Preenrollment Immunization Policies of American Colleges: An Assessment of the Need for Policy Implementation

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Abstract
The purpose of this study was to determine: (1) the preadmission immunization policies of American colleges and universities; (2) the disease occurrence on campuses for 1979–1981; and (3) the validity of self-report of immune status. Ninety-three institutions completed a questionnaire distributed at the 1981 American College Health Association meeting. Sixty-two percent of the respondents stated that they require a preadmission immunization record. Of those who require a record, 86% require it for tetanus, 72% require it for diphtheria, and 70% for polio. Only 40% require it for measles and 56% for rubella. Reports of disease incidence at the same colleges and universities, however, revealed that there were no cases of tetanus and only one case of diphtheria in the preceding two years. In contrast, the diseases reported with greater frequency on those campuses during this time were measles and rubella. Serologic titers in a group of 46 medical and nursing students indicated that 59% were immune to measles and 93% were immune to rubella. In this group of presumably health-conscious students, undocumented histories were not valid indicators of immunity status. The implications for precollege enrollment immunization policies are discussed. “Running—An Analogue of Anorexia?,” Alayne Yates, Kevin Leehey, and Catherine M. Shisslar. We have explored the apparent similarity between patients with anorexia nervosa and a subgroup of male athletes designated as “obligatory runners.” Case examples are provided from interviews with more than 60 marathon and trail runners. Obligatory runners resemble anorexic women in terms of family background; socioeconomic class; and such personality characteristics as inhibition of anger, extraordinarily high self-expectations, tolerance of physical discomfort, denial of potentially serious disability, and a tendency toward depression. Anorexic women and members of their families are often compulsively athletic, and obligatory runners may demonstrate a bizarre preoccupation with food and an unusual emphasis on lean body mass. We speculate that both phenomena could represent a partially successful—albeit dangerous—attempt to establish an identity. These preliminary observations will require further study for validation. (New England Journal of Medicine 1983;308:251–5.) “Cigarette Smoking as a Risk Factor for Epidemic A(H1N1) Influenza in Young Men,” Jeremy D. Kark, Moshe Lebiush, and Lotte Rannon. We studied an outbreak of A(H1N1) influenza in an Israeli military unit of 336 health young men to determine the relation of cigarette smoking to the incidence of clinically apparent influenza and to the influenza-antibody response. Of 168 smokers, 68.5 per cent had influenza, as compared with 47.2 per cent of nonsmokers (P < 0.0001). Influenza was also more severe in the smokers; 50.6 per cent of the smokers lost work days or required bed rest, or both, as compared with 30.1 per cent of the nonsmokers. The proportion of all influenza in smokers that was attributable to smoking was 31.2 per cent (95 per cent confidence intervals, 16.5 to 43.1 per cent). For severe influenza, the attributable risk in the smokers was 40.6 per cent (95 per cent confidence intervals, 21.6 to 54.8 per cent). A quarter of all severe morbidity from influenza in the overall study population was attributable to smoking antibody levels to A/USSR/90/77(H1 N1) antigen were higher in smokers but not markedly so. We conclude that smoking is a major determinant of morbidity in epidemic influenza and may contribute substantially to incapacitation in outbreaks in populations that smoke heavily. (New England Journal of Medicine 1982;307:1042–6.)

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