Sunday, May 19, 2024
| Immunization program | Kindergarten population§§ | Percentage | PP change in any exemption from 2021–22 school year | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Surveyed¶¶ | 2 doses of MMR*** | 5 doses of DTaP††† | 4 doses of polio§§§ | 2 doses of VAR¶¶¶ | Grace period or provisional enrollment | Any exemption | |||
| National estimate**** | 3,832,381 | 92.9 | 93.1 | 92.7 | 93.1 | 92.9 | 2.5 | 3.0 | 0.4 |
| Median**** | — | — | 92.1 | 91.9 | 92.2 | 92.7 | 2.0 | 3.3 | 0.6 |
| U.S. state/Jurisdiction | |||||||||
| Alabama††††,§§§§ | 59,113 | 100.0 | ≥93.9 | ≥93.9 | ≥93.9 | ≥93.9 | NP | 2.0 | 0.3 |
| Alaska§§§§,¶¶¶¶ | 9,650 | 88.8 | 83.6 | 83.8 | 84.4 | 81.8 | NR | 5.7 | 1.1 |
| Arizona***** | 80,814 | 97.7 | 89.9 | 89.6 | 90.3 | 94.1 | NR | 7.4 | 0.6 |
| Arkansas | 38,358 | 95.8 | 91.9 | 90.6 | 90.7 | 91.1 | 9.2 | 3.1 | 0.6 |
| California§§§§,*****,††††† | 541,132 | >99.9 | 96.5 | 95.6 | 96.3 | 96.1 | 1.5 | 0.2 | –0.1 |
| Colorado | 65,576 | 97.2 | 87.0 | 87.2 | 87.0 | 85.9 | ≥0.6 | ≥4.3 | 1.1 |
| Connecticut††††,§§§§ | 35,580 | 100.0 | 97.3 | 97.3 | 97.3 | 97.0 | NP | 0.8 | –1.5 |
| Delaware§§§§,††††† | 10,674 | 9.7 | 95.1 | 93.8 | 94.0 | 94.0 | NR | 2.1 | 0.9 |
| District of Columbia††††,§§§§ | 8,064 | 100.0 | 87.5 | 85.0 | 87.8 | 86.8 | NR | 1.3 | 0.8 |
| Florida§§§§ | 230,309 | 97.7 | ≥90.6 | ≥90.6 | ≥90.6 | ≥90.6 | 4.7 | 4.5 | 0.6 |
| Georgia††††,§§§§ | 123,771 | 100.0 | ≥88.1 | ≥88.1 | ≥88.1 | ≥88.1 | 0.5 | 3.8 | –0.9 |
| Hawaii§§§§ | 13,195 | 8.1 | 86.4 | 87.0 | 87.0 | 84.4 | 0.5 | 6.4 | 3.0 |
| Idaho | 23,721 | 99.3 | 81.3 | 81.0 | 81.8 | 80.7 | 1.9 | 12.1 | 2.3 |
| Illinois††††,§§§§ | 135,332 | 100.0 | 91.7 | 91.5 | 91.4 | 91.3 | NR | ≥2.1 | 0.4 |
| Indiana§§§§,§§§§§ | 81,307 | 87.5 | 92.0 | 83.0 | 88.8 | 91.6 | NR | 2.8 | 0.4 |
| Iowa††††,§§§§ | 39,178 | 100.0 | ≥89.9 | ≥89.9 | ≥89.9 | ≥89.9 | 5.3 | 3.0 | 0.6 |
| Kansas§§§§,†††††,§§§§§,¶¶¶¶¶ | 35,543 | 30.8 | 91.6 | 90.5 | 92.2 | 90.8 | NP | 2.9 | 0.6 |
| Kentucky§§§§,†††††,§§§§§ | 54,742 | 96.9 | ≥90.1 | ≥90.6 | ≥91.2 | ≥89.8 | NR | 1.7 | 0.4 |
| Louisiana†††† | 54,314 | 100.0 | 92.2 | 93.1 | 98.3 | 93.6 | NP | 2.3 | 1.2 |
| Maine | 12,403 | 93.9 | 96.8 | 96.6 | 96.8 | 96.6 | NR | 0.9 | –0.9 |
| Maryland††††,§§§§,††††† | 59,684 | 100.0 | 96.7 | 96.9 | 97.2 | 96.6 | NR | 1.9 | 0.4 |
| Massachusetts††††,§§§§,††††† | 66,041 | 100.0 | 96.5 | 96.2 | 96.3 | 96.0 | NP | 1.4 | 0.4 |
| Michigan†††† | 113,678 | 100.0 | 92.9 | 93.1 | 93.7 | 92.9 | 1.0 | 5.4 | 0.9 |
| Minnesota | 68,152 | 97.9 | 87.6 | 88.3 | 88.6 | 87.9 | NR | ≥4.5 | 0.8 |
| Mississippi††††,§§§§,***** | 36,048 | 100.0 | ≥98.4 | ≥98.4 | ≥98.4 | ≥98.4 | 1.0 | 0.2 | 0.1 |
| Missouri††††,§§§§ | 69,126 | 100.0 | 91.3 | 91.1 | 91.5 | 90.8 | NR | ≥3.8 | 0.8 |
| Montana | NR | NR | NR | NR | NR | NR | NR | NR | NA |
