Immunizations:Revised July 14, 2016
Information Regarding
MENINGOCOCCAL DISEASE
For all public or nonpublic postsecondary education institutions in Colorado, the state law requires that
each new student residing in student housing, as defined by the institution, or any student who the
institution requires to complete and return a standard certificate indicating immunizations received by the
student as a requirement for residing in student housing, be provided with the information below. If the
student is under the age of 18 years, the student’s parent or guardian must be provided with this
information.
To receive the immunization against meningococcal disease, students should check with their own health
care provider or their local health department (for a list of the local public health agencies in Colorado, go
to www.cdphe.state.co.us/oll/locallist.html). The institution itself may offer the vaccine at special clinics
held at the beginning of the school year or may know of other nearby locations.
Each institution must require each new student who has not received a vaccination against meningococcal
disease within the last 5 years, or, if the new student is under the age of 18 years, the student’s parent or
guardian, to check a box and sign (see below) to indicate that the signor has reviewed the information on
meningococcal disease and has decided that the new student will not obtain a vaccination against
meningococcal disease.
Please check to indicate that you have reviewed the information on meningococcal disease
and have decided that the student will not obtain a vaccination against meningococcal
disease.
Signature:_______________________________________________ Date:_______________________
(Student or parent/guardian, if student is under the age of 18 years)
Print Name of Student:__________________________________________________________________
Date of Birth:______________________________ Student ID:___________________________________
Meningococcal disease is a serious disease, caused by bacteria.
Meningococcal disease is a contagious, but a largely preventable, infection of the spinal cord
fluid and the fluid that surrounds the brain. Meningococcal disease can also cause blood infections.
About 2,600 people get meningococcal disease each year in the United States; 10 to 15 percent of those
people die, in spite of treatment with antibiotics. Of those who live, another 10 percent lose their arms or
legs, become deaf, have problems with their nervous system, become developmentally disabled, or suffer
seizures or strokes.
Anyone can get meningococcal disease, but it is most common in infants less than one year of age and in
people with certain medical conditions. Scientific evidence suggests that college students living in
dormitory facilities are at a modestly increased risk of contracting meningococcal disease.
Immunization against meningococcal disease decreases the risk of contracting the disease.
Meningococcal vaccine can prevent four types of meningococcal disease; these include two of the three
most common in the United States. Meningococcal vaccine cannot prevent all types of the disease, but it
does help to protect many people who might become sick if they do not get the vaccine.
A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reaction. The
risk of the meningococcal vaccine causing serious harm, or death, is extremely small. Getting a
meningococcal vaccine is much safer than getting the disease.
More information can be obtained from the Vaccine Information Statement available at
www.cdc.gov/vaccines/pubs/vis/default.htm. Students and their parents should discuss the risks and
benefits of vaccination with their health care providers.
