During the 2022-2023 school year, coverage remained near 93% for all reported vaccines, including 92.7% for diphtheria, tetanus, and acellular pertussis vaccine (DTaP) to 93.1% for measles, mumps, and rubella (MMR) and poliovirus (polio). The exemption rate now has increased 0.4 percentage points to 3.0%; however, with exemptions increased in 41 states, exceeding 5% in 10 states.
That represents a decline from a 95% rate in the 2019-2020 school year, according to the article in Morbidity & Mortality Weekly Report.
“Exemptions >5% limit the level of achievable vaccination coverage, which increases the risk for outbreaks of vaccine-preventable diseases,” the CDC noted. “Vaccination before school entry or during provisional enrollment periods could reduce exemptions resulting from barriers to vaccination during the COVID-19 pandemic.”
U.S. vaccination requirements for school attendance and conditions and procedures for exemptions from these requirements are set by states and local jurisdictions. States annually report data to the 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 MMR, DTaP, 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 (D.C.) for the 2022-2023 school year.
“This kindergarten class became age-eligible to complete most state-required vaccinations during the COVID-19 pandemic,” according to the authors. “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.”
Overall, the CDC reported that exemptions increased in 40 states and Washington D.C., with 10 states reporting an exemption from at least one vaccine for more than 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,” the article stated. “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 under vaccination due to COVID-19 pandemic–related barriers to vaccination, such as reduced access to vaccination appointments.”
The study added that state-level exemption rates in excess of 5% prevent 10 states from potentially achieving ≥95% MMR coverage, even if all nonexempt kindergartners in 2022-2023 were vaccinated, up from four states in 2021-2022. National MMR coverage of 93.1% during the 2022-2023 school year translates to approximately 250,000 kindergartners who are at risk for measles infection, the CDC pointed out.
To address pandemic-related declines in routine immunization coverage across the lifespan, public health officials announced that they launched the Let’s RISE initiative earlier in 2023 and are providing “a broad range of communication and enhanced technical assistance, including back-to-school campaigns, to jurisdictions to get routine vaccination coverage back to prepandemic levels.”
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