Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2019-20 School Year

Abstract

State and local school vaccination requirements serve to protect students against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage among children in kindergarten (kindergartners) in 48 states, exemptions for kindergartners in 49 states, and provisional enrollment and grace period status for kindergartners in 28 states for the 2019-20 school year, which was more than halfway completed when most schools moved to virtual learning in the spring because of the coronavirus 2019 (COVID-19) pandemic. Nationally, vaccination coverage^† was 94.9% for the state-required number of doses of diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP); 95.2% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 94.8% for the state-required number of varicella vaccine doses. Although 2.5% of kindergartners had an exemption from at least one vaccine,^§ another 2.3% were not up to date for MMR and did not have a vaccine exemption. Schools and immunization programs can work together to ensure that undervaccinated students are caught up on vaccinations in preparation for returning to in-person learning. This follow-up is especially important in the current school year, in which undervaccination is likely higher because of disruptions in vaccination during the ongoing COVID-19 pandemic (2-4).

FIGURE 1

Potentially achievable coverage*^,†,§ with measles, mumps, and rubella vaccine (MMR) among kindergartners, by state — 48 states, 2019–20 school year * States are ranked from lowest to highest potentially achievable coverage. Potentially achievable coverage is estimated as the sum of the percentage of students with up-to-date MMR and the percentage of students without up-to-date MMR and without a documented vaccine exemption. ^† The exemptions used to calculate the potential increase in MMR coverage for Arizona, Arkansas, Colorado, Idaho, Illinois, Maine, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, Texas, Utah, Vermont, Wisconsin, and Wyoming are the number of children with exemptions specifically for MMR vaccine. For all other states, numbers are based on an exemption to any vaccine. ^§ Alaska, Delaware, and the District of Columbia did not report kindergarten vaccination coverage for the 2019–20 school year and are excluded from this analysis.

FIGURE 2

Change in percentage of kindergartners who are fully vaccinated with measles, mumps, and rubella vaccine (MMR) and in the percentage who are undervaccinated and nonexempt,*^,†,§ by state — 48 states, 2018–19 to 2019–20 school years * States are ranked from greatest decrease to highest increase in the percentage of kindergartners who are undervaccinated and nonexempt. The exemptions used to calculate the MMR not up to date and no documented vaccine exemptions for Arizona, Arkansas, Colorado, Idaho, Illinois, Maine, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, Texas, Utah, Vermont, Wisconsin, and Wyoming are the number of children with exemptions specifically for MMR vaccine. For all other states, numbers are based on an exemption to any vaccine. ^† Alaska, Delaware, and the District of Columbia did not report kindergarten vaccination coverage for the 2019–20 school year and are excluded from this analysis. ^§ California, Michigan, New Jersey, New York, Oregon, Pennsylvania, Texas, and Washington experienced >15 cases of measles during the 2018–2019 outbreak.