Meeting the Preteen Vaccine Law: A Pilot Program in Urban Middle Schools
Boyer-Chuanroong, Lynda, Deaver, Paul, Journal of School Health
Including vaccinations as part of the requirements for school entry or moving into the next grade level provides one of the most effective ways of achieving widespread vaccination coverage.[1,2] School entry requirements are based on recommendations by the Advisory Committee on Immunization Practices (ACIP), a group of physicians that establishes national recommendations about immunizations.
In 1989, the ACIP recommended a second measles dose (MMR #2) for all students, kindergarten through university-level, to protect individuals who may not have developed immunity after the first dose. In 1991, the ACIP recommended Hepatitis B vaccination for infants. In 1996, the ACIP recommended varicella (chickenpox) vaccination for children age 12 months or older who had not been previously infected. In that same year the ACIP, with many other national health organizations, wrote a landmark statement recommending seven different vaccines for adolescents including hepatitis B, measles, and varicella vaccines. The recommendations for hepatitis B, measles. and varicella are "catch-up" strategies to assure protection of youth overlooked or past the age-group for the 1989 MMR #2 recommendation, the 1991 infant hepatitis B recommendation, and the 1996 varicella recommendation.
California is one of 23 states with legislation or regulations regarding adolescent hepatitis B vaccination.[2,7] Requirements for each state may differ by which vaccines are required, the targeted age group, and the applicable grade level. According to a recent survey conducted by the Immunization Action Coalition (St. Paul, Minn., 612/647-9009), 23 states (including Washington DC) have legislated/regulated hepatitis B vaccinations for preteens. These states are California, Colorado, Delaware, Washington, DC. Florida, Idaho, Illinois, Massachusetts, Minnesota (9/01). Missouri, Nebraska (7/00), New Mexico, New York (9/00), North Carolina, Oklahoma, Oregon (9/00), Rhode Island (8/00), South Carolina, Texas (8/00), Vermont (7/01), Virginia (7/01), Wisconsin, and Wyoming. Unless otherwise noted in parentheses (month, year), all these states have already implemented the requirement or are implementing it this school year (1999-2000).
California's requirement was established through California Law AB 381. Effective July 1, 1999, students entering seventh grade were required to have three doses of hepatitis B, a second dose of measles-containing vaccine, and a recommended tetanus-diphtheria booster (Td). Because AB 381 was signed by the governor in October 1997, schools and school health personnel had an entire school year (1998-99) to inform sixth graders and their parents. This article describes the efforts, outcomes, and resulting recommendations from an urban school district pilot program.
Diverse School District
The school district under discussion has an enrollment of 64,000 students attending 110 school sites scattered throughout the city. Of these 110 sites, 17 are middle schools (grades 6-8). The profile of this district is similar to that of other urban school districts: it is ethnically, culturally, and economically diverse. The largest ethnic groups include Chinese (28%), Latinos (21%), African-Americans (16%), Caucasians/"Other White" (12%), and Filipinos (7%). The remaining 16% include many other groups, including Southeast Asians, Middle-Easterners, and other Asians. A notable feature of this district is the home language diversity: eight languages are specifically enumerated and dozens more are included in the "other" category.
Limited Health Care Staffing
The district has its own department responsible for health-related programs. Largely grant-supported, the staff consists of nurses, health workers, health educators, and others. The department has received sizable grants designating nurses, among others, to support youth development services. All 17 middle schools have a nurse on-site for one or two days a week. …