By James A. Baumann
It was in February of this year when the alert was issued. An individual who had toured a university campus in western Texas a week earlier had tested positive for measles. Details later revealed that the risk of exposure to others at the time was relatively mild; however, the concern felt by staff and students was genuine. After all, the news at the time was filled with stories about the rise in measles cases. By the middle of March, more than 250 cases would be identified in Texas as well as 378 total cases across 17 states and the country’s first measles-related deaths in more than a decade. Fortunately, two weeks later, when the measles incubation period had passed with no new cases reported on campus, the all-clear was given.
Accounts of campus outbreaks, such as those involving whooping cough or chickenpox, will always earn headlines as a public service. The recent spate of measles stories, however, has an additional element, due to the severity and novelty of the disease. In 2000, the World Health Organization had declared measles “eliminated” in the United States. Since then, there have been scattered cases and minimal outbreaks, including a spike in 2019 when students on some California campuses actually were forced to quarantine after another suspected exposure. By the beginning of July, however, the U.S. Centers for Disease Control and Prevention (CDC) had reported 1,267 confirmed measles cases, approximately the same total as 2019 and more than four times the number reported for all of 2024.
Measles is an airborne virus generally transmitted by droplets from an infected person’s nose, mouth, or throat. Symptoms typically appear 10-14 days after infection and are highlighted by the telltale rash that spreads from the head to the torso and extremities. Additionally, the infected will experience fever, cough, and small white spots that appear inside the mouth. It’s highly infectious, yet also highly preventable. So why is this disease, which usually has case numbers in the dozens, making a comeback, and what might it mean for college and university campuses, particularly the students gathered in the close proximity of the residence halls?
The American College Health Association (ACHA) website addresses the issue, stating that “the United States is experiencing re-emergence of these diseases, in part due to factors such as un-immunized and under-immunized persons, global travel, and the politicization of vaccine science.” JoLynn Montgomery, senior manager of applied public health at the University of Michigan and chair of the ACHA’s Vaccine-Preventable Disease Committee (VPDC), notes that the pandemic may have exacerbated concerns about vaccination. “Anecdotally, we hear that many people feel that governmental public health pushed too hard with requirements during the COVID-19 pandemic. We seem to be seeing a backlash as a result.”
With such variations in vaccination laws and policies, it often falls to campuses, professional associations, public health organizations, government agencies, and other groups to both educate and advocate for students to take preventive steps.
The ACHA promotes the use of vaccines “to protect the health of our individual students and our campus communities,” while noting the “vital role that vaccine coverage plays in community immunity.” It recommends that college students receive vaccines against influenza, mpox, the human papillomavirus (HPV), COVID-19, multiple meningitis variants, and measles, mumps, and rubella (MMR), among others.
Anu Murthy, an assistant professor at Emory University’s department of Family and Preventive Medicine and member of ACHA’s VPDC, says, “We see students from vaccine-hesitant families, but many are open to vaccination after one-on-one conversations about benefits and safety. HPV is a common example. Barriers like cost and access, especially for international students, continue to impact vaccine uptake. For instance, Tdap isn’t currently available for adults in mainland China.”
While current students are largely protected, trends show there may be reason for concern in the future. A recent CDC report states that the percentage of kindergarten students who met the state-required vaccinations dipped from 95% in 2019-20 to approximately 93% in 2022-23. Experts highlight this figure because 95% is considered the threshold for herd immunity against the measles. Additionally, the report noted that in a 2024 survey of U.S. parents, 8.3% disagreed with the statement that school and child care “vaccination requirements for children are important and necessary.”
“Something we’re worried about is how the decrease in childhood vaccinations now will impact higher ed in the future,” says Robyn Buchsbaum, the ACHA director of strategic partnerships. “I know many are worried about what’s coming. Outbreaks on campus are disruptive and burdensome, emotionally and financially, to students and staff. Campuses are highly motivated to avoid outbreaks.”
Complicating the process of preventing outbreaks is the state-by-state and even campus-by-campus vaccine requirements, as well as technologies, policies, and procedures for collecting and tracking that information.
