Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2021–22 School Year

Abstract

State and local school vaccination requirements protect students and communities against vaccine-preventable diseases (1). This report summarizes data collected by state and local immunization programs* on vaccination coverage and exemptions to vaccination among children in kindergarten in 49 states † and the District of Columbia and provisional enrollment or grace period status for kindergartners in 27 states § for the 2021-22 school year. Nationwide, vaccination coverage with 2 doses of measles, mumps and rubella vaccine (MMR) was 93.0% ¶ ; with the state-required number of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) doses was 92.7%**; with poliovirus vaccine (polio) was 93.1% † † ; and with the state-required number of varicella vaccine doses was 92.8%. § § Compared with the 2020-21 school year, vaccination coverage decreased 0.8-0.9 percentage points for all vaccines. Although 2.6% of kindergartners had an exemption for at least one vaccine, ¶ ¶ an additional 4.4% who did not have an exemption were not up to date with MMR. Although there * Federally funded immunization programs are located in 50 states and the District of Columbia, five cities, and eight U.S territories and freely associated states. Two cities reported data, which were also included in data submitted by their state, to CDC. State-level data were used to calculate national estimates and medians. Immunization programs in territories reported vaccination coverage and exemptions; however, these data were not included in national calculations. † Montana did not report school vaccination data. reported data on the number of students within a grace period or provisionally enrolled at the time of assessment. ¶ All states require 2 doses of a measles-containing vaccine. Seven states (Alaska, Georgia, New Jersey, New York, North Carolina, Oregon, and Virginia) require only 1 dose of rubella vaccine. Alaska, New Jersey, and Oregon require only 1 dose of mumps vaccine; mumps vaccine is not required in Iowa. ** Nebraska requires 3 doses of DTaP, Maryland and Wisconsin require 4 doses, and all other states require 5 doses, unless dose 4 was administered on or after the fourth birthday. The reported coverage estimates represent the percentage of kindergartners with the state-required number of DTaP doses, except for Kentucky, which requires 5 doses of DTaP by age 5 years but reported 4-dose coverage for kindergartners. † † Two states (Maryland and Nebraska) require only 3 doses of polio vaccine; all other states require 4 doses unless the last dose was given on or after the fourth birthday. § § Five states require 1 dose of varicella vaccine; 44 states and the District of Columbia require 2 doses. ¶ ¶ Colorado, Illinois, Minnesota, and Missouri did not report the number of kindergartners with an exemption but instead reported the number of exemptions for each vaccine, which could have counted some children more than once. For these states, the percentage of kindergartners exempt from the vaccine with the highest number of exemptions by exemption type (the lower bound of the potential range of exemptions) was included in the national and median exemption rates. has been a nearly complete return to in-person learning after COVID-19 pandemic-associated disruptions, immunization programs continued to report COVID-19-related impacts on vaccination assessment and coverage. Follow-up with undervac-cinated students and catch-up campaigns remain important for increasing vaccination coverage to prepandemic levels to protect children and communities from vaccine-preventable diseases. As mandated by state and local school entry requirements, parents provide children's vaccination or exemption documentation to schools, or schools obtain records from state immunization information systems. Federally funded immunization programs work with departments of education, school nurses, and other school personnel to assess vaccination and exemption status of children enrolled in public and private kindergartens and to report unweighted counts, aggregated by school type, to CDC via a web-based questionnaire in the Secure Access Management system, a federal, web-based system that provides authorized personnel with secure access to public health applications operated by CDC. CDC uses these counts to produce state-and national-level estimates of vaccination coverage among children in kindergarten. During the 2021-22 school year, 49 states and the District of Columbia reported coverage with all state-required vaccines and exemption data for public school kindergartners; 48 states and the District of Columbia reported coverage with all state-required vaccines and exemption data for private school kindergartners.*** Data from cities were included with their state data. State-level coverage and national and median coverage with the state-required number of DTaP, MMR, polio, and varicella vaccine doses are reported. Hepatitis B vaccination coverage is not included in this report but is available at SchoolVaxView (2). Twenty-seven states reported the number of kindergartners who were attending school under a grace period (attendance without proof of complete vaccination or exemption during a set interval) or provisional enrollment (school attendance while completing a catch-up vaccination schedule). All counts were current as of the time of the assessment. † † † National estimates, medians, and summary measures include only U.S. states and the District of Columbia. *** Twelve states reported coverage and exemption data for at least some homeschooled kindergartners, either separately or included with data from public or private schools. † † † Assessment date varied by state and area. Three states assessed schools on the first day of school; 10 states assessed schools by December 31; 18 states and the District of Columbia assessed schools by some other date, ranging from October 15, 2021, to June 23, 2022; and 18 states assessed schools on a rolling basis.