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January 18, 2012

Mandatory HPV Vaccination

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Bureau of Immunization (Drs Berger and Blog), Office of Public Health (Dr Birkhead), New York State Department of Health, Albany (

JAMA. 2012;307(3):252-255. doi:10.1001/jama.2011.2019

To the Editor: Mr Gostin,1 in his Commentary, highlighted the unique issues and controversies surrounding the institution of a state vaccination law, or mandate, with regard to the HPV vaccine. The Commentary provided a much-needed focus on the undisputed safety and efficacy of the HPV vaccine in light of recent negative public attention.

We think, however, that it is important to clarify the author's statement that “research on the effectiveness of mandates is unavailable.”1 While specific evidence does not yet exist regarding the effectiveness of school mandates on HPV vaccination rates, it is clear that school mandates have uniformly increased state vaccination rates for other vaccines. In 1999, the Task Force on Community Preventive Services concluded, after a review of all available studies on the effectiveness of school-entry vaccination laws, that these laws are both effective at reducing disease rates and outbreaks as well as increasing overall vaccination coverage.2 An updated Task Force review in 2009 similarly demonstrated the effectiveness of vaccination mandates and, as a result, the Centers for Disease Control and Prevention currently lists school mandates among the recommended interventions to increase vaccination rates.2 States that currently have school mandates for adolescent hepatitis B vaccine have rates almost twice that of states without such mandates.3 Most recently, the 2007 school mandate at the middle school level in New York state for the combined tetanus, diphtheria and pertussis vaccine was found to be associated with a greater than 2-fold increase in tetanus, diphtheria and pertussis vaccination rates in 1 New York City cohort.4

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