Projected Annual Costs and Savings
Pertussis Booster Vaccine Requirement for School Entry in
Estimated Annual State Costs Estimated Annual Savings
(including additional ADA funds to schools for
improved pupil attendance)
$1.4 – 2M per year $12M per year
A. Estimated annual costs of requiring pertussis vaccination for school entry
Reimbursement for record checks by school staff1:
$<550,000 7th grade check (permanent)
$<440,000 optional 12th grade check (temporary catch-up provision for 5 years)
Vaccine cost for indigent children – federally purchased by Vaccines for Children
$ 0 (VFC) Program
Medi-Cal vaccine administration fees for children who would have only been
vaccinated because of school entry requirement2:
$<300,000 7th graders (permanent)
$<200,000 optional 12th grade check (temporary catch-up provision for 5 years)
B. Estimated annual benefits of requiring pertussis vaccination for school entry
$12,000,000 Direct and indirect cost savings3, which include
$400,000 Medi-Cal direct cost savings4
Additional avoided costs for schools and local health departments in not having
to respond to >3700 cases (mailings, phone calls, home visits) of pertussis in
grade 7-12 students in order to prevent transmission to peers and families
C. Estimated annual cost to State and benefit to schools from preventing absenteeism
$580,000 additional attendance funding (“ADA”) to schools for avoided absences from
pertussis in 7-12 grade students5
1) --The reimbursement to schools during the 2003-2004 school year for checking vaccination in 7th graders was
approximately $1.10 per dose (California State Controller’s Office,
--Only 1 dose of the pertussis booster vaccine would be needed for students from grades 7-12.
--There were ~500,000 students in Grade 7 in California in 2003-2004.
--There were ~400,000 students in Grade 12 in California in 2003-2004.
(California Department of Education, http://www.cde.ca.gov/ds/sd/cb/sums03.asp)
$1.10 x 1 x 500,000 = $550,000 per 7 grade class
$1.10 x 1 x 400,000 = $440,000 per 12 grade class
These estimates are elevated, as private schools are usually not reimbursed for checking vaccination for their
2) --At least half of Medi-Cal recipients would be estimated to receive the pertussis booster vaccination without a
school-entry requirement, while fewer than a half would be immunized because of it.
--The reimbursement of pertussis booster vaccine administration to Medi-Cal recipients in $9.00, half of which ($4.50)
is paid by State funds and half by Federal funds.
--There were ~500,000 students in Grade 7 in California in 2003-2004 (see note 1).
--27% of 12-year-olds in California were Medi-Cal eligible in 2003:
769,440 persons aged 10-14 years were Medi-Cal eligible in 2003
(Rand California, http://ca.rand.org/stats/health/medi-calzip.html).
2,821,729 persons aged 10-14 years resided in California in 2003
(California Department of Finance, Demographic Research Unit,
--There were ~400,000 students in Grade 12 in California in 2003-2004 (See note 1).
--23% of 17-year-olds in California were Medi-Cal eligible in 2003:
585,619 persons aged 15-19 years were Medi-Cal eligible in 2003 (Rand California, see above).
2,579,680 persons aged 15-19 years resided in California in 2003 (California DOF, see above).
0.5 x $4.50 x 500,000 x 0.27 = $300,000 or less per 7 grade class
0.5 x $4.50 x 400,000 x 0.23 = $200,000 or less per 12th grade class
3) --Universal adolescent booster immunization in the U.S. is estimated to save approximately $100 million annual
savings direct and indirect costs (Purdy et al., Clin Infect Dis. 2004;39:20-28).
--12% of the U.S. population resides California. (U.S. Census Bureau, 2005
$100 million x 0.12 = $12,000,000 annual savings in California
4) --$12 million annual estimated savings in California (see note 3).
--12% of estimated savings in adolescent pertussis vaccination attributable to direct medical costs (Purdy et al., Clin
Infect Dis. 2004;39:20-28).
--27% of 12-year-olds in California were Medi-Cal eligible in 2003 (see note 2).
$12,000,000 x 0.12 x 0.27 = $400,000 annual Medi-Cal savings
5) --The annual incidence of pertussis in persons aged 10-19 in recent years in the US has been 130 per 100,000 or
higher (CDC, http://www.bt.cdc.gov/coca/ppt/10).
--There were ~2,900,000 students in grades 7-12 in California in 2003-2004
(California Department of Education, http://www.cde.ca.gov/ds/sd/cb/sums03.asp).
--The mean days missed by adolescents due to pertussis in Massachusetts was 5.5 days
(Lee et al., Clin Infect Dis. 2004;39:1572-80).
130 x 29 x 5.5 = 20,735 days of school missed due to pertussis by 7-12 graders in California per
--ADA reimbursement reflects absences through April 15 of each school year, or about 140 days of 180 day school
year (School Fiscal Services Division, California Department of Education).
20,735 days x (140/180) = 16,130 days missed up to April 15
--Average ADA reimbursement per pupil-year = $~5,000 (School Fiscal Services Division, California Department of
Loss of annual ADA reimbursement from in 16,130 days from 2,900,000 7-12 graders =
[2,900,000 – ((2,900,000 x 140) – 16,130) /140)] x $5,000 = $580,000