Few university students from overseas have been vaccinated against meningococcal infection

EDITOR—It is now a year since the new conjugated meningococcal group C vaccine was introduced to the United Kingdom.1 Students in higher education are at a higher risk of meningococcal disease than other students and were targeted in the government vaccination campaign. Because of the limited supply and late licensing of the new vaccine the pre-existing polysaccharide vaccine was used.

To determine the effect of the policy we performed a cross sectional study of 3028 first year undergraduate and overseas postgraduate students at the University of Birmingham in autumn 1999. Only 1070 (51%) of the 2110 students from the United Kingdom had been vaccinated before arriving at the university. The main reason for this low uptake was a shortfall in supply of the vaccine to general practitioners. Uptake of the vaccine was not uniform: significantly more students reading health related subjects than those reading arts, social science, or science were vaccinated (227/383 (59%) v 843/1727 (49%); P<0.001).

Fortunately, this academic year (2000-1) most first year undergraduate students from the United Kingdom will have been vaccinated as part of the school programme. An alarming finding from our study, however, was that only 31 (4%) of the 826 overseas students had been vaccinated before arrival. This left both the students and those with whom they came into contact at higher risk of meningococcal infection.

Overseas students will continue not to be vaccinated against meningococcal infection in future years while the countries of origin do not have a school vaccination programme similar to that in the United Kingdom. At present there seems to be no policy for vaccinating this group in the future. Recent reports of an increase in W135 serotype meningococcal disease with the Hajj pilgrimage2 and high levels of carriage in the Gambia3 highlight the potential for importing the meningococcus from outside the United Kingdom.

Our study also found that international students did not receive adequate health promotion information before arriving in the United Kingdom. Their first contact with university health services might be at the point of registration, and there may be only a small window of opportunity to target these students during their first weeks in the United Kingdom. If further vaccination programmes are to be effective—for example, if a group B vaccine becomes available—lessons must be learnt from the failings of the group C programme. Careful consideration of the needs of university medical practices is required, as sometimes they do not have enough staff or vaccine supplies to meet demand.