According to the National Conference of State Legislatures, “at least 34 states and the District of Columbia require some type of vaccination for students who are attending college or university classes,” with exemptions for religious beliefs. Detailing it further, “at least 23 states require up-to-date vaccination for measles . . . at least 13 require up-to-date vaccination for diphtheria, pertussis and/or tetanus . . . [and] at least 10 states require hepatitis B vaccination.” Additionally, “at least 22 states require the meningococcal vaccine,” with most specifying that the requirement applies to students who live on campus or are younger than a specified age.
Those states without vaccine requirements defer to individual campuses to determine requirements for students. According to the ACUHO-I Campus Housing Index for the 2023-24 academic year, of the 119 reporting campuses, 59.7% require the MMR vaccine and 58% require it for meningitis. Almost 28% do not require any proof of vaccination. Generally, almost twice as many private institutions require proof of vaccination as public ones.
With such variations in vaccination laws and policies, it often falls to campuses, professional associations, public health organizations, government agencies, and other groups to both educate and advocate for students to take preventive steps. “All parents have one thing in common: We want to protect our children. Vaccines save lives, but many people are afraid because of misleading or inaccurate information in the media,” says Montgomery. “It’s okay to have questions, and I encourage people to make informed decisions. Just be sure you know that your source of information is reliable. Primary care providers are often good sources of information around vaccinations.”
The American Society for Meningitis Prevention (ASMP) is one organization that promotes such efforts. ASMP co-executive directors Patti Wukovits and Alicia Stillman each had formed separate foundations after having a daughter die from meningitis. In 2014, they combined their efforts to educate the public about meningitis and vaccines as well as honor their daughters’ memories.
Meningitis bacteria can cause infections in membranes around the brain or spinal cord or in the bloodstream, often requiring early detection and treatment to prevent death or lasting effects. The disease is most common in people younger than 20 years old and can spread easily among those living in close quarters, which makes campuses a prime focus for educational efforts.
Current CDC standards recommend the meningococcal vaccine MenACWY for people around age 11 or 12, with a booster dose at 16. This is the vaccine often required by campuses. Less known is the fact that people between 16 and 23 years old can receive a MenB vaccine. Only approximately one-third of 17-year-olds have received at least one dose of the MenB vaccine. This is where ASMP focuses a significant portion of its attention. “We’re hopeful that momentum will continue to grow,” says Wukovits. “Many campuses are not clearly communicating that there are two separate meningitis vaccines, MenACWY and MenB, and that you need both to be as protected as possible, even if both are not required on campus. This leads to confusion and missed vaccinations. Since 100% of meningitis outbreaks on college campuses since 2011 have been Meningitis B, improving awareness is critical. We recognize that updating vaccine requirements can be complex, so we encourage campuses to start by ensuring that their websites and immunization forms clearly explain the difference between the two vaccines. These simple steps can go a long way in helping students and families make informed decisions about protection.”
The ASMP website offers articles and educational materials for use by campuses and other outlets. Whether it is making the case for students to be vaccinated or for other health-related education programs, showing the personal effects is a valuable strategy. As Stillman explains, “What really makes a difference is sharing our personal stories – like my daughter Emily, who was a college sophomore when she died from Meningitis B at just 19. Hearing from real people hits differently than any statistic ever could. We also focus on keeping the message positive and empowering, not scary. We want to encourage young people to take charge of their health, ask questions, and get vaccinated. It’s about helping them and their parents feel confident in their health decisions.”
With memories of COVID-19 still fresh and dramatic changes happening in terms of vaccine guidance and advisory resources, even more responsibilities will fall to campuses to remain vigilant and informed about healthcare processes. “I think ongoing communication among key stakeholders is crucial,” Montgomery says. “At the University of Michigan, we have a vaccination information team that meets weekly. Having this infrastructure in place makes it much easier for us to adapt to changes. We established this group after the COVID-19 pandemic and have maintained it as part of the basic public health response framework.” Murthy adds, “Ongoing education around vaccine safety and efficacy is essential. At Emory, we review vaccine status during clinical visits and host on-campus vaccine fairs.”
James A. Baumann is editor of the Talking Stick. On August 19, 2025, ACUHO-I will host representatives from the American Society for Meningitis Prevention for a free webinar, “Meningitis Isn’t New— Its Impact on Campus Life Is Deeper Than You Think.” Registration is open here.
