Mandates for middle school vaccines like Tdap decrease incidence of pertussis by more than half, and increase uptake of other vaccines less frequently required in adolescents, according to a new paper.
The Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) recommends that children receive vaccinations against meningococcal infections (MCV), human papillomavirus (HPV) and seasonal influenza before entering middle school, but state mandates for these vaccinations vary.
A new working paper from researchers at Vanderbilt University investigates the efficacy of school vaccination mandates. Using data from the National Immunization Survey between 2008 and 2013, the research team studied herd immunity as well as “cross-vaccine spillover”—where teens who were required to receive the Tdap vaccine opted for other recommended vaccines, as well.
Christopher Carpenter, PhD, an economics professor at Vanderbilt University who co-authored the working paper, said the goal was to investigate the efficacy of school mandates for vaccination, which have been increasingly utilized. Forty-six states now require Tdap vaccination for middle school entry. Nineteen states also require MCV, and two states require HPV vaccination.
“We find that when there is a vaccine-specific mandate, vaccination rates for Tdap and Meningococcal Conjugate are about 80%, so there seems to be substantial non-compliance,” Carpenter told Medical Economics.
He added that during the sample period, exemptions could be obtained for individuals whose religious beliefs oppose vaccination in all but two states, and 20 states additionally allowed exemptions for personal/philosophical beliefs. All states grant exemptions for children who cannot be vaccinated due to medical reasons.
Carpenter noted that researchers did not find that mandates had smaller effects in states that allowed exemptions for personal/philosophical beliefs compared to other states.
Tdap vaccination is widely required for middle school entry and is very effective, according to the paper. By 2013, 80% of incoming middle school students had received the vaccine, resulting in a 53% decline in pertussis cases. Mandates requiring the vaccine increased uptake by 29%, according to the paper.