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BACKGROUND: Assessment of vaccination coverage in schools is a key component to minimizing the risk of vaccine preventable disease in children. In Texas, two doses of measles, mumps and rubella (MMR) vaccine are required for kindergarten entry. School districts are required to annually report vaccination coverage levels for school-required vaccines. Recent outbreaks of measles in Texas highlight the importance of maintaining high MMR vaccination coverage among children and the community. The goal of this study is to identify factors associated with low MMR vaccination coverage in Texas public school districts.
METHODS: School district demographic and funding data were obtained from the Texas Education Agency (TEA) annual report. School district characteristics were examined for impact on MMR vaccination coverage levels reported through the Texas Department of State Health Services Annual Report of Immunization Status. Univariate statistical analyses were conducted to assess the association of individual characteristics with MMR vaccination coverage. Low MMR vaccination coverage was defined as below 95%. Variables not significantly associated with MMR vaccination coverage were removed from further data analysis. The remaining variables were tested for collinearity, resulting in further reductions. Logistic regression was conducted to ascertain which variables gave rise to a model predictive of high or low MMR vaccination coverage levels and to determine the variables’ respective odds ratios. All statistical analyses were conducted using SAS 9.3.
RESULTS: Out of 17 school district characteristic variables examined, the following four variables were found to be significant: percent of students with a conscientious exemption on file (OR= 1.777, CI: 1.483-2.131), school district type (charter vs. public) (OR= 2.913, CI: 1.559-5.440), percent of general funds spent on health services (OR= 0.446, CI: 0.308- 0.647), and whether the percentage of white students was above 50 (OR= 1.978, CI: 1.281-3.054).
CONCLUSIONS: This study replicated results seen in previous studies showing white race/ethnicity as a predictor of low vaccination coverage. School districts composed of 50% or more white students were more likely to have low MMR vaccination coverage. We also found percent of students with a conscientious exemption to be a significant predictor of low coverage, along with designation as a charter school. School districts that spent a higher percentage of their general funds on health services had higher MMR vaccination coverage. The school district characteristics that were identified to predict low MMR vaccination coverage will be used to target interventions and education.