摘要：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. The resurgence of more than 50 000 measles cases in the United States during the late 1980s 1, 2 and awareness that as many as 70% of the hepatitis B viral infections occur during adolescence and early adulthood 3 led to recommendations that adolescents not already immune should receive hepatitis B (HB) vaccine and measles, mumps, rubella (MMR) vaccine, as well as tetanus and diphtheria (Td) toxoids and varicella vaccines. 4 The recommendations call for a routine health care visit for children aged 11 through 12 years, during which they should be screened for and administered indicated vaccinations. Although most states now require a second dose of MMR and HB vaccine for school entry, 5 not all adolescents are up to date for MMR and HB vaccines because both vaccination recommendations and school entry requirements were phased in during the 1990s. 1, 2, 6, 7 Therefore, programs specifically targeting adolescents remain necessary. 8 Middle school–entry vaccination requirements have been suggested as a way of ensuring vaccination of adolescents, 4 and an increasing number of states have adopted middle school–entry vaccination requirements of 2 doses of MMR and HB vaccine. 5 Although vaccination requirements have been shown to be effective in primary school, 9 few data exist on their effectiveness in middle schools. A study from Florida suggests that middle school–entry vaccination requirements may be effective in ensuring vaccination of adolescents 10 ; however, that report lacked data on the vaccination coverage of adolescents before enactment of the requirement.
