Background New university students are at particular risk of invasive meningococcal disease (IMD). Group W, a particularly aggressive strain, is increasing in prevalence and the high case-fatality rate is concerning. This age group has been offered the MenACWY vaccine since 2015. National uptake has been low, leaving students vulnerable to infection.

Aims To investigate MenACWY uptake, knowledge of and attitudes towards vaccination among first-year students, with the aim of informing university vaccination policy and practice.

Methods A mixed methods approach was used, involving a questionnaire (response rate = 4.4%, n=144) and follow-up interviews (n=13). Eligibility criteria were first year students, undergraduates and over the age of 18. Statistical tests, including multiple logistic regression, were carried out and interviews were analysed thematically.

Results MenACWY uptake was 84%, with more socioeconomically disadvantaged students less likely to be vaccinated (aOR = 0.117, p=0.006). Most students thought vaccines were safe (95.1%) and important (97.2%). Students with above average knowledge were more likely to be vaccinated (OR=3.057, p=0.019). Students unaware that meningitis can be fatal were less likely to be vaccinated (aOR = 0.173, p=0.035). Vaccination views were positive and knowledge level was moderate to high. Reasons for vaccination include influence of authority figures and peers, to avoid disease and due to an inherent trust of vaccines. Reasons for non-vaccination included temporary illness, laziness, forgetfulness and difficulty with GP access. Opinions regarding the university’s vaccination campaign were positive, and in particular there was praise for the university’s awareness campaign. Issues raised by this study include difficulty in accessing GP services and the belief that the vaccine prevents any cause of meningitis.

Conclusion High vaccine uptake is essential to protect students. Uptake was higher than at other universities in previous studies. These results highlight several areas requiring further study, including the association between uptake and socioeconomic group and understanding of post-vaccination risk of meningitis. This research has implications for vaccination policy at UK universities.