Adding Vaccines to the Back-To-School List

Pencils? Check. Notebooks? Check. Backpack? Check. Vaccinations? Check!


August is a time when parents and students prepare to return to school from summer break. Adding routine vaccinations to that preparation can help protect individual patients, particularly middle schoolers, and their classmates from vaccine-preventable disease.

School Vaccination Requirements

Public schools require young students to receive a long list of vaccinations prior to entering the school system, as evidenced by data compiled by Most states and the District of Columbia mandate that children be immunized against diphtheria, tetanus and pertussis (DTaP); polio (PCV); hepatitis B (Hep B); measles, mumps and rubella (MMR); and varicella (chickenpox) before joining a classroom.

Yet around the age of 11 or 12 years – the start of middle school years – the CDC recommends another set of immunizations: the Tdap (Tetanus, diphtheria and acellular pertussis) booster, the human papillomavirus (HPV) vaccination and the meningococcal vaccination, with varying state mandates.

The Safeguard Booster

Around the age of five or six, according to the CDC-recommended schedule, children should be finishing up their final dose of many immunization series required for admittance into public kindergarten across the U.S., including the DTaP vaccination series. But between the ages of 11 and 12, Tdap, DTaP’s related booster, is recommended to strengthen immune response to the covered diseases.

Tdap is required by 49 states and the District of Columbia, according to Given that Tdap is a generally-accepted immunization with 88% percent uptake (2016 CDC report), providers can use a Tdap appointment as an opportunity to introduce other vaccinations recommended in the same age window.

The Newcomer

Though meningitis contraction is not common in the U.S., the CDC warns that teens are at increased risk of the disease, particularly as it spreads in communal spaces like schools. Yet recent statistics from the National Meningitis Association reveal that still about 20% of U.S. teens are not protected against meningococcal disease.

The CDC recommends the first dose of the meningococcal vaccination be given between 11 and 12 years of age, with a booster at 16. These recommendations are relatively new compared with other vaccinations among school-mandated lists, according to an timeline, but as of the 2017-18 school year, 36 states and the District of Columbia required meningococcal vaccination. The relative newness of implementation of this vaccine and its protection against disease creates an opportunity for clinicians to help parents understand that this immunization is as important as other recommended inoculations, and thereby continue to help increase uptake.

The Cancer Shield

As we have discussed in a previous blog, inoculation rates for HPV have come along slower than the CDC desired after it first recommended a vaccine in 2006. The HPV immunization series is currently recommended to begin at 11 years of age. Yet research has shown that some parents believe it is not relevant to their young children because the virus is sexually transmitted.

Successful strategies providers have implemented to increase uptake have including reframing the discussion to focus on cancer prevention rather than sexual transmission. And while reports that only two states and D.C. require HPV immunization for secondary schooling, providers can encourage parents to be overachievers – to go above and beyond school requirements.

Although vaccination mandates vary greatly for secondary education, following the CDC-recommended schedule can help keep children and their classmates healthy this school year. Providers seeing patients this summer can continue to educate parents about the benefits of staying on track with immunizations before they send their kids back to school in the fall.