Assessing HPV mandates through a public health law lens, this study of the District of Columbia's HPV Mandate responds to the Public Health Law Research question regarding analysis of the impact of laws using a time series design and one or more health outcome datasets to assess the effect of the laws on relevant health outcomes. It will employ both systematic review and secondary data analysis to examine HPV vaccination policy in Washington D.C. The intention is to identify the successes and challenges of the HPV mandate across D.C. communities and the mandate’s impact on parental acceptability and vaccination rates, particularly among minorities and under-served populations.
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Funding Date: Mon, 11/15/2010
Researching Institution: Georgetown-Lombardi Comprehensive Cancer Center
Researcher: Sherrie Flynt Wallington, Ph.D.
In the United States, vaccinations against certain diseases are accepted as an important step in leading a healthy life and helping to keep other people from getting sick. It is not unusual to be required to show proof that you have had certain vaccinations before you are allowed to register for school or college, for example. But these common requirements for vaccination do not always extend to influenza—commonly known as flu—even for hospital workers who are at the most risk of exposure to the flu virus and who are likely to come into contact with people who are at a high risk of serious health complications if they were to become infected with the flu virus. This study will take a state-by-state inventory of laws that regulate influenza immunization among people who work in hospitals. Investigators will also review policies that individual hospitals and health systems might have to require their employees to receive a flu vaccination. The study will then match these findings with data on rates of vaccination among hospital workers to determine what, if any, effect such laws and policies have on vaccination rates.
Grant Number: 68394
Funding Date: Mon, 11/15/2010
Researching Institution: University of Pittsburgh Graduate School of Public Health, Center for Public Health Practice
Researcher: Patricia Sweeney, J.D., M.P.H., R.N.; Richard Zimmerman, M.D., M.P.H., M.A.
Publication Date: 12/07/2009
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.
Additional Resources: Centers for Disease Control and Prevention, Immunization Action Coalition
This project will explore how individuals make decisions about: 1) vaccinations, 2) sexual behavior, 3) preventative medication and health habits, 4) medical procedures and treatment, and 5) health insurance coverage. The study will map existing case law and regulations on the presentation of risk-related information, such as the validity and interpretation of waivers and disclaimers and will uncover patterns in choices and preferences building on behavioral insights. Deliverables for this project include journal articles, law briefs, conference presentations, policy briefs and a broader audience book, tentatively titled Healthy Choices: How We Decide About Our Health and Well Being.
Grant Number: 67148
Funding Date: Tue, 12/01/2009
Researching Institution: University of San Diego School of Law
Researcher: Orly Lobel,LL.B., LL.M., S.J.D., On Amir, Ph.D.
This project will explore the relationship between non-medical exemption laws and variability in those state laws and disease rates. The project will employ mixed-effects hierarchical models at 3 levels (year, state, and region) of analysis for 5 vaccine-targeted diseases (measles, mumps, pertussis, varicella, andhepatitis B). We will use a longitudinal research design to examine state-level data from 51 jurisdictions over 8 years (2001-2008). Deliverables for this project include at least two publications for highly visible law and health journals, an Issue Brief to be distributed in the NCLS newsletter, the Forum for State Health Policy and to State Health Commissioners. The project staff also aims to present findings to the Institute for Medicine and in other legislative venues.
Grant Number: 67143
Funding Date: Tue, 12/01/2009
Researching Institution: George Mason University
Researcher: Y. Tony Yang, Sc.D., M.P.H., Vicky Debold, Ph.D. R.N.
Origin: New England Journal of Medicine, May 27, 2010
Additional URL(s):
New England Journal of Medicine
Publication Date: 12/07/2009
The Problem:
Vaccine coverage for vaccine preventable disease is an essential public health goal. Vaccination against specific diseases is particularly important for high risk populations, which may include individuals of a certain age (e.g., greater than 68 years for Pneumococcal Polysaccharide) or with specified medical conditions (e.g., HIV/AIDS for influenza). CDC: General Recommendations on Immunization.
The Law:
Laws and policies require vaccination (subject to enumerated exceptions) as a condition of certain jobs. In some states, state law or hospital policies require hospital staff to be vaccinated against influenza. In Rhode Island, for example, health care workers with direct patient contact must be vaccinated for measles, mumps, and rubella. RI Code R. 14-090-007. Illinois requires rubella vaccinations for nursery workers. Ill. Admin. Code tit. 77, § 250.1820.
The Evidence:
In a systematic review, a Community Guide expert panel attempted to systematically review the evidence concerning the impact of requiring vaccinations outright or as a condition of specified activities such as employment as a healthcare worker. Ndaiye SM, Hopkins DP, Shefer AM, et al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. Am J Prev Med 2005;28(5S):248-79. The reviewers were unable to locate any studies that measured the impact of these laws in the U.S. As a result, the reviewers concluded there is insufficient evidence to currently evaluate the effectiveness of these laws and policies as public health measures aimed at protecting vulnerable populations against specific diseases.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is insufficient evidence to assess the effectiveness of requiring vaccinations as a condition for specified jobs as a means of reducing incidence of specific diseases among particularly vulnerable populations.
Additional Information:
The Centers for Disease Control and Prevention has compiled and provided online access to state laws requiring or encouraging vaccination of health care workers.
Additional Resources: Centers for Disease Control and Prevention
Publication Date: 12/07/2009
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:
To increase vaccination rates among specified adult populations, states authorize or require hospitals to create standing orders. Standing orders allow healthcare workers without prescription authority to prescribe and or administer vaccines under defined circumstances. Without standing orders, such vaccinations would be barred by laws regulating medical practice and the scope of patient-doctor relationships. Laws that provide standing order authority to non-physicians apply to registered nurses (Rev. Code Wash. § 18.79.260, Washington), pharmacists (N.D. Admin. Code 61-04-08-03, North Dakota) and physician assistants (ORS § 677.515, Oregon)
The Evidence:
In a systematic review, a Community Guide expert panel reviewed 11 studies assessing the use of standing orders to deliver vaccines to specified adult populations. 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. Of the 11 studies, six measured the impact of standing orders as an isolated intervention and five measured the effectiveness of standing orders in conjunction with other interventions. The reviewers identified a median 28 percent increase in vaccination among targeted populations following the adoption of standing order policies. The panel viewed all the results as strong evidence that standing orders improve vaccination coverage in adults as standalone intervention or as part of broader multifaceted interventions.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is strong evidence supporting the effectiveness of standing orders as a public health intervention aimed at increasing vaccination rates.
Additional Information:
The Centers for Disease Control and Prevention has compiled and provides online access to all state vaccination laws.
The Immunization Action Coalition also provides online access to maps showing specific legal requirements for the fifty states.
Additional Resources: Centers for Disease Control and Prevention, Immunization Action Coalition