Middle School Vaccination Requirements and Adolescent Vaccination Coverage

Background: It is well-documented that kindergarten entry vaccination requirements result in higher coverage for early childhood vaccines but little is known about the effect of middle school requirements on adolescent vaccine coverage.

Objectives: To determine if middle school vaccination requirements are associated with higher coverage for adolescent vaccines.

Methods: State laws in place for the 2008-2009 school year for the 50 states and the District of Columbia were reviewed.  We included requirements that required receipt of vaccination for school entry or required education of parents for 3 vaccines recommended for adolescents: tetanus/diphtheria-containing (Td or Tdap), meningococcal (MCV4), and human papillomavirus (HPV) vaccines. Vaccination coverage levels for adolescents 13-17 years of age stratified by mandate status were assessed using the 2009 National Immunization Survey-Teen.

Results: For the 2008-2009 school year, 31 states had requirements for Td/Tdap (14 specifically requiring Tdap); 3 states required MCV4 vaccine and 10 required education; 2 states required HPV vaccine and 5 required education. Vaccination requirements were associated with significantly higher coverage for MCV4 (71% vs 53%, p<0.001) and Td/Tdap (80% vs 70%, p<0.001) vaccines. No association was found between education requirements and coverage levels for MCV4 and HPV vaccines or between requirements for HPV vaccine and HPV vaccine coverage. States with Tdap-specific requirements had significantly higher Tdap coverage than states with Td-specific or no requirements (64% vs 57% vs 49%, p<0.001).

Conclusions: Middle school vaccination requirements are associated with higher coverage for Td/Tdap vaccines. States specifically requiring Tdap vaccine have higher coverage for Tdap than those with Td-specific requirements. While few states had requirements for MCV4 in 2008, initial data indicate that requirements may lead to higher coverage. We will continue to monitor the impact on coverage as more states adopt requirements.