| Nebraska††††,§§§§,††††† | 23,176 | 100.0 | 95.1 | 95.7 | 97.0 | 94.9 | 2.6 | 2.6 | 0.1 |
| Nevada§§§§ | 34,333 | 89.1 | 92.8 | 92.2 | 92.8 | 92.6 | 1.7 | 5.6 | 0.8 |
| New Hampshire ††††,§§§§,§§§§§ | 11,332 | 100.0 | ≥89.4 | ≥89.4 | ≥89.4 | ≥89.4 | 4.5 | 3.4 | 0 |
| New Jersey††††,§§§§,§§§§§ | 104,468 | 100.0 | ≥94.3 | ≥94.3 | ≥94.3 | ≥94.3 | 1.1 | 3.2 | 0.6 |
| New Mexico††††,§§§§ | 21,068 | 100.0 | 94.9 | 94.7 | 95.0 | 94.4 | 2.0 | 1.5 | 0.1 |
| New York (including NYC) §§§§,***** | 205,906 | 96.6 | 97.9 | 97.2 | 97.5 | 97.5 | 2.3 | 0.1 | 0 |
| NYC§§§§,***** | 85,379 | 97.6 | 97.3 | 96.3 | 96.6 | 96.7 | 2.3 | 0.1 | 0 |
| North Carolina §§§§,†††††,§§§§§ | 125,679 | 83.1 | 93.8 | 93.7 | 93.9 | 93.6 | 1.6 | 2.4 | 0.5 |
| North Dakota | 10,554 | 99.4 | 92.0 | 91.8 | 91.9 | 91.4 | NR | 5.1 | –0.2 |
| Ohio | 134,893 | 93.7 | 89.3 | 89.4 | 89.7 | 88.8 | 5.9 | 3.8 | 0.8 |
| Oklahoma††††† | 52,548 | 89.5 | 89.6 | 90.0 | 91.0 | 94.6 | NR | 4.7 | 1.2 |
| Oregon††††,††††† | 40,963 | 100.0 | 91.9 | 90.9 | 91.5 | 94.1 | NR | 8.2 | 1.2 |
| Pennsylvania | 137,259 | 97.2 | 94.0 | 94.3 | 94.1 | 93.7 | 2.3 | 3.8 | 0.5 |
| Rhode Island§§§§,†††††,§§§§§ | 10,532 | 96.5 | 96.9 | 96.9 | 96.9 | 96.3 | 0.9 | 1.5 | 0.3 |
| South Carolina§§§§,¶¶¶¶¶ | 58,878 | 28.1 | 93.2 | 92.1 | 92.4 | 92.8 | 4.7 | 4.1 | 0.7 |
| South Dakota††††,§§§§ | 12,081 | 100.0 | 92.5 | 92.2 | 92.3 | 92.0 | NR | 4.1 | 0.6 |
| Tennessee††††,§§§§,§§§§§ | 79,692 | 100.0 | 95.4 | 94.8 | 95.0 | 95.1 | 2.0 | 3.2 | 0.8 |
| Texas (including Houston)†††††,§§§§§ | 381,680 | 98.0 | 94.2 | 93.8 | 94.1 | 93.7 | 1.9 | 3.5 | 0.6 |
| Houston†††††,§§§§§ | 37,664 | 98.8 | 91.3 | 90.7 | 91.0 | 90.6 | 2.6 | 2.3 | 0.8 |
| Utah††††,****** | 46,635 | 100.0 | 90.0 | 89.7 | 89.9 | 89.6 | 3.7 | 8.1 | NA |
| Vermont††††,§§§§ | 5,816 | 100.0 | 93.1 | 92.8 | 92.8 | 92.6 | 6.3 | 3.6 | 0.3 |
| Virginia§§§§,¶¶¶¶¶ | 93,271 | 1.6 | 95.8 | 97.8 | 94.2 | 95.6 | NR | 2.2 | 0.4 |
| Washington§§§§§ | 86,284 | 97.9 | 91.4 | 90.1 | 90.2 | 90.1 | 1.6 | 4.0 | 0.3 |
| West Virginia§§§§,*****,§§§§§,††††† | 19,175 | 86.1 | ≥95.6 | ≥95.6 | ≥95.6 | ≥95.6 | NR | <0.1 | 0 |
| Wisconsin††††† | 63,593 | 93.9 | 86.5 | 87.0 | 88.2 | 85.9 | 5.7 | 7.2 | 0.9 |
| Wyoming††††,§§§§ | 7,060 | 100.0 | 90.8 | 89.4 | 90.1 | 90.5 | 2.4 | 4.8 | 0.9 |
| Territories and freely associated states | |||||||||
| American Samoa†††† | NR | NR | NR | NR | NR | NR | NR | NR | NA |
| Federated States of Micronesia†††† | 1,595 | 100.0 | 92.2 | 77.6 | 82.7 | NReq | NR | NR | NA |
| Guam††††,§§§§ | 2,079 | 100.0 | 91.0 | 86.0 | 89.1 | NReq | NR | NR | NA |
| Marshall Islands††††, §§§§,***** | 860 | 100.0 | 98.1 | 89.2 | 90.3 | NReq | NR | NR | NA |
| Northern Mariana Islands†††† | 791 | 100.0 | 93.4 | 98.0 | 97.5 | 91.8 | NR | 0 | 0 |
| Palau†††† | 261 | 100.0 | ≥81.2 | ≥81.2 | ≥81.2 | NReq | NR | 0 | NA |
