A middle school immunization law rapidly and substantially increases immunization coverage among adolescents

Am J Public Health. 2004 Jun;94(6):978-84. doi: 10.2105/ajph.94.6.978.


Objectives: This study assessed the effectiveness of a middle school vaccination requirement for raising second-dose measles, mumps, and rubella vaccine and hepatitis B vaccine coverage among adolescents.

Methods: Random-digit-dialed telephone surveys were conducted before (1998) and after (1999) the implementation of a vaccination requirement for entry into the seventh grade in San Diego, Calif.

Results: Vaccination coverage was higher among children subject to the vaccination requirement (seventh-grade students; 60%) than among fifth- and sixth-grade students 1 year before the requirement (13%, P <.001), and 8th- through 12th-grade students not subject to the requirement (27%, P <.0001).

Conclusions: Middle school-entry vaccination requirements can rapidly and substantially raise vaccination coverage among students subject to the law.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • California
  • Female
  • Health Services Research
  • Hepatitis B Vaccines / administration & dosage
  • Humans
  • Immunization Programs / legislation & jurisprudence*
  • Immunization Programs / statistics & numerical data*
  • Immunization, Secondary
  • Male
  • Measles-Mumps-Rubella Vaccine / administration & dosage
  • Program Evaluation


  • Hepatitis B Vaccines
  • Measles-Mumps-Rubella Vaccine