3. Required Screening For International Students ONLY
1. Have you ever had a positive TB skin test?..................................................YES ________ NO ________
2. Have you ever had close contact with anyone who was sick with TB?.........YES ________ NO ________
3. Have you ever been vaccinated with BCG?..................................................YES ________ NO ________
4. Are you are a member of a high-risk group¹?................................................YES ________ NO ________
5. If No (to #4), you are not required to have a TB screening. If YES, you are required to have a TB screening.
BCG vaccine is not acceptable to meet this requirement.
a. Tuberculin Skin Test:
Mo Day Yr Mo Day Yr
Result: mm (Record actual mm of induration, transverse diameter; if no induration, write “0”)
Positive Negative (Interpretation, based on mm of induration as well as risk factors)
b. Chest X-ray (required if tuberculin skin test is positive)
Date of chest x-ray
Normal _______ Abnormal
Mo Day Yr
Chest X-ray Findings (if abnormal)____________________________________________
Recommended Immunizations for All Students
Although they are not yet required, meningococcal and hepatitis B vaccinations are strongly recommended based on
recommendations from the Centers for Disease Control (CDC) and the American College Health Association. These recommendations
are made based on recent studies showing that college students, particularly freshmen living in residence halls, have a six-times
greater risk for meningitis and an increased risk of hepatitis B than the general population.
Meningococcal disease is a rare but potentially fatal bacterial infection that occurs in one of two forms, either as meningococcal
Meningitis (a bacterial infection that causes inammation of the brain and spinal cord) or meningococcemia (a bacterial infection of
the blood). Meningitis is difcult to diagnose because of its u-like symptoms. It progresses very quickly and may result in permanent
disability or death within a matter of hours of the rst symptoms. Transmission of the disease occurs from person to person through
respiratory or oral secretions. Cases of meningitis among teens and young adults 15 to 24 years of age have more than doubled since
1991. Ask about the Menactra vaccine for protection against Meningitis & Meningococcemia.
Hepatitis B virus (HBV) exposure can result in a serious disease that attacks the liver. There is no cure for this disease. The CDC
estimates that some 80,000 new cases occur in the US each year and approximately 500 people die from chronic liver problems
related to hepatitis disease annually. HBV is a blood-borne disease and is commonly spread by contact with infected blood, needles or
other sharps, or by having sex with an infected person. The best protection against HBV is immunization.
In addition, it is recommended that students receive two varicella (chicken pox) vaccines if they have never had chicken pox or receive
a second varicella vaccine if they have only received one previously. It is also recommended that female students receive the series of
three Gardasil vaccines to protect them from cervical cancer.
For more detailed information, visit the Centers for Disease Control & Prevention web site at www.cdc.gov or the American College
Health Association website at www.acha.org. Consult with your family physician, local Health Department and your Student Health
Center for vaccine information.
¹ Categories of high risk students include those students who have arrived within the past 5 years from countries where TB is endemic. It is easier to identify
countries of low rather than high TB prevalence. Therefore, students should undergo TB screening if they have arrived from countries EXCEPT those on the
following list: Canada, Jamaica, Saint Kitts and Nevis, Saint Lucia, USA Virgin Islands (USA), Belgium, Denmark, Finland, France, Germany, Greece, Iceland,
Ireland, Italy, Liechtenstein, Luxembourg, Malta, Monaco, Netherlands, Norway, San Marino, Sweden, Switzerland, United Kingdom, American Samoa, Australia
or New Zealand.