Teen immunization rates improve with middle school vaccine mandates

Because no state requires all recommended immunizations, physicians are advised to educate adolescents and their families about them.

By — Posted May 18, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

States that require middle schoolers to be up to date with vaccines have greater coverage among teens for those particular immunizations than states without such mandates, a recent study shows.

But because no state requires all of the three vaccines recommended for adolescents, physicians should review youths’ immunization history at each visit and offer any vaccine the teen is missing, said Shannon Stokley, MPH, co-author of the study published online May 7 in Pediatrics.

The Centers for Disease Control and Prevention recommends that youths 13 to 17 receive the following vaccines: meningococcal conjugate (MenACWY); tetanus, diphtheria, acellular pertussis (Tdap); and human papillomavirus (HPV).

“We need to do a better job of reducing missed opportunities to vaccinate adolescents and taking advantage of every visit with” adolescent patients, said Stokley, a CDC epidemiologist.

Researchers examined data from the National Conference of State Legislatures and several other organizations to identify states with middle school vaccination requirements in place at the start of the 2008-09 academic year. They also assessed the results of the 2008-09 National Immunization Survey-Teen to determine vaccination coverage rates for adolescents 13 to 17.

They found that 32 states require middle schoolers to receive the Td or Tdap vaccine. In those states, 80% of adolescents had at least one dose of either Td or Tdap compared with 70% of youths in states without a mandate for either of the immunizations.

Similarly, in Arizona, New Jersey and North Dakota — the three states with a MenACWY requirement for middle school — 71% of adolescents received at least one dose of the vaccine compared with 53% of youths in states without the mandate, data show. Those states also require the Td or Tdap vaccine (link).

Data were not studied for coverage of the HPV vaccine because only one state — Virginia — requires it.

The Healthy People 2020 targets for youths 13-15 are 80% coverage for at least one dose of Tdap and MenACWY immunizations and at least 80% for three doses of HPV vaccine among females.

Researchers found that 12 states required middle schools to educate parents about the MenACWY or HPV vaccines rather than mandate that the child get the immunization. Such education often is in the form of informational materials that the school mails to parents or sends home with students, the study said.

Only three states required either immunizations or education on all three recommended vaccines: New Jersey, which requires education on HPV; and North Carolina and Washington, which require Tdap and education on MenACWY and HPV. Twelve states require neither vaccination nor education.

Parental education requirements were not associated with higher immunization rates, data show.

“The issue is determining the best ways to disseminate the information so parents can make an educated decision about whether or not to vaccinate their child,” Stokley said.

The Pediatrics study did not assess which forms of vaccine education are most beneficial.

“We know adolescents don’t visit the doctor as often as recommended,” she said. “So it’s really important that doctors take advantage of every opportunity to administer all the vaccines they can while they have the adolescent in the office.”

Back to top


Does your state require teens to be vaccinated?

States have varying requirements about vaccinations in middle school. Thirty-two states require middle schoolers to get the Td/Tdap vaccine, three states mandate the meningococcal conjugate immunization and only Virginia requires female students get the HPV vaccine. In some states, middle schoolers are required to get educational materials on vaccine-preventable illnesses. Twelve states — Arkansas, California, Delaware, Georgia, Hawaii, Idaho, Maine, Maryland, Nebraska, South Carolina, South Dakota and West Virginia — have no such requirements for middle schoolers.

State Vaccine requirement Education requirement
Alabama Td-containing
Alaska Td-containing
Arizona Tdap-specific, MenACWY
Colorado Tdap-specific
Connecticut MenACWY
District of Columbia Tdap-specific
Florida Td-containing
Illinois Td-containing
Indiana MenACWY, HPV
Iowa HPV
Kansas Td-containing
Kentucky Td-containing
Louisiana Td-containing
Massachusetts Td-containing MenACWY
Michigan Td-containing
Minnesota Td-containing HPV
Mississippi MenACWY
Missouri Td-containing
Montana Td-containing
Nevada Tdap-specific
New Hampshire Td-containing
New Jersey Tdap-specific, MenACWY HPV
New Mexico Tdap-specific
New York Tdap-specific
North Carolina Tdap-specific MenACWY, HPV
North Dakota Tdap-specific, MenACWY
Ohio MenACWY
Oklahoma MenACWY
Oregon Tdap-specific
Pennsylvania Td-containing
Rhode Island Td-containing
Tennessee MenACWY
Texas Td-containing MenACWY
Utah Td-containing
Vermont Tdap-specific
Virginia Tdap-specific, HPV
Washington Tdap-specific MenACWY, HPV
Wisconsin Tdap-specific
Wyoming Td-containing

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn