Higher Education Pre-Matriculation Immunization Requirements: A Comprehensive Assessment and Policy/Program Considerations

Background: In 1980, the CDC's Advisory Committee on Immunization Practices recommended routine college student immunization, followed by the American College Health Association's 1985 call for “comprehensive pre-matriculation immunization requirements (“PIRs”)… mandated by state law.” Significance: Both widespread (e.g. school-entry) and targeted immunization strategies have demonstrated success by way of reduced mortality and morbidity. Advancement of college immunization strategies could significantly benefit the population and other populations secondarily. Purpose: To determine state-level compliance with the above recommendations and identify considerations related to potential PIR additions or changes. Methodology: A qualitative, multi-state analysis was conducted by review of state-level PIRs and compilation into a comprehensive matrix for comparison. Additionally, key informant interviews were conducted with campus health services administrators to identify considerations for potential PIR additions or changes. Detailed notes were taken during each telephone interview. Responses were analyzed using qualitative methods. Findings: Despite longstanding recommendations for comprehensive state-level PIRs, policies vary significantly by state in terms of PIR existence, specific immunizations required, regulatory authority and targeted student population. Key informant interviews revealed strong attitudes and priorities regarding specific immunizations, identified barriers and yielded several systems, program and individual level considerations with respect to future PIR additions or changes. Both forms of data indicated a lack of theory-based approaches with regard to voluntary immunization strategies. Conclusion/Recommendations: Those responsible for developing immunization policies and administering immunization programs should evaluate state-level policies through the lens of these considerations. Furthermore, the limits of state authority and political will to impose additional PIRs should be determined.