Table 1:

Methods and findings of included studies

Investigator/year	Setting	Method	Data source (population)	Mandate change studied (year)	Outcome of interest	Main findings
Averhoff et al., (23) 2004	San Diego, Calif., US	Uncontrolled before–after study using survey data	Random-digit-dial telephone survey in 1998 (n = 205) and 1999 (n = 378)	7th grade hepatitis B and MMR mandate (1999)	3-dose hepatitis B and 2-dose MMR	In year mandate took effect, 7th grade students more likely to be vaccinated than other cohorts not subject to mandate Effect was larger for hepatitis B, which had lower uptake before mandate No other factors found to be significantly associated with being vaccinated
Bugenske et al., (24) 2012	US	Retrospective analysis of data from cross-sectional vaccination coverage survey	NIS-Teen 2008–2009 (landline only, provider-verified records only) (2008 n = 17 835; 2009 n = 20 066)	Middle school vaccination mandate (2008–2009)	Increase in coverage of Tdap, HPV and MCV vaccines, and increase of all recommended vaccines in adolescents 13–17 yr of age	Tdap and MCV coverage increased from 2008 to 2009 in all states States with existing or new mandates had higher coverage of Tdap and MCV than states without mandate; however, coverage did not differ among states with new and old mandates HPV and MenACWY coverage did not differ in states with educational requirements compared to states without educational requirements (no states had educational requirements for Tdap) Presence of vaccine mandates was not associated with increase in up-to-date status for all vaccines
Carpenter et al., (25) 2019	US	Difference-in-differences analysis based on retrospective analysis of data from cross-sectional vaccination coverage survey	NIS-Teen 2008–2013 (including cellphone from 2011 onward) (n = 116 403)	Middle school Tdap vaccination mandate (2005–2015)	Increase in Tdap coverage at age 10–13 yr in states with Tdap mandates	Tdap uptake about 13% higher in states with mandates, with spillover effects to other vaccines (HPV and MCV)
Cuff et al., (26) 2016	Virginia, US	Prospective cohort study using administrative data and telephone survey	University of Virginia Clinical Data Repository 2014 (n = 908 girls)	6th grade HPV mandate for girls (2009)	HPV vaccine initiation (≥ 1 dose) in girls 11–12 yr of age and proportion vaccinated in 2009 and 2014 cohorts	Mandate had no effect on HPV coverage 5 yr after mandate implementation
D’Ancona et al., (20) 2018	Italy	Uncontrolled before–after study of administrative data	Administrative information database collected by local health units for the Ministry of Health 2013–2017 (entire population; n unspecified)	Increase from 4 to 10 required vaccines; imposition of fines up to age 16 yr and exclusion up to age 6 yr for noncompliance (2017)	Polio and measles vaccine by age 7 yr	Early results indicated slight increase in 2017; statistical significance of change and trends not tested Increases in uptake of some vaccines among younger children as well
Jackson et al., (39) 1972	Oklahoma, US	Uncontrolled before–after study of administrative data	1st grade students in 33 randomly selected counties (n = 8762)	School entry mandate for diphtheria, tetanus, pertussis, measles and rubella (1970)	3 doses DTP and orally administered polio, 1 dose rubella and measles or record of disease, smallpox vaccine	Increase in vaccination completion in first year of mandate, including for nonmandated smallpox; statistical significance of change not tested
Jacobs et al., (27) 2004	US	Cohort study using clinical data sample	Practices (n = 53) recruited through mailing to doctors in AMA master file and enrolling first practices to respond; 20 adolescent patients (11–15 yr) per pediatric or general practice (n = 982 patients)	Middle school entry hepatitis B mandates (pre-2000)	Completion of 2- or 3-dose hepatitis B series	Presence of mandate was strongest predictor of completion of hepatitis B series
Karikari et al., (28) 2017	Illinois, US	Uncontrolled before–after study of administrative data	Illinois State Board of Education database 2012–2013 and 2014–2015 (n = 1 151 993) and CDC survey data from 2012–2014 (n not unspecified; data source unclear)	Tdap mandate for 6th–12th grade (2013)	Adolescent Tdap vaccination	Both data sources showed higher Tdap coverage after the mandate, although numbers varied greatly between the 2 data sources
Kharbanda et al., (32) 2010	New York, NY, US	Uncontrolled before–after study using administrative data from a clinical network	EzVAC, a hospital- and clinic-based vaccination registry, 2006–2008 (n = 2577)	6th grade entry Tdap mandate (2007)	Tdap and MCV4 coverage in 11- to 14-year-olds enrolled in EzVAC network	Tdap coverage increased in both years after mandate, including some shift from Td to Tdap MCV4 coverage (nonmandated) also increased
Morita et al., (29) 2008	Chicago, Ill., US	Uncontrolled before–after study of administrative data	Chicago public schools’ vaccination database 2000–2005 (n = 106 541)	5th grade hepatitis B mandate (1997)	Hepatitis B coverage by grade 12 (overall, and racial/ethnic disparities in coverage)	Postmandate cohorts had higher hepatitis B coverage rates than premandate cohorts Disparities in coverage rate by race and ethnicity also decreased after mandate
