States where vaccines are required for students to attend middle school have significantly higher rates of teens who are up-to-date with their vaccinations, a new report says.

The findings show that in the states where middle schools required tetanus and diphtheria vaccinations, 80 percent of teens ages 13 to 17 were up-to-date with these vaccines, where as in states where middle schools did not require these vaccines, 70 percent of teens were up-to-date.

"Adolescent vaccination coverage levels are increasing but remain low," the researchers wrote in their article, published May 7 in the journal Pediatrics.

Most school vaccination requirements are aimed at children entering kindergarten, but many states have also implemented requirements targeting children entering middle school, the report said.

In the study, researchers at the Centers for Disease Control and Prevention analyzed school entry requirements for the 2008-2009 school year, and compared them with teen vaccination rates for three vaccines: tetanus/diphtheria-containing (Td) or tetanus/diphtheria/acelullar pertussis (TdaP), meningococcal conjugate (which protects against some types of bacterial meningitis), and human papillomavirus (HPV).

They found that 32 states required either Td or TdaP for middle schoolers, three states required the meningitis vaccine and 10 required that information about the disease and vaccine be disseminated to parents. Additionally, one state required the HPV vaccine for teen girls, and five required education of parents about HPV.

Vaccination requirements were also linked with significantly higher coverage for meningitis vaccine — 71 percent of teens were vaccinated in states where middle schools required the vaccine, compared with 53 percent vaccinated in states where middle schools didn't require the vaccine.

The researchers found that states requiring education about vaccines did not have vaccination rates than states without such requirements.

"Education-only requirements appear not to have an impact at this time," the researchers said.

Since the 2008–2009 school year, 21 states have enacted new or updated vaccination requirements for TdaP vaccines, six have issued new requirements for meningitis vaccine and one enacted a requirement for the HPV vaccine.

Vaccination requirements may not be feasible for every vaccine, or in every location, the researchers said. Factors that should be considered include whether states have infrastructure for buying and storing vaccines, consistency with existing school entry requirements, and adequate political and public support.

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