Learning Objectives for this Presentation:
By the end of the presentation participants will be able to explain how primary school (PS) requirements impact 7th graders' vaccination status.

Background:
By the time they enter 7th grade, adolescents should be up-to-date for five vaccines: Tdap, MMR, MCV4, hepatitis B and varicella. While the impact of middle school (MS) laws is usually considered in isolation, 7th graders in states without MS requirements may have already been vaccinated because of PS requirements.

Objectives:
To analyze the combined effect of PS and MS requirements.

Methods:
We developed a database of school vaccination laws by merging results of three surveys and verifying information from primary state sources. We next constructed a three-dimensional array to determine how a specific state's school entry requirements affect children in any grade and year.

Results:
In 2006, 7th graders in 43 states are affected by hepatitis B requirements. In 33 states, 7th graders are affected in MS and in 10 states, in PS. MMR laws affect 7th graders in 50 states (27 MS and 23 PS). For varicella, 7th graders are affected in 20 states (19 MS and 1 PS). Only 4 states have Td vaccination laws affecting 7th graders; 9 others require a Td booster ten years following the primary DTaP series. No states require the MCV4 or Tdap vaccine for all 7th graders. Only in Massachusetts and Rhode Island are 7th graders affected by requirements for all other vaccines. States with the fewest requirements are Alabama, Idaho, Kansas, Maryland, Montana, North Dakota and West Virginia.

Conclusions:
If PS and MS requirements are considered together, the majority of adolescents are covered by school entry laws for MMR and hepatitis B. Only a minority of states have requirements for varicella and Td. Most state school laws would have to be changed to reflect the ACIP recommendations for Tdap and MCV4.