KEYWORD1:
Varicella, varicella vaccine, state mandates

BACKGROUND:
Before varicella vaccine became available, approximately four million cases of varicella occurred annually in the US, resulting in 11,000 hospitalizations and 105 deaths.¹ Since varicella vaccine licensure in 1995, varicella cases and hospitalizations have declined approximately 80% in parts of the country.² In 1996, varicella vaccine was added to the list of recommended childhood vaccinations. In May 1999, the Centers for Disease Control and Prevention (CDC) recommended that all states require varicella vaccinations for school-age children.

OBJECTIVE:
To determine whether school-based varicella vaccination mandates have impacted on varicella vaccine use at the state level.

METHOD:
State-specific estimates of varicella vaccine use were obtained from the CDC National Immunization Survey. Information about state-specific, school-based varicella vaccination requirements, including implementation dates was obtained from several sources. States were ranked based on their vaccination rate relative to the national rate. Vaccine coverage data were examined for evidence that the adoption of school mandates influenced vaccination rates.

RESULT:
Currently, 37 states and the District of Columbia require varicella vaccination for day care and/or school entry. Six states (11.8%) are leading the way in achieving high utilization of varicella vaccine among children 19 months to 35 months of age. Fourteen states (27.5%) are making strong progress and five states (9.8%) have coverage rates that approximate the national value. All 20 states categorized as making strong progress or leading the way have varicella vaccination mandates. Of the 13 states without varicella vaccine mandates, 4 (7.8%) are categorized as Making Slow Progress and 7 (13.7%) are Falling Behind.

CONCLUSION:
Substantial differences in varicella vaccine coverage exist among states. Those with mandates tended to have higher coverage than those without mandates.
LEARNINGOBJECTIVES:
Discuss the impact of varicella vaccination mandates on immunization coverage rates.