State Vaccination Requirements for HPV and Other Vaccines for Adolescents, 1990-2015

State Vaccination Requirements for HPV and Other Vaccines for Adolescents, 1990-2015 Eight years after human papillomavirus (HPV) vaccines were first recommended in the United States, vaccination coverage is substantially below the Healthy People 2020 target of 80%.1 Data from the US Centers for Disease Control and Prevention (CDC) show that 37.6% of adolescent girls and 13.9% of adolescent boys had completed the 3-dose series in 2013.2 Recent efforts to address these deficits emphasize that HPV vaccines should not be viewed or treated differently than other routinely recommended vaccines.1,2 School requirements are a mainstay of US vaccination policy, widely used by states to promote high vaccination rates. Depending on the vaccine, requirements may exist for attendance at day care, preschool, kindergarten, or higher grade levels.3 Attention to their potential value has been largely absent from recent discussions of strategies to improve HPV vaccination rates. However, requirements were extensively discussed following the approval of the first HPV vaccine in 2006.4 Proponents of vaccination argued at that time that requirements would be premature, explaining that a multi-year implementation period focused on supply, safety, financing, and education is warranted before requiring any new vaccine.5,6 We sought to examine the presence and timing of state requirements for vaccines with particular relevance to adolescent health and to compare those findings to the implementation of HPV vaccines. Methods | Vaccines studied were those used by the CDC to evaluate adolescent vaccination (ie, included in the National Immunization Survey—Teen) that were added to the recommended schedule since 1990 and protected against new disease targets: hepatitis B, varicella, meningococcal conjugate, and HPV. Using legal databases, CDC and other publications, and information from health departments, we identified the earliest date that a requirement, if applicable, took effect for each vaccine in every state and the District of Columbia (DC) for any childhood, adolescent, or college-aged population. Requirements approved through March 2015 were identified, including those with later effective dates. We calculated the time that elapsed between the publication of the corresponding recommendation of the CDC Advisory Committee on Immunization Practices (ACIP) in the Morbidity and Mortality Weekly Report, formalizing a change to the recommended vaccination schedule, and the effective date of each requirement.