Louisiana teenager Brittany Hill receives a vaccine booster shot. (Getty Images )
States that require vaccination for pertussis, meningitis and tetanus for admission to middle school have a higher vaccination rate than states that do not, but the rate is not nearly as high as one might expect from such a requirement, researchers reported Monday. States that required only that educational materials be sent home for those vaccines and the human papilloma virus (HPV) vaccine showed no improvement in vaccination rates.
Vaccines for tetanus and pertussis are typically given during childhood, but the effects can diminish over time and a booster shot is recommended in early adolescence. The meningitis and HPV vaccines typically are given in adolescence. Concern has been spreading about low vaccination rates because of recent outbreaks of pertussis, commonly called whooping cough, in California and Washington. Some parents refuse to have their children vaccinated because of groundless fears about vaccine side effects -- particularly the now-refuted link to autism -- but others simply find that it is easier to express "philosophical opposition" to the vaccines rather than take their children for the shots. But these unvaccinated children serve as a natural reservoir for the diseases, enhancing their spread, particularly to those who are too old or immune-impaired to receive the vaccines themselves.
Thirty-two states required middle school vaccination with either the tetanus/diptheria (Td) vaccine or the tetanus/diptheria/acellular pertussis (TdaP) vaccine when the survey was performed in 2008-09. Fourteen of those specifically required the TdaP vaccine. None required that educational materials about those vaccines be sent home. Three states required the meningitis vaccine and 10 required education. Only Virginia and the District of Columbia required HPV vaccination, which is controversial because the virus is transmitted primarily by sexual contact. It is also expensive for the three-dose series required.
Dr. Christina Dorrell and her colleagues at the Centers for Disease Control and Prevention used data from the 2008-09 National Immunization Survey-Teen, in which telephone numbers are randomly called to provide a cross-section of households with teenagers. Parents were questioned about vaccinations, then asked for permission to contact vaccine providers.
The team reported in the journal Pediatrics that 71% of teens in states with vaccination requirements had indeed been immunized against meningitis, compared to 53% in states with no requirements. For Td and TdaP, the corresponding numbers were 80% and 70%. Educational requirements did not raise immunization rates for any of the vaccines. Since the data was collected for the study, 21 states have enacted new or updated vaccination requirements for TdaP and six have made new requirements for the meningitis vaccine.