Starting this fall, incoming students at many colleges face a new health requirement: They have to say whether they've been vaccinated against a dangerous form of meningitis.

The policy change is a reaction to a burst of new state laws around the country. This summer alone, Missouri, New York, North Carolina and Tennessee passed legislation requiring more vigilance against this particular cause of meningitis, called meningococcal disease, on college campuses. That's on top of six other states that passed similar laws during the year. In all, nearly half of all U.S. states now have these mandates. Some of the laws ask certain students to show whether they've been vaccinated, while others demand simply that students show they've received information on the disease and its dangers.

Meningitis, an inflammation of the tissue layers surrounding the brain and spinal cord, is an increasingly hot topic among health professionals. Each year, as many as 3,000 cases of meningococcal disease occur in the U.S., and about 10% of those who get it die, according to the Centers for Disease Control and Prevention. Between 11% and 19% of those who don't die are left with a severe impairment, such as loss of limbs or hearing loss. But whether the disease is enough of a threat on college campuses to warrant the new laws is the subject of debate among health professionals and lawmakers.

BIG SHOT ON CAMPUS

In the last year alone, 10 states have passed laws that require some college students to show whether they've been vaccinated against meningococcal disease. Here are a few of them:

State When effective
Missouri 2004-05 school year
New York Aug. 15, 2003
North Carolina 2003-04 school year
Tennessee July 1, 2003

Source: The states


One factor driving some of the new legislation is aggressive lobbying by French company Aventis SA, which makes a vaccine that is effective in most, but not all, strains of meningococcal disease. The pharmaceutical company hires firms in various states, from Tennessee to Wisconsin, to make legislators aware of the life-threatening disease and to promote its vaccine, which can cost as much as $88.

The new laws Aventis is advocating go beyond the recommendations of the CDC, the federal agency in charge of disease prevention in the U.S. In the 1990s, after analyzing whether college students are at greater risk than other population groups for meningococcal disease, the CDC concluded that in general the risk among college students is low. In fact, the overall rate of the disease among college undergraduates is about half that of people of the same age who aren't attending college. However, the data also showed that college freshmen, particularly those living in dormitories, are at "modestly increased risk" compared with others of the same age.

In its recommendations published in June 2000, the CDC concludes that "vaccination of all college students, all freshmen, or only freshmen who live in dormitories or residence halls is not likely to be cost-effective for society as a whole." It says that while health-care providers should give information on the disease to college freshmen (and provide the vaccine to those students who want it), the CDC does not go so far as to recommend routine vaccination.

The American Academy of Family Physicians, which represents primary-care doctors, urges a similar approach.

While most of the new state laws stop short of requiring students to get immunized, many students and their parents seem to be taking that extra step. In Maryland, Towson University's director of health services, Jane Halpern, says she has noticed a big change. Before a 2000 law required college students living on campus to get vaccinated (or show that they'd chosen to waive it), Dr. Halpern estimates that the rate of vaccination was less than 20% among those students. Now, she says, it's over 90%. At the University of Virginia, Charlottesville, the percentage of students with vaccinations has jumped to 87% for all undergraduates (and 95% for freshman) from 58%.

Since this stepped-up effort by state legislatures began, reported cases of the meningococcal disease have dropped. In 2002, total cases of the disease fell 29%, to 1,578, from the year before. It's unclear whether the spread of the disease has been checked or the statistical drop is just part of "normal variation," says Marc Fischer, who researches the disease at the CDC.

Parents don't know anything about this" disease, says Mike Kepferle, who lost his 18-year-old son, Patrick, to meningococcal meningitis three years ago. Mr. Kepferle now promotes awareness of it through the National Meningitis Association, a nonprofit that Aventis helps to fund.

Meningitis can be caused by either a virus or by bacteria, with the bacterial variety being far more dangerous and potentially deadly. Of the three main forms of bacteria that cause meningitis, the meningococcal variety has become the leading cause in the past decade, as vaccines are now typically used in young children to shield them from the other two types.

The vaccine lasts for three to five years and is sometimes covered by insurance. "Pretty quickly you could see a shot, if mandated across a state with over 200,000 students, starts bringing in new profit without a real public health benefit," says Wisconsin state Rep. Mark Pocan, a Democrat who opposed legislation that would have required students to show they'd been vaccinated or sign a waiver. (A scaled-down version requiring college students to simply receive information about the disease is pending.)

But some experts in college health strongly encourage the vaccine for entering freshmen. Of those living in dormitories, the chance of coming down with the disease is about five in 100,000, says James Turner, chairman of the Vaccine Preventable Diseases Task Force of the American College Health Association, an advocacy group that represents college-health professionals. "That's not a lot," he says. But for the price of a pair of sneakers or a college textbook, he adds, "you can reduce that risk significantly. Most parents say it's a no-brainer," particularly with some insurance companies covering the cost.