The impact of a school entry law on adolescent immunization rates

School of Nursing, University of Missouri-Kansas City, Missouri 64108, USA.
Journal of Adolescent Health (Impact Factor: 3.61). 12/2005; 37(6):511-6. DOI: 10.1016/j.jadohealth.2005.07.009
Source: PubMed


Middle school entry laws increase coverage with recommended vaccines, but their effect on vaccines that are not required is unknown. We compared vaccination coverage for hepatitis B, tetanus and diphtheria (Td), and measles, mumps and rubella (MMR) in areas of states with discordant middle school, hepatitis B school entry laws, and evaluated the relationship between demographic characteristics and adolescent immunization rates.
Retrospective design with purposive school sampling, using location of residence to determine study group. In each school, immunization records from a random sample of up to 75 students in ninth grade (affected by a new hepatitis B law) and 12th grade (not affected by the law) from 11 schools in two areas discordant for the law were analyzed. All areas had long standing two-dose MMR and Td requirements.
Ninth graders in schools with the law had hepatitis B rates higher (72.8%) than those without the law (18.6%) (U = 2.0, p < .01). There were no significant differences between grades or schools for MMR and Td. However, even in the presence of the law, rates were significantly lower in schools with lower socioeconomic indicators.
Middle school immunization laws are effective at raising adolescent hepatitis B, but in this study there wasn't enough power to discern the effect on rates for other vaccines or the influence of demographic variables on rates. Results suggested that laws did not appear to completely overcome disparities. For school mandates to be more effective, additional efforts, presumably on enforcement, especially in areas with lower socioeconomic indicators, are needed.

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    • "(Centers for Disease Control and Prevention, 2010) As of 2009, initiation of the 3-dose series among 13–17 year old girls was estimated at only 44.3 %, and series completion 26.7%. In the past, mandates requiring vaccination for school attendance have resulted in substantial increases in vaccination coverage for both adolescents (Olshen et al., 2007; Wilson et al., 2005) and younger children. (Centers for Disease Control and Prevention, 2007; Briss et al., 2000) However, mandates requiring HPV vaccination for adolescent girls' school attendance have been Correspondence: Amanda F. Dempsey, MD, PhD, MPH, 300 North Ingalls, Rm 6E08, Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5456 USA, PH: 011-1-734-615-0398, FAX: 011-1-734-764-2599, "
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    ABSTRACT: We sought to examine nationally the association between school mandates for adolescent tetanus-containing vaccines (Td and/or Tdap) and adolescent female human papillomavirus (HPV) vaccination. Each state was categorized by whether a school mandate for adolescent Td and/or Tdap vaccines was enacted. Mean HPV vaccine series initiation levels among adolescent females were compared between each mandate category. Mean HPV vaccine series initiation levels were significantly lower in states without Td/Tdap vaccine mandates than in those with mandates (42.9% vs. 47.3%; p=0.004). School mandates for adolescent Td/Tdap vaccination may have a carry-over effect on HPV vaccination.
    Preventive Medicine 12/2010; 52(3-4):268-9. DOI:10.1016/j.ypmed.2010.12.010 · 3.09 Impact Factor

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    ABSTRACT: Cervical cancer, a direct consequence of infection with human papillomavirus (HPV), is the most common cause of cancer-related deaths among women in the developing world. Although cervical cancer screening programs have successfully reduced the burden of disease in devel- oped countries, the cost and complexity of these programs have made effective implementation impossible in low-resource settings. Recent United States and European Commission regu- latory approval of one of two highly efficacious HPV vaccines, and anticipated approval of the second, has prompted international recognition of some of the difficulties associated with assuring equitable access to these vaccines for populations in greatest need in the near future. Administration of the HPV vaccine necessitates reaching preadolescent and adolescent girls before the peak age of infection, which occurs at the onset of sexual activity, differentiating it from almost all other global vaccine initiatives. In addition, the need is greatest where the disease burden is highest, where the population may be hardest to reach and health systems are weak. Forecasting demand for the vaccine has been hampered by special concerns regarding acceptability; without demand forecasts, costs remain uncertain. This background document summarizes current knowledge about HPV vaccines, avenues for service delivery, and critical information gaps that will inform future efforts to ensure access in the developing world. Edu- cated and informed stakeholders who share goals and objectives can advocate more strongly at the international and national levels.
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