Coverage with Selected Vaccines and Exemption from School Vaccine Requirements Among Children in Kindergarten — United States, 2022–23 School Year

Ranee Seither · Oyindamola Bidemi Yusuf · Devon Dramann · Kayla Calhoun · Agnes Mugerwa-Kasujja · Cynthia L. Knighton

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Vaccine Coverage and Hesitancy Virology and Viral Diseases Child and Adolescent Health

Abstract

U.S. states and local jurisdictions set vaccination requirements for school attendance and conditions and procedures for exemptions from these requirements. States annually report data to CDC on the number of children in kindergarten who meet, are exempt from, or are in the process of meeting requirements. National- and state-level estimates for complete vaccination with measles, mumps, and rubella vaccine (MMR); diphtheria, tetanus, and acellular pertussis vaccine (DTaP); poliovirus vaccine (polio); and varicella vaccine (VAR); exemptions from vaccination; and legally allowed kindergarten attendance while meeting requirements were based on data reported by 49 states and the District of Columbia (DC) for the 2022-23 school year. This kindergarten class became age-eligible to complete most state-required vaccinations during the COVID-19 pandemic. National coverage remained near 93% for all vaccines; exemptions were low but increased to 3%, compared with those during the 2021-22 school year (2.6%). At the state level, coverage with MMR, DTaP, polio, and VAR decreased in 29, 31, 28, and 25 states, respectively, compared with coverage during the 2021-22 school year. Exemptions increased in 40 states and DC, with 10 states reporting an exemption from at least one vaccine for >5% of kindergartners. Schools and providers should work to ensure that students are vaccinated before school entry, such as during the enrollment process, which is often several months before school starts. State and local provisional enrollment periods that allow students to attend school while on a catch-up schedule also provide the opportunity to fully vaccinate students and to prevent nonmedical exemptions resulting from lingering undervaccination due to COVID-19 pandemic-related barriers to vaccination, such as reduced access to vaccination appointments.

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References

2009Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases 2000Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults11The names and affiliations of the Task Force members are listed on page v of this supplement and at http://www.thecommunityguide.org22Some of this material was published previously in: Shefer A, Briss P, Rodewald L, et al. Improving immunization coverage rates: an evidence-based review of the literature. Epidemiol Rev 1999;20:96–142.2022Impact of the COVID-19 pandemic on pediatric and adolescent vaccinations and well child visits in the United States: A database analysis 2022Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2020–21 School Year

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2025Pediatric Vaccine Hesitancy in the United States—The Growing Problem and Strategies for Management Including Motivational Interviewing

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