Meningitis Vaccination Response Form

Meningitis Information

Dear Student:

As the college health service director at Long Island University, I am writing to inform you about meningococcal disease, a potentially fatal bacterial infection commonly referred as meningitis, and a new law in New York State. On July 22, 2003, Governor Pataki signed New York State Public health Law (NYS PHL) #2167 requiring institutions, including colleges and universities, to distribute information about meningococcal disease and vaccinations to all students meeting enrollment criteria, whether they live on or off campus. This law became effective on August 15, 2003 (prior to the Fall 2003 semester).

Long Island University is required to maintain a record of the following for each student:

  • A response to receipt of meningococcal disease and vaccine information signed by the student or student's parent or guardian.
  • A record of meningococcal meningitis immunization within the past 10 years; OR
  • An acknowledgment of meningococcal disease risks and refusal of meninggococcal meningitis immunization signed by the student or student's parent or guardian.

Meningitis is rare. However, when strikes, its flu-like symptoms make diagnosis difficult. If not read early, meningitis can lead to swelling of the fluid surrounding the brain and spinal column as well as severe and permanent disabilities, such as hearing loss, brain damage, seizures, limb amputation and even death.

Cases of meningitis among teens and young adults 15 to 24 years of age (the age of most college students) have more than doubled since 1991. The disease strikes about 3,000 Americans each year and claim 300 lives. Between 100 and 125 meningitis cases occur on college campuses and as many as 15 students will die from the disease.

A vaccine is available that protects against four types of the bacteria that causes meningitis in the United States--- types A, C, Y and W-135. These types account for nearly two thirds of meningitis cases among college students.

To learn more about meningitis and the vaccine, please feel free to contact our health services department and / or consult your physician. You can also find information about the disease at, NEW YORK STATE DEPARTMENT OF health WEBSITE: www.health.state.ny.us, Website of the centers for Disease Control and Prevention (CDC): www.cdc.gov/ncidod/diseaseinfo, ACHA'S website: www.acha.org

I encourage you to carefully review the enclosed materials. Please complete the Meningoccal Meningitis Response Form and return it to Long Island University health and Medical Services at 175 Willoughby Street(entrance on fleet street) Brooklyn NY 11201.


Diane Green
Director/ UHMS

Long Island University

Brooklyn Campus

University health & Medical Services