ATLANTA - Studies conducted by the Centers for Disease Control and Prevention (CDC) indicate that 99% of Florida's students have had their full quota of required vaccinations by the time they are ready to enter high school.
The CDC and the Florida Department of Health analyzed data on state vaccination coverage. At the beginning of the 1997-1998 school year, approximately 194,074 students entered the seventh grade in 1,286 public and private schools in Florida. By November 1997, it was estimated that 121,219 of those students were fully vaccinated with three doses of hepatitis B vaccine, a second dose of measles-mumps-rubella (MMR) and a tetanus-diphtheria toxoid (Td). An additional 72,275 students were found to be lacking one or more of the required vaccinations but were on schedule and compliant with those vaccines required by law. However, 763 students were exempted for either medical or religious reasons.
The percentage of seventh grade students fully vaccinated varied by county. Coverage varied in six counties with more than 10,000 seventh graders. Three of the six who had the highest percentages were Palm Beach County (77.9%), Dade County (43.8%) and Orange County (55.1%). Statewide, coverage among the 177,903 seventh graders enrolled in the state's 617 public schools was lower (59.6%) than that among the 18,171 enrolled in the 669 private schools (83.8%).
From 1995 to 1997, the number of vaccinations given to children 10-14 years of age by Florida public health facilities (school-based, county or city clinics) increased substantially. Vaccines in Florida are mandated by law and must be made available to children free by the state department of health, regardless of the child's insurance status, said Kieran Fogarty, PhD, clinical investigator for the CDC's National Immunization Program and the study's lead investigator.
"The large numbers of vaccinated kids really surprised us; it was amazing," he said. "Florida just did it right."
In 1989-91, the Advisory Committee on Immunization Practices (ACIP) recommended that hepatitis B vaccination (hepB) should be required for school entry. Studies indicated that whole sections of children were not getting their shots. The ACIP stressed that it is particularly important for teens to get their hepB shots because they are at a high-risk point in their lives.
Four statesColorado, Florida, Oklahoma and Wisconsinhave implemented middle school hepB entry requirements. Fourteen states will have similar entry requirements as Florida by 2006, when an estimated 75% of adolescents 11-12 years of age will be subject to hepB vaccine through elementary and middle school requirements.
To ensure vaccination of their seventh graders, officials at the Orange County Department of Health (OCHD) teamed with a community coalition consisting of private and public health care providers, local businesses, nongovernment organizations and local colleges. The Orange County strategy included the vaccination of adolescents by private providers, public health department clinics and school-based vaccination programs.
At the start of the 1997-98 school year, 11,122 students entered seventh grade in Orange County. Of these students, 10,166 (91.4%) were enrolled in 33 public schools and 956 (8.6%) were enrolled in 24 private schools. In anticipation of the law, during the 1996-97 school year, OCHD sent pamphlets home with all sixth graders explaining the new requirement. In January 1997, the "Cool School Shots Campaign" was initiated, including local media announcements and a public school-based vaccination program targeting sixth graders.
Three sessions were scheduled at schools to allow students to receive all their required vaccines, including the three doses of hepB. Overall, 3,739 (34%) students received at least one vaccination during the first of three school-based events conducted during January 1997. HepB accounted for 35.7% of the vaccine doses administered during the first session, 92.7% during the second and 100% during the third. However, 44% fewer third doses of hepB (1,886) than first doses (3,329) were administered. Based on anecdotal information from OCHD staff, lack of parental knowledge regarding school entry vaccination requirements was a key barrier to achieving higher participation and completion by students in the program.
During July-September 1997, immediately before implementation of the seventh grade entry requirement and after the school-based vaccination campaign, the OCHD administered 9,087 total vaccine doses, including 5,015 doses of hepB, 1,700 doses of MMR and 2,372 doses of Td booster to children aged 10-14 years of age, representing a 381% increase from 2,372 total doses administered during the same period in 1996. By November 1997, 6,123 (55.1%) of Orange County seventh graders entering school were fully vaccinated. A total of 4,988 (44.9%) students lacked one or more required vaccinations, but were considered in compliance with the requirement; eight were exempted for either medical or religious reasons and three lacked documentation. Seventh graders enrolled in private schools were more likely to be fully vaccinated than seventh graders enrolled in public schools (86.4% vs. 52.1%). The reasons behind this were not entirely known, but Fogarty said it could be due to socioeconomic factors or more parental intervention on the part of private school students.
"The key thing with Florida was that [the vaccine program] was well-planned," Fogarty said. "Other states have these laws but they are not mandatory, and if they are they don't seem to really check up on it. Florida was the first state who really insisted that the kids have their vaccination cards and their immunizations completed."
For your information:
- Report: Effectiveness of a seventh grade school entry vaccination requirement - statewide and Orange County, Florida, 1997-98. MMWR 47;34:711-15.
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