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Vaccine coverage rates high for kindergartners, but remain short of 2020 goal
CDC. MMWR. 2011;60(21):700-704.
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Vaccination coverage rates for children entering kindergarten were more than 90% in most states, but some pockets of the country are falling below Healthy People 2020 goals of more than 95% coverage, according to a report published online.
“Maintaining high measles-mumps-rubella (MMR) vaccination coverage rates, particularly among preschool children and school-aged children, is essential to maintain measles elimination in the United States,” the CDC researchers wrote, adding that only half of the states involved in the surveillance reported that more than 95% of kindergartners surveyed had received two doses of MMR vaccine (M-M-R II, Merck).
Overall, exemption rates were low, the researchers said, with only four states — Alaska, Oregon, Vermont and Washington — having exemption rates exceeding 5%. Most of those exemptions were granted on the basis of parents having philosophical objections to vaccines. Most other regions had exemption rates of less than 1%.
The report from the CDC was the first to contain exemption rates, and CDC officials wrote that monitoring exemption rates is important “because several measles outbreaks in recent years occurred among school-aged children who were eligible for vaccination but whose parents chose not to have them vaccinated.”
They said there were a few limitations to their findings, including that it is not always possible to determine why some parents seek exemptions, and that “the variation of required vaccinations and assessment methods among kindergarten children across grantees and over time limits comparability of data.” In addition, “data included in this report are a cross-sectional representation of vaccination coverage and exemption rates at one point in time; therefore, students who were in the process of obtaining required vaccines or claiming an exemption, as allowed by local policy, might not be accounted for in the reported estimates.”
CDC researchers said in their report that they are working with state immunization programs to strengthen their immunization programs, identify pockets of undervaccinated children and standardize reporting data for state comparisons.
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First the good news. The most recent report from the CDC shows that most states have nonvaccination exemption rates of less than 1%. Now the bad news. Four states have vaccination exemption rates exceeding 5%. Most of the parents exercised their right not to vaccinate based on philosophical reasons, which is allowed only on a state -by-state legislative decision. Could a federal mandate to disallow philosophical exemptions override the state legislation? Perhaps we need to take our case to the national legislative level to eliminate these philosophical exemptions. The only other obvious recourse that I see for this problem in the immediate future is to levy a hefty health insurance surcharge for commercially insured folks who elect not to vaccinate their children timely and appropriately. This would be similar to a surcharge for pre-existing high-risk medical conditions - which it is. However, "Obama-care" could eliminate this potential economic disincentive, too.
Stan L. Block, MD
Infectious Diseases in
Children Editorial Board member
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