Publication Date: 
Sunday, July 12, 2009

The Problem: Vaccine coverage for preventable disease is an essential public health goal. Low vaccine coverage rates enable otherwise avoidable outbreaks of harmful diseases.  CDC: Vaccines and Immunizations.

The Law: State vaccination laws require children to be immunized prior to entering school.  National Vaccine Program Office: Immunization Laws. Subject to instances where exemptions apply, these laws require written proof of a child’s immunization status provided from a health provider. For examples of state vaccination laws, see Colorado (6 CCR 1009-2), Iowa (Iowa Administrative Code), Nebraska (173 NAC 3) and Massachusetts (105 CMR 220.000).

The Evidence: In a systematic review, a Community Guide expert panel reviewed the evidence concerning the effectiveness of requiring vaccinations as a condition of matriculation into child care, secondary school or college.  Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(1S):97-140. The review identified nine studies in the U.S. and Canada that measure the impact of these requirements. Of the nine studies, seven examined the impact of school laws; one examined vaccination mandates for child care, and one looked at requirements for college attendance. Six studies measuring the effect of vaccination requirements on the incidence of specific diseases (e.g., measles) found an inverse relationship suggesting that laws reduce rates of the targeted diseases. Three studies also observed a positive relationship between mandated immunization programs and rates of vaccination among the target populations. On the basis of this evidence, the reviewers concluded that there is sufficient evidence that school vaccination requirements are an effective public health intervention aimed at increasing vaccination coverage and decreasing the incidence of certain diseases.

The Bottom Line: In the judgment of a Community Guide expert panel, there is sufficient evidence supporting the effectiveness of requiring vaccinations as a condition for attending child care facilities and schools.

Additional Information: The Centers for Disease Control and Prevention has compiled and provided online access to all state vaccination laws.

The Immunization Action Coalition also has online maps showing specific legal requirements for the fifty states.