School Entry Requirements and Coverage of Nontargeted Adolescent Vaccines.

Background: Low human papillomavirus (HPV) vaccination coverage is an urgent public health problem requiring action. To identify policy remedies to suboptimal HPV vaccination, we assessed the relationship between states' school entry requirements and adolescent vaccination.
Methods: We gathered data on states' school entry requirements for adolescent vaccination (tetanus, diphtheria, and pertussis [Tdap] booster; meningococcal; and HPV) from 2007 to 2012 from Immunization Action Coalition. The National Immunization Survey-Teen provided medical record-verified vaccination data for 99 921 adolescents. We calculated coverage (among 13- to 17-year-olds) for individual vaccinations and concomitant vaccination. HPV vaccination outcomes were among female adolescents. Analyses used weighted longitudinal multivariable models.
Results: States with requirements for Tdap booster and meningococcal vaccination had 22 and 24 percentage point increases in coverage for these vaccines, respectively, compared with other states (both P < .05). States with HPV vaccination requirements had <1 percentage point increase in coverage for this vaccine (P < .05). Tdap booster and meningococcal vaccination requirements, respectively, were associated with 8 and 4 percentage point spillover increases for HPV vaccination coverage (both P < .05) and with increases for concomitant vaccination (all P < .05).
Conclusions: Ensuring all states have meningococcal vaccination requirements could improve the nation's HPV vaccination coverage, given that many states already require Tdap booster but not meningococcal vaccination for school entry. Vaccination programs and clinicians should capitalize on changes in adolescent vaccination, including concomitant vaccination, that may arise after states adopt vaccination requirements. Additional studies are needed on the effects of HPV vaccination requirements and opt-out provisions.
Competing Interests: POTENTIAL CONFLICT OF INTEREST: Drs Moss, Truong, and Rimer have indicated they have no potential conflicts of interest to disclose. Dr Reiter has received a research grant from Merck Sharp & Dohme Corp and has also received a research grant from Cervical Cancer–Free America, via an unrestricted educational grant from GlaxoSmithKline. Dr Brewer has served on paid advisory boards or received research grants from Merck, GlaxoSmithKline, the Centers for Disease Control and Prevention (CDC), and the US Food and Drug Administration, and now serves as chair of the CDC-funded National HPV Vaccination Roundtable. None of these entities had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
(Copyright © 2016 by the American Academy of Pediatrics.)