KEYWORDS:
School law; hepatitis B; adolescent coverage

BACKGROUND:
California School Immunization Law was amended in 1997 to require students entering seventh grade after July 1, 1999 to have documented proof of three hepatitis B and two MCV doses or to have obtained an exemption on medical or personal beliefs grounds. Forty-three states had similar laws by July 2001. School requirements are recognized as effective in raising immunization coverage.

OBJECTIVE(S):
Determine the impact of enforcing school laws on hepatitis B immunization coverage among seventh grade students.

METHOD(S):
A baseline telephone survey of 489 households was conducted in 1998 in San Diego County. Data from all San Diego County schools with seventh grades was collected in October 1999 and October 2000, and record reviews of randomly selected schools were conducted in February-April 1999 and 2000 to confirm the October results.
County findings were compared to State data. County immunization staff train school staff on immunization law compliance and selectively monitor follow-up.

RESULT(S):
1998 baseline coverage was 15.8% for three doses of hepatitis B and 70.0% for two doses of MCV. Only 13.3% reported receipt of both vaccines. In October 1999, 68.5% had received 3 doses of hepatitis B and 92.6% had received two doses of MCV, with 62.7% of students in compliance with the law by vaccination and 1.8% by exemption. In April 2001, 92.2% of San Diego students were compliant, with 89.5% having three doses of HBV and two doses of MCV. The rate of students with exemptions was 2.7%

CONCLUSIONS(S):
School immunization laws can be an effective means of raising immunization coverage. Public health agencies can and should create a climate of expectation that supports implementation of these laws.

LEARNING OBJECTIVES:
Describe the impact of a school immunization law on adolescent vaccine coverage. Describe the impact on implementation of enforcement by public health agencies.