Suboptimal human papillomavirus (HPV) vaccination coverage in the United States is an ongoing crisis in cancer prevention. We assessed the impact of states’ school-entry requirements for adolescent vaccination, focusing on HPV vaccination.
We categorized US states according to their 2007-2012 school-entry requirements for adolescent vaccination (tetanus, diphtheria, and pertussis (Tdap) booster; meningococcal; and HPV). The National Immunization Survey-Teen (2008-2012) provided physician-verified data for 99,921 adolescents that we used to calculate vaccination coverage (percent of 13- to 17-year-olds vaccinated), timeliness (percent of adolescents vaccinated by age 13), and seasonality (percent of doses administered in June, July, and August). We also assessed same-day (“concomitant”) vaccination. HPV vaccination outcomes were among female adolescents only. We used longitudinal, weighted multivariable regressions to examine the impacts of vaccination requirements on these outcomes.
Many states adopted Tdap booster (7-42 states) or meningococcal vaccination requirements (0-14 states), but very few adopted HPV vaccination requirements (0-2 states). Tdap and meningococcal vaccination requirements increased coverage for targeted vaccines (22-24% absolute higher coverage in states with versus without requirements), but HPV vaccination requirements did not (<1%). Tdap and meningococcal vaccination requirements also had spillover effects for HPV vaccines (4-8%). Tdap and meningococcal vaccination requirements were associated with increases in coverage, timeliness, and seasonality (all p<.05) for all targeted, spillover, and concomitant vaccinations.
School-entry requirements for HPV vaccination are ineffective in the US, but requirements for meningococcal vaccination could substantially improve HPV vaccination coverage. Policymakers and clinicians should anticipate and capitalize on changes in adolescent vaccination patterns that may arise after states adopt vaccination requirements.