| Puerto Rico§§§§ | 21,255 | 9.3 | 92.8 | 95.2 | 96.7 | 92.9 | NR | 1.1 | –0.7 |
| U.S. Virgin Islands | NR | NR | NR | NR | NR | NR | NR | NR | NA |
TABLE. Estimated* coverage† with measles, mumps, and rubella; diphtheria, tetanus, and acellular pertussis; poliovirus; and varicella vaccines; grace period or provisional enrollment§; and any exemption¶,** among kindergartners, by immunization program — United States,†† 2022–23 school year
Abbreviations: DTaP = diphtheria, tetanus, and acellular pertussis vaccine; DTP = diphtheria and tetanus toxoids and pertussis vaccine; MMR = measles, mumps, and rubella vaccine; polio = poliovirus vaccine; NA = not available; NP = no grace period or provisional policy; NR = not reported to CDC; NReq = not required; NYC = New York City; PP = percentage point; VAR = varicella vaccine.
*Estimates adjusted for nonresponse and weighted for sampling where appropriate.
†Estimates based on a completed vaccination series (i.e., not vaccine-specific) use the "≥" symbol. Coverage might include history of disease or laboratory evidence of immunity. In Kentucky, public schools reported numbers of children up to date with specific vaccines, and most private schools reported numbers of children who received all doses of all vaccines required for school entry.
§A grace period is a set number of days during which a student can be enrolled and attend school without proof of complete vaccination or exemption. Provisional enrollment allows a student without complete vaccination or exemption to attend school while completing a catch-up vaccination schedule. In states with one or both of these policies, the estimates represent the number of kindergartners who were within a grace period, were provisionally enrolled, or were in a combination of these categories.
¶Some programs did not report the number of children with exemptions, but instead reported the number of exemptions for each vaccine, which could count some children more than once. Lower bounds of the percentage of children with any exemptions were estimated using the individual vaccines with the highest number of exemptions. Estimates based on vaccine-specific exemptions use the "≥" symbol.
**Exemptions, grace period or provisional enrollment, and vaccine coverage status might not be mutually exclusive. Some children enrolled under a grace period or provisional enrollment might be exempt from one or more vaccinations, and children with exemptions might be fully vaccinated with one or more required vaccines.
††Includes five territories and three freely associated states.
§§The kindergarten population is an approximation provided by each program.
¶¶The number surveyed represents the number surveyed for coverage. Exemption estimates are based on 30,224 kindergartners for Kansas, 58,878 for South Carolina, and 92,424 for Virginia.
