with New York State Public Health Law 2167,

which requires ALL students attending colleges and universities in New York State to be

given information relating to immunization against meningococcal meningitis. By law

you must respond to this notification within 30 days.

An airborne disease, meningococcal meningitis is transmitted through droplets of

respiratory secretions and from direct contact with persons infected with the disease.

College students spending many hours together in close physical contact and/or living in

confined areas such as residence halls are at an increased risk of contracting the disease.

Meningococcal meningitis causes an inflammation of the membranes covering the

brain and spinal cord. It can be treated with antibiotics but is sometimes not diagnosed

early enough. Symptoms of the most common type of meningococcal meningitis are

high fever, severe headache, stiff neck, nausea and vomiting, lethargy and a rapidly

progressing rash. The disease strikes about 3,000 Americans and claims about 300 lives

each year. Between 100 and 125 meningitis cases occur on college campuses and as

many as 15 students will die from the disease each year. Though it occurs most often

in late winter or early spring, it can occur in any season.

A vaccine is available to protect against four types of the bacteria causing meningitis

in the United States: types A, C, Y and W-135. These types account for nearly two-

thirds of meningitis cases among college students. The vaccine does not protect against

all strains of the disease and does not provide lifelong immunity. To help you make an

informed decision about being immunized, talk with your health care provider to consider

the benefits and risks of meningococcal meningitis immunization.

Though Student Health Services does not provide the vaccine on campus, we can refer

students to local health care providers if requested. The cost of the vaccine varies, but in

our area the approximate cost is about $100–$200. Be advised that insurance

may not pay for the cost of the vaccine.

For your information, we enclose a fact sheet about meningitis provided by the

New York State Department of Health. After reading the fact sheet and consulting

with your health care provider, please complete the form provided and return

it to this office. You may also fax the form to the Student Health Services.

Thank you for taking the time to consider this important information about

meningococcal meningitis and the available vaccine.

Meningitis Form