Thad R. Wilson

This research was designed to evaluate the impact on health departments of the implementation of a 1999 policy requiring hepatitis B (HBV) vaccination for seventh grade school entry in the state of Missouri. The authors employed a retrospective descriptive design using data from the Missouri Health Strategic Architectures and Information Cooperative (MOHSAIC) system. They based their assessment of the impact of the new policy on six outcome variables: total immunizations administered, HBV immunizations administered, HBV immunizations given to children ages 10 to 14, percentage of total immunizations that were HBV, percentage of total HBV immunizations that were given to children ages 10 to 14, and percentage of total immunizations that were HBV given to children ages 10 to 14. Outcome variables from the months of July through September 1998 were compared to similar data from the same period in 1999. Statewide, there was a significant increase in all outcome variables. Health departments in non-rural settings, however, did not have a significant increase in total immunizations (t = -1.49, p = 0.158). The number of HBV immunizations did increase at health departments where alternative strategies (e.g., school-based programs) were used, but the increase was not as dramatic as for sites where no such strategies were employed. Implementation of a state policy requiring additional immunizations can be expected to have a significant impact on the resources of health departments statewide. The use of alternative strategies for managing immunizations outside the traditional health department setting can limit that impact.

A descriptive correlational research design assessed factors influencing participation and completion rates, and to determine vaccine administration costs, in a school‐based Hepatitis B vaccination program. Of 18,046 students in public and private schools in the metropolitan Kansas City, Mo., area, 12,986 (73.4%) participated with approximately 75% of these students completing the vaccine series. Larger schools reported decreased participation and completion rates. Both rates were highest in schools providing educational interventions. Schools with a large population of commercially insured students reported low participation rates (65%), but high completion rates (85%). Schools with a high number of Medicaid‐eligible students had high participation rates (97%), but low completion rates (67%). The vaccine cost $5.06 per dose to administer.

The results of an evaluation of a large metropolitan‐wide, school‐based hepatitis B vaccination program provide further evidence that such programs are effective and cost‐beneficial. The percentage of 6th grade students fully immunized against hepatitis B rose from approximately 8% to 82% in the program. Administering the vaccine at school was $1.46 per dose less than traditional methods. Over $24 million of potential health care costs have been avoided through the program.