***Most states require 2 doses of MMR; Alaska, New Jersey, and Oregon require 2 doses of measles, 1 dose of mumps, and 1 dose of rubella vaccines. Georgia, New York, New York City, North Carolina, and Virginia require 2 doses of measles and mumps vaccines and 1 dose of rubella vaccine. Iowa requires 2 doses of measles vaccine and 2 doses of rubella vaccine. Wyoming requires 1 dose of MMR for kindergarten entry, allowing students until the day before their seventh birthday to receive their second dose, but reported kindergarten coverage with 2 doses of MMR at the time of the assessment.
†††Pertussis vaccination coverage might include some DTP doses if administered in another country or by a vaccination provider who continued to use DTP after 2000. Most states require 5 doses of DTaP for school entry, or 4 doses if the fourth dose was received on or after the fourth birthday; Maryland and Wisconsin require 4 doses; Nebraska requires 3 doses. The reported coverage estimates represent the percentage of kindergartners with the state-required number of DTaP doses, except for Kentucky, which requires ≥5 but reports ≥4 doses of DTaP. Wyoming requires 4 doses of DTaP for kindergarten entry, allowing students until the day before their seventh birthday to receive their fifth dose, but reported kindergarten coverage with 5 doses of DTaP at the time of the assessment.
§§§Most states require 4 doses of polio vaccine for school entry, or 3 doses if the fourth dose was received on or after the fourth birthday; Maryland and Nebraska require 3 doses. The reported coverage estimates represent the percentage of kindergartners with the state-required number of polio doses, except for Kentucky, which requires ≥4 but reports ≥3 doses of polio. Wyoming requires 3 doses of polio for kindergarten entry, allowing students until the day before their seventh birthday to receive their fourth dose, but reported kindergarten coverage with 4 doses of polio at the time of the assessment.
¶¶¶Most states require 2 doses of VAR for school entry; Alabama, Arizona, New Jersey, Oklahoma, and Oregon require 1 dose. Reporting of VAR status for kindergartners with a history of varicella disease varied within and among states; some kindergartners were reported as vaccinated against varicella and others as medically exempt. Wyoming requires 1 dose of VAR for kindergarten entry, allowing students until the day before their seventh birthday to receive their second dose, but reported kindergarten coverage with 2 doses of VAR at the time of the assessment.
****National coverage and exemption estimates and medians were calculated using data from 49 states and the District of Columbia (i.e., did not include American Samoa, Federated States of Micronesia, Guam, Houston, Marshall Islands, Montana, Northern Mariana Islands, NYC, Palau, Puerto Rico, and the U.S. Virgin Islands). National grace period or provisional enrollment estimates and medians were calculated using data from the 28 states that have either a grace period or provisional enrollment policy and reported relevant data to CDC. Data reported from 3,559,366 kindergartners were assessed for coverage, 3,711,948 for exemptions, and 2,683,880 for grace period or provisional enrollment. Estimates represent rates for populations of coverage and exemptions (3,832,381), and grace period or provisional enrollment (2,763,250).
††††The proportion surveyed is reported as 100% but might be <100% if based on incomplete information about the actual current enrollment.
§§§§Philosophical exemptions were not allowed.
¶¶¶¶ Reported public school data only.
*****Religious exemptions were not allowed.
†††††Counted some or all vaccine doses received regardless of Advisory Committee on Immunization Practices–recommended age and time interval; vaccination coverage rates reported might be higher than those for valid doses.
§§§§§Did not include certain types of schools, such as kindergartens in child care facilities, online schools, correctional facilities, or those located on military bases or tribal lands.
¶¶¶¶¶Vaccination coverage data were collected from a sample of kindergartners; exemption data were collected from a census of kindergartners.
******Utah changed the way data were reported between the 2021–22 and 2022–23 school years and is excluded from this analysis.
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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.
State and local school vaccination requirements promote vaccination to protect students, schools, and communities against vaccine-preventable diseases.[1] After 10 years of near 95% nationwide vaccination coverage, measles, mumps, and rubella vaccine (MMR)*; diphtheria, tetanus, and acellular pertussis vaccine (DTaP);† poliovirus vaccine (polio);§ and varicella vaccine (VAR)¶ coverage declined approximately 1 percentage point during the 2020–21 school year and fell an additional percentage point during the 2021–22 school year, to approximately 93%.[2] For both the 2020–21 and 2021–22 school years, states reported impacts of the COVID-19 pandemic and response for both vaccine administration and data collection.[3,4] This analysis summarizes data collected and reported by state and local immunization programs** on vaccination coverage and exemptions to vaccination among kindergartners in 49 states†† and the District of Columbia (DC), and provisional enrollment or grace period status for kindergartners in 28 states§§ for the 2022–23 school year.
