BACKGROUND:
Neisseria meningitidis can cause life-threatening illnesses such as meningitis and bacteremia. Studies have shown that the incidence of N. meningitidis is higher among college students living on campus than those residing off campus. In 2000, Maryland became the first state to require meningococcal vaccination or a signed waiver for students living in on campus housing at institutions of higher learning. Neither a formal assessment of the Maryland law nor a review of the methods employed by these institutions regarding its enforcement has been conducted.

OBJECTIVE:
This project's goal was to evaluate the practices and policies that Maryland educational institutions have implemented in response to the law. We obtained information regarding institutional requirements, methods for information dissemination, vaccination and waiver coverage, accessibility issues, and barriers to vaccination. This information will be used to establish best practices and policies for the implementation and continued use of successful student vaccination programs within Maryland.

METHOD:
A standard questionnaire was mailed to all Maryland colleges and universities with on campus housing (N = 32). The frequency of practices, vaccination coverage, and waiver rates were determined.

RESULT:
Twenty-four institutions responded (response rate: 75%). Seventeen institutions (71%) required meningococcal vaccination solely because it was mandated by law. During the 2003–4 academic year, the median vaccination coverage among students living on campus at these institutions was 58.1% (range: 9.7–95%). The median waiver rate among students living on campus was 13.5 % (range: 0.2–60.7%).

CONCLUSION:
The establishment of mandatory vaccination laws does not ensure uniformity with respect to implementation by institutions. Vaccination and waiver coverage is partially dependent on institutional practices and policies. Recommendations based on effective practices and policies should be developed and provided to institutions of higher learning.

LEARNING OBJECTIVES:
Describe a policy evaluation project.
Evaluate how vaccination laws are implemented.
Provide guidance regarding meningococcal vaccination programs.