Learning Objectives for this Presentation:
1.Describe the impact of fifth grade Hepatitis B vaccine(HBV) requirement on coverage levels attained by ninth grade
2.Describe the impact of fifth grade Hepatitis B vaccine requirement on racial/ethnic disparities in HBV coverage levels.

Background:
Data from NHIS indicate that coverage levels for ≥ 3 doses of HBV among 13-15 year olds increased from 15%(1997) to 52%(2003). Middle school entry requirements may have contributed to this increase. In 1997, Illinois implemented a requirement for ≥ 3 doses of hepatitis B vaccine by fifth grade.

Objectives:
To evaluate the impact of Illinois' HBV fifth grade requirement on coverage levels attained by ninth grade and on racial/ethnic disparities.

Methods:
We obtained demographic information and immunization dates for 6 cohorts of Chicago Public High School (CPHS) seniors enrolled during 2000-2005. For each cohort, we determined HBV coverage levels from third to twelfth grade by race/ethnicity. We compared the ninth grade coverage levels stratified by race/ethnicity of students who had enrolled in fifth grade before and after the school requirement.

Results:
We included 106,541 students in the analysis. HBV coverage levels increased from third through twelfth grade for all cohorts. The post-implementation cohort had significantly higher HBV coverage levels than the pre-implementation cohort at fifth (38.2% vs 4.3%, p<.0001 ) and ninth grade entry (85.0% vs 37.4 %, p<.0001). Additionally, by ninth grade, coverage levels for white, black and Hispanic students exceeded 80% and the absolute difference in coverage levels between white and black students for the pre- and post-implementation cohorts decreased from 14% to 5.2%.

Conclusions:
Among CPHS students impacted by the fifth grade requirement, ninth grade HBV coverage levels exceeded 84% and racial/ethnic disparities were dramatically reduced. As health care providers and public health professionals seek strategies to achieve effective coverage levels of the three recently recommended adolescent vaccines (MCV4,Tdap,HPV) middle school entry requirements should be considered.