Vaccine exemption rate remains stagnant among US kindergarteners

The national vaccine exemption rate among children entering kindergarten in the 2019-2020 school year was 2.5% from at least one vaccine, the same rate as the previous year, new data published in MMWR showed.

Ranee Seither, MPH, an epidemiologist in the CDC’s Immunization Services Division, and colleagues reported on U.S. kindergarteners’ vaccine coverage in 48 states, vaccine exemptions in 49 states and provisional enrollment and grace period status in 28 states.

The reported estimates for the 2019-2020 school year were based on 3,675,882 kindergarteners who were surveyed for vaccination coverage, 3,914,961 surveyed for exemptions and 2,955,220 surveyed for grace period and provisional enrollment among the total of 4,025,574 children enrolled in kindergarten through immunization programs in 49 states. Seither and colleagues noted that the 2019-2020 school year was more than halfway completed before students were moved to virtual learning because of the COVID-19 pandemic.

Nationally, vaccination coverage was 95.2% for both doses of MMR (range = at least 86.6% in Alabama to at least 99.1% in Mississippi). Twenty states reported coverage of at least 95%, whereas three reported coverage of less than 90%. The authors reported that 2.3% of kindergarteners were not up to date for MMR vaccinations and were not exempt.

Vaccination coverage was 94.9% (range = 84% in Indiana to at least 99.1% in Mississippi) for the state-required number of doses of DTaP. As with MMR, coverage of at least 95% was reported by 20 states and coverage of less than 90% was reported by three states.

In regard to the state-required number of varicella doses, coverage was 94.8% (range = at least 86.6% in Alabama to at least 99.1% in Mississippi), with 21 states reporting coverage of at least 95% and four states reporting coverage of less than 90%.

The unchanged vaccination exemption rate from one or more required vaccines of 2.5% ranged from 0.1% in New York and West Virginia to 7.6% in Idaho. Nationally, 0.3% of children had a medical exemption and 2.2% had a nonmedical exemption.

The percentage attending kindergarten with a grace period or who were provisionally enrolled among 28 states that reported data was 1.6% (range = less than 0.1% in Hawaii and Mississippi to 6.1% in Ohio).

The authors noted that of the 28 states with less than 95% MMR coverage, 24 could potentially increase their coverage rate to at least 95% if all nonexempt kindergarteners were vaccinated.

The authors reported an increase in MMR coverage in 26 states during the 2019-2020 school year due to a decrease in the percentage of kindergarteners who were not up to date for MMR and did not have an exemption that school year compared with the 2018-2019 year.

MMR coverage in three states — Illinois, North Carolina and South Carolina — increased to at least 95% in 2019-2020. During the 2018-2019 school year, all three states reported less than 95% coverage.

“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,” Seither and colleagues wrote. “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.”