May 7, 2012 -- States that require immunizations for students entering middle school have significantly higher numbers of adolescents who actually get recommended vaccinations compared with states that simply require that parents be informed about the vaccinations, according to a new study.
The Advisory Committee on Immunization Practices currently recommends pre-teens and teens receive the tetanus-diphtheria-pertussis vaccine, the vaccine against meningitis and the HPV vaccine.
Researchers from the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases (NCIRD) wanted to determine if state requirements and parental education had an impact on vaccination rates, so they analyzed data from 13- to 17- year-olds who participated in a national survey.
The vaccination coverage in states requiring immunization against meningitis was 71 percent compared with 53 percent in states with no requirements and 51 percent in states with education-only requirements. The rate of tetanus-diphtheria-pertussis vaccination was 80 percent in states requiring the shot and 70 percent in states with no requirements. There were no states reported that only required education about the tetanus vaccine. There was no difference in vaccination rates for the HPV vaccine.
"The education finding was interesting. I think that it didn't really have any effect," said Shannon Stokley, a co-author and researcher at NCIRD. "That doesn't mean that education isn't working, but education materials may not be reaching its audience. They may not be getting to parents."
This study comes just days after Washington State tapped into emergency funds to help get a whooping cough outbreak under control.
A fairly high number of parents in the state have been exempt from having their children vaccinated, according to Reuters, and a spokesman for the state Health Department said that could be a contributing factor.
Washington Gov. Chris Gregoire freed up $90,000 of emergency money to ramp up vaccination awareness efforts.
"Pertussis is very serious, especially for babies. It's vital that teens and adults are current on their immunizations because they're often the ones who give whooping cough to babies," state Secretary of Health Mary Selecky said in a statement.
Despite the study findings, mandatory vaccination requirements are more effective than education and the whooping cough immunization push in Washington state, there is still debate over whether vaccinating children should be mandatory.
A group of parents, health care providers recently lobbied against a bill in Vermont that would mandate vaccines for all school children by eliminating "philosophical exemption" as a reason to opt against the shots.
"It should be a parent's choice, this should be a free country," said Nicole Matten, whose 7-year-old daughter died after receiving a flu shot.
"Given that vaccines have known risks associated with them, it seems only prudent to continue the philosophical exemption, and to make sure that we are not divided by fear mongering," the group advocating against the law, Vermont Coalition for Vaccine Choice, said on its web site.
Vermont, Washington and Oregon all have high exemption rates, and all three states had had outbreaks of whooping cough.
And a 2011 study, also by CDC, found that nearly 80 percent of parents surveyed felt uncomfortable about getting their children immunized for a variety of reasons, including the fear of the shot, concerns over safety of vaccines and the number of vaccines their children receive and worry that vaccination may be linked to autism.
Vaccines Wear Off, Hence the Need for More Shots
Parental fears aside, some experts stress the importance of vaccination throughout childhood. The tetanus-diphtheria-pertussis vaccine doesn't confer a lifetime of immunity, and the risk of meningitis also peaks at different ages.
"Meningitis is most likely in the elementary school years, in middle school, and the first couple of years in college," said Dr. Eugene Hershorin, professor of pediatrics at the University of Miami's Miller School of Medicine. He was not involved in the CDC study. "We want to protect them during those years."
Because of susceptibility after vaccines wear off and the potential dangers of spreading diseases like pertussis, Stokley and Hershorin are in favor of mandatory vaccination.
"Children are susceptible to acquiring infections," said Stokley. "These diseases are still out there. Pertussis is still circulating."
"Part of the theory behind immunization is 'herd immunity,'" Hershorin said. "If everyone in the world is protected except one person, that person can't get the disease because there's no one to give it to them. By immunizing the majority of kids in a confined environment like a middle school, they can be protected."
Adolescents get immunized far less frequently than infants and younger school children, despite the recommendations.
"One issue is that with the infant vaccine schedule, infants are routinely going in for checkups with their providers, and there are many more opportunities for shots," Stokley explained. "For adolescents, they're making few preventive visits, and they may not be coming in every year for a checkup. Parents may not be aware these vaccines are available."