Uptake of meningococcal vaccine in Arizona schoolchildren after implementation of school-entry immunization requirements

Public Health Rep. 2013 Jan-Feb;128(1):37-45. doi: 10.1177/003335491312800106.


Objectives: Meningitis and bacteremia due to Neisseria meningitidis are rare but potentially deadly diseases that can be prevented with immunization. Beginning in 2008, Arizona school immunization requirements were amended to include immunization of children aged 11 years or older with meningococcal vaccine before entering the sixth grade. We describe patterns in meningococcal vaccine uptake surrounding these school-entry requirement changes in Arizona.

Methods: We used immunization records from the Arizona State Immunization Information System (ASIIS) to compare immunization rates in 11- and 12-year-olds. We used principal component analysis and hierarchical cluster analysis to identify and analyze demographic variables reported by the 2010 U.S. Census.

Results: Adolescent meningococcal immunization rates in Arizona increased after implementation of statewide school-entry immunization requirements. The increase in meningococcal vaccination rates among 11- and 12-year-olds from 2007 to 2008 was statistically significant (p<0.0001). All demographic groups had significantly higher odds of on-schedule vaccination after the school-entry requirement change (odds ratio range = 5.57 to 12.81, p<0.0001). County demographic factors that were associated with lower odds of on-schedule vaccination included higher poverty, more children younger than 18 years of age, fewer high school graduates, and a higher proportion of Native Americans.

Conclusions: This analysis suggests that implementation of school immunization requirements resulted in increased meningococcal vaccination rates in Arizona, with degree of response varying by demographic profile. ASIIS was useful for assessing changes in immunization rates over time. Further study is required to identify methods to control for population overestimates in registry data.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Arizona
  • Child
  • Cluster Analysis
  • Humans
  • Immunization / legislation & jurisprudence*
  • Indians, North American
  • Logistic Models
  • Meningitis, Meningococcal / prevention & control*
  • Meningococcal Vaccines / administration & dosage*
  • Neisseria meningitidis / immunology
  • Odds Ratio
  • Schools
  • Socioeconomic Factors
  • Vaccination / statistics & numerical data*


  • Meningococcal Vaccines