title: Middle school vaccination requirements and adolescent vaccination coverage.
abstract: OBJECTIVE
  To determine if middle school vaccination requirements are associated with higher coverage for adolescent vaccines.
  
  
  METHODS
  School entry requirements for receipt of vaccination for school entry or education of parents for 3 vaccines recommended for adolescents: tetanus/diphtheria-containing (Td) or tetanus/diphtheria/acellular pertussis (TdaP), meningococcal conjugate (MenACWY), and human papillomavirus (HPV) vaccines in place for the 2008-2009 school year were reviewed for the 50 states and the District of Columbia. Vaccination coverage levels for adolescents 13 to 17 years of age by state requirement status and change in coverage from 2008 to 2009 were assessed by using the 2008-2009 National Immunization Survey-Teen.
  
  
  RESULTS
  For the 2008-2009 school year, 32 states had requirements for Td/TdaP (14 specifically requiring TdaP) and none required education; 3 states required MenACWY vaccine and 10 others required education; and 1 state required HPV vaccine and 5 required education. Compared with states with no requirements, vaccination requirements were associated with significantly higher coverage for MenACWY (71% vs 53%, P < .001) and Td/TdaP (80% vs 70%, P < .001) vaccines. No association was found between education-only requirements and coverage levels for MenACWY and HPV vaccines. States with new 2008-2009 vaccination requirements (n = 6, P = .04) and states with preexisting vaccination requirements (n = 26, P = .02) for Td/TdaP experienced a significant increase in TdaP coverage over states with no requirements.
  
  
  CONCLUSIONS
  Middle school vaccination requirements are associated with higher coverage for Td/TdaP and MenACWY vaccines, whereas education-only requirements do not appear to increase coverage levels for MenACWY or HPV vaccines. The impact on coverage should continue to be monitored as more states adopt requirements.
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-19, Atlanta, GA 30333, USA. icw6@cdc.gov
authors.forename: Erin
authors.initials: E
authors.lastname: Bugenske
authors.forename: Shannon
authors.initials: S
authors.lastname: Stokley
authors.forename: Allison
authors.initials: A
authors.lastname: Kennedy
authors.forename: Christina
authors.initials: C
authors.lastname: Dorell
mesh_terms: D000293:Adolescent; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence*; D008297:Male; D022401:Meningococcal Vaccines / Q000627:therapeutic use; D053918:Papillomavirus Vaccines / Q000627:therapeutic use; D012572:School Health Services / Q000191:economics / Q000331:legislation & jurisprudence*; D012574:Schools / Q000191:economics / Q000331:legislation & jurisprudence*; D014611:Vaccination / Q000191:economics / Q000331:legislation & jurisprudence*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines