Factors Associated with Tdap and Meningococcal Vaccination Coverage Among Middle School Students — North Dakota, 2010

Background:  North Dakota state law requires students to receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) and meningococcal conjugate vaccine (MCV4) for middle school entry, according to the North Dakota Department of Health (NDDoH) recommended schedule. However, in 2009, vaccine coverage in North Dakota was only 72% for Tdap and 66% for MCV4 among persons aged 13-17 years. 

Objectives:  To determine factors associated with high (≥90%) Tdap and MCV4 vaccination coverage among North Dakota middle school students.

Methods:  We added questions to the 2010 NDDoH annual vaccination survey of all public and private schools to assess school vaccination policies, assignment of a school nurse, and personnel who determine vaccination status. State-law–compliant vaccination policies were policies that exclude students from school who have not received required vaccinations or provided a valid exemption. 

Results:  Preliminary results from 51 middle schools identified 27 (53%) with state-law–compliant vaccination policies. Seventeen (33%) have a school nurse assigned at least part-time. Thirty-eight (75%) schools have a school nurse or local public health nurse determine student vaccination status, whereas the remaining 13 schools have nonhealthcare personnel make this determination. A higher, though not statistically significant, proportion of schools with state-law–compliant policies reported high Tdap coverage (56% with state-law–compliant policies, 29% with noncompliant policies; P = 0.058) and high MCV4 coverage (52% and 29%, respectively; P = 0.10). Neither having a school nurse assigned nor having a nurse determine vaccination status was significantly associated with high Tdap or MCV4 coverage.

Conclusions:  Vaccination coverage at North Dakota middle schools regardless of the presence of state-law–compliant vaccination policies could be improved. The NDDoH should support middle schools in the development of effective vaccination policies, and investigate barriers to student vaccination and school policy enforcement.