Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2020-21 School Year

Abstract

State and local school vaccination requirements serve to protect students against vaccine-preventable diseases (1). This report summarizes data collected for the 2020-21 school year by state and local immunization programs* on vaccination coverage among children in kindergarten in 47 states and the District of Columbia (DC), exemptions for kindergartners in 48 states and DC, and provisional enrollment or grace period status for kindergartners in 28 states. Vaccination coverage^† nationally was 93.9% for 2 doses of measles, mumps, and rubella vaccine (MMR); 93.6% for the state-required number of doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP); and 93.6% for the state-required doses of varicella vaccine. Compared with the 2019-20 school year, vaccination coverage decreased by approximately one percentage point for all vaccines. Although 2.2% of kindergartners had an exemption from at least one vaccine,^§ an additional 3.9% who did not have a vaccine exemption were not up to date for MMR. The COVID-19 pandemic affected schools' vaccination requirement and provisional enrollment policies, documentation, and assessment activities. As schools continue to return to in-person learning, enforcement of vaccination policies and follow-up with undervaccinated students are important to improve vaccination coverage.

FIGURE 1

Change in measles, mumps, and rubella vaccine coverage, any exemption, grace period or provisional enrollment, and no documentation among kindergartners — 47 states,^† 2019–20 to 2020–21 school year Abbreviation: MMR = measles, mumps, and rubella vaccine. * States are sorted from lowest to highest by change in MMR coverage (n = 46), any exemption (n = 47), grace period or provisional enrollment (n = 28), and no documentation (n = 29). Not all states reported data for all categories. ^† Delaware and District of Columbia did not report for any categories for the 2019–20 school year, and Illinois and West Virginia did not report for any categories for the 2020–21 school year. All were excluded from this analysis.

FIGURE 2

Potentially achievable coverage^,† with measles, mumps, and rubella vaccine among kindergartners, by state — 47^§ states and District of Columbia, 2020–21 school year Abbreviation: MMR = measles, mumps, and rubella vaccine. * States are ranked from lowest to highest by potentially achievable coverage. Potentially achievable coverage was 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, District of Columbia, Idaho, Maine, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, Texas, Utah, Vermont, and Wisconsin were the number of children with exemptions specifically for MMR vaccine. For all other states, numbers were based on an exemption to any vaccine. ^§ Alaska, Illinois, and West Virginia did not report kindergarten vaccination coverage for the 2020–21 school year and are excluded from this analysis.