Vaccine coverage levels after implementation of a middle school vaccination requirement, Florida, 1997-2000

Public Health Rep. Mar-Apr 2004;119(2):163-9. doi: 10.1177/003335490411900209.


Objective: Little information is available about the effectiveness of school entry vaccination requirements at the middle school level. This study examined coverage levels among students entering seventh grade in Florida following implementation of a school entry vaccination requirement in 1997.

Methods: The authors analyzed county-specific vaccination coverage levels (three doses of hepatitis B vaccine, a second dose of measles, mumps, and rubella [MMR] vaccine, and a booster dose of tetanus and diphtheria toxoids [Td]) among students entering public and private schools in Florida from 1997 through 2000. In 1998, a survey of all county health departments was conducted, and the resulting data were linked to county-specific vaccination rates.

Results: During the 1997-1998 school year, the first year the requirement went into effect, at school entry 121,219 seventh-grade students (61.8%) were fully vaccinated, 72,275 seventh grade students (36.9%) lacked one or more doses of vaccine but were considered in process, 1,817 were non-compliant (0.9%), and 763 had medical or religious exemptions (0.4%). In the 2000-2001 school year, the proportions of students reported fully vaccinated at school entry had increased to 66%. Most of this change was related to an increase in hepatitis B coverage. There was a significant inverse relationship between the proportion of students fully vaccinated and the size of the county's seventh grade population.

Conclusions: The seventh grade vaccination entry requirement was associated with sustained high levels of vaccination coverage. Passing a school entry vaccination requirement appears may be sufficient to increase coverage, but other strategies may be required to achieve full immunization of middle school students.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Data Interpretation, Statistical
  • Diphtheria Toxoid / administration & dosage
  • Florida
  • Hepatitis B Vaccines / administration & dosage
  • Humans
  • Immunization Programs*
  • Immunization, Secondary
  • Measles-Mumps-Rubella Vaccine / administration & dosage
  • Tetanus Toxoid / administration & dosage
  • Vaccination / standards*


  • Diphtheria Toxoid
  • Hepatitis B Vaccines
  • Measles-Mumps-Rubella Vaccine
  • Tetanus Toxoid