An analysis of secondary school meningococcal vaccination mandates in the United States using NIS-Teen 2010
In 2005, the Advisory Committee on Immunization Practices (ACIP) recommended the meningococcal conjugate vaccine for teens aged 11–18 years. After the recommendation of the ACIP, state response varied from non-action to mandated vaccination as condition of enrollment and vaccine education in secondary schools. Although the meningococcal vaccination coverage of adolescents has been increasing, it remains below the Healthy People 2020 target of 80%. This coverage level shortfall demonstrates the need to study which interventions work, especially those currently in effect. Mandates are one such intervention. This thesis examines the association of state mandates for meningococcal vaccine education and vaccination requirements for enrollment in secondary schools with the likelihood of having received the meningococcal vaccine in 13 year olds. Consideration was also given to gender, racial/ethnic, and socioeconomic variables in which inequalities in vaccination coverage have been shown. Methods. The National Immunization Survey - Teen 2010 data were used to determine vaccination status, and state policy information was gathered from the National Conference of State Legislatures and Immunization Action Coalition websites. Descriptive, bivariate, and multivariate analyses were conducted. Results. After adjustment, teens in states with mandated meningococcal vaccination requirements for enrollment in secondary schools were more than twice as likely to be vaccinated (OR=2.20; 95% CI:1.56–3.10) as their counterparts in states without mandates. Mandated meningococcal education in secondary schools was not associated with increased likelihood of vaccination (OR=1.07; 95% CI:0.78–1.45). Having both mandated meningococcal vaccination and education in secondary schools was not associated with increased likelihood of vaccination (OR=0.85; 95% CI:0.43–1.68). Teens who were recommended the meningococcal vaccine by a health care provider were 37 (OR=36.65; 95% CI:26.51–50.65) times more likely to be vaccinated than those who did not receive a recommendation. Compared with Non-Hispanic Whites, Hispanics (OR=2.07; 95% CI:1.32–3.24) and Non-Hispanic Blacks (OR=1.46; 95% CI:1.06–2.02) were more likely to be vaccinated. Participants in households below the poverty line (OR=1.82; 95% CI:1.24–2.68) were more likely to be vaccinated than those above the poverty line. Conclusion. Mandated meningococcal vaccination requirement for enrollment in secondary schools appears to be an effective population based intervention for increasing meningococcal vaccination coverage of 13-year olds. Additionally, a health care provider recommendation greatly increases the likelihood of a teen being vaccinated. These findings present a path to potentially increase meningococcal vaccination of teens dramatically. This rise in vaccination coverage will result in increased herd immunity for the population, which may in turn decrease the burden meningococcal disease.^
Health Sciences, Public Health
Zottarelli, James A, "An analysis of secondary school meningococcal vaccination mandates in the United States using NIS-Teen 2010" (2012). Texas Medical Center Dissertations (via ProQuest). AAI1516321.