Moss et al., (30) 2016	US	Retrospective analysis of data from cross-sectional vaccination coverage survey	NIS-Teen 2009–2012 (unspecified whether provider-verified or all, or whether cellphone included from 2011 on) (n = 99 921)	Middle school Tdap, MCV and HPV mandates (various)	Adolescent (13–17 yr) coverage of Tdap booster and MCV, and HPV among girls (1-dose series)	Tdap and MCV mandates were associated with higher coverage of those vaccines and also of HPV for girls HPV mandates had no effect
Olshen et al., (31) 2007	27 US states + DC	Cross-sectional study	Health Plan Employer Data and Information Set 2003 (n = 100 000)	Mandates for hepatitis B and varicella before 2003 (various)	Policy attribute that is associated with higher mean coverage	Mandate policy at middle school level was associated with higher mean hepatitis B and varicella coverage Other policy attributes (e.g., exemptions, payment and deductibles, universal purchasing) not associated
Omer et al., (22) 2018	Washington State, US	Uncontrolled before–after study using administrative data	Washington State Department of Health 1997–1998 to 2013–2014 (n not reported)	New procedures requiring certificate signed by health care provider for medical exemptions (2011)	Kindergarten vaccination rates	Vaccination rates for each vaccine stayed the same or increased slightly after the policy Proportion of students up to date for all vaccines increased
Perkins et al., (33) 2016	US	Retrospective analysis of data from cross-sectional vaccination coverage survey	NIS-Teen 2009–2013 (provider-verified responses only; unspecified whether cellphone included from 2011 on) (n = 47 845 parents of girls)	Middle school HPV mandate for girls (DC, Virginia) and HPV education mandate (Louisiana, Michigan, Colorado, Indiana, Iowa, Illinois, New Jersey, North Carolina, Texas, Washington) (various)	HPV vaccine coverage (series initiation, completion) in girls	No difference in HPV coverage between girls in states with school entry vaccine mandates or education mandates compared to no mandates
Pierre-Victor et al., (34) 2017	Virginia, Tennessee, and South Carolina, US	Retrospective analysis of data from cross-sectional vaccination coverage survey	NIS-Teen 2008–2012 (landline only; excluding those who did not respond about HPV) (n = 3203 parents of girls)	Middle school HPV mandate for girls (Virginia) (2009)	HPV vaccine initiation	Trends were not different in Virginia with mandate compared to Tennessee and South Carolina without mandate
Potter et al., (35) 2014	Michigan, US	Uncontrolled before–after study using administrative data	Michigan Care Improvement Registry (statewide vaccination registry) 2009 and 2010 (2009 n = 133 738; 2010 n = 131 051)	New mandate at 6th grade entry for Tdap, MCV4, varicella (2010)	Completion of all required vaccines (as a single variable); time to completion (up-to-date status) of all required vaccines; initiation of HPV vaccine (girls only)	Vaccine completion (up to date for all) was higher in year after mandate, and time to completion was shorter
Simpson et al., (36) 2013	Arizona, US	Uncontrolled before–after study using administrative data	Arizona State Immunization Information System 2006–2011 (n = 954 953 records)	New mandate for MCV4 for 6th grade entry if aged ≥ 11 yr (2008)	MCV4 coverage	Vaccine coverage for 12-year-olds was higher after mandate than before mandate
Thompson et al., (21) 1994	Victoria, Australia	Uncontrolled before–after study using administrative data	Victoria Directorate of School Education mid-year census 1991 and 1992 (1576 schools included; 1992 n = 45 049 students)	Documentation mandate for school entry (1992)	Submitted documentation of immunization status; documentation of complete (up-to-date) vaccination for age	Small increase in submitted documentation after policy mandate, including small increase in documentation of fully vaccinated students and larger increase in documentation of incompletely vaccinated students
Thompson et al., (37) 2018	Rhode Island, US	Retrospective analysis of data from cross-sectional vaccination coverage survey	NIS-Teen 2010–2016 (unspecified whether cellphone included from 2011 on; parent report only) (n unspecified)	HPV mandate for initiation by 7th grade and completion by 9th grade (2015)	Initiation of HPV series	Only initiation in boys showed small increase after mandate; no change among girls No increase among boys in other states
Wilson et al., (38) 2005	Kansas City, Mo., and Kansas City, Kan., US	Retrospective cohort study of school samples	Random sample of vaccine records from purposive sample of 11 high schools in 2003 (n = 2230)	Hepatitis B mandate for elementary school (1997) and middle school (1999) (Missouri)	3 hepatitis B vaccine doses at 9th grade	Students affected by middle school hepatitis B mandate were more likely to have been vaccinated than earlier cohort in same area or contemporaries in comparison area without mandate No spillover differences observed for MMR or Td vaccines

Note: AMA = American Medical Association, CDC = Centers for Disease Control and Prevention, MCV = meningococcal vaccines, MenACWY = meningococcal conjugate vaccine for protection against serogroups A, C, W and Y, MMR = measles/mumps/rubella, NIS-Teen = National Immunization Survey-Teen, (40) Td = tetanus/diphtheria, Tdap = tetanus/diphtheria/acellular pertussis.