• Nicole L Hair, Anja Gruber, and Carly J Urban.
• Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina. Electronic address: hairnl@mailbox.sc.edu.
• Am J Prev Med. 2021 Jun 1; 60 (6): e269-e276.

IntroductionVaccination mandates for elementary and middle school attendance have been shown to increase vaccination rates and decrease the burden of vaccine-preventable diseases. Fewer studies have evaluated similar requirements for child care attendance. This study provides robust, quasi-experimental estimates of the effect of state laws mandating the pneumococcal conjugate vaccine for child care attendance on vaccination coverage among children aged 19-35 months.MethodsUsing provider-verified immunization histories from the 2001-2018 waves of the National Immunization Survey-Child and leveraging the staggered implementation of vaccination requirements across states, a generalized difference-in-differences approach was implemented to compare regression-adjusted changes in vaccination coverage among children in states with and without a child care mandate for the pneumococcal conjugate vaccine. The dynamics of estimated treatment effects were analyzed using an event study analysis. All data analyses were conducted in 2019‒2020.ResultsState adoption of a child care mandate for the pneumococcal conjugate vaccine increased the likelihood that resident children aged 19-35 months completed the 4-dose pneumococcal conjugate vaccine series by 3.12 percentage points (p<0.01). Statistically significant gains in pneumococcal conjugate vaccine coverage were identified in the first year following policy implementation and were found to persist over a period of ≥7 years.ConclusionsResults indicate that state adoption of a child care mandate for the pneumococcal conjugate vaccine leads to an increase in the proportion of resident children aged 19-35 months who are up to date with pneumococcal conjugate vaccine.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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