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CDC: Kindergarten vaccination rates dip; pandemic to blame

April 21, 2022

Vaccination coverage rates among U.S. kindergartners decreased by approximately one percentage point for state-required vaccines in 2020-’21 compared to the previous school year, a new study revealed, and experts say the COVID-19 pandemic largely is to blame.

Nearly 94% of students nationally were up to date on two doses of measles, mumps and rubella (MMR) vaccine, and 93.6% were vaccinated with the state-required number of doses of both diphtheria, tetanus and acellular pertussis vaccine (DTaP) and varicella vaccine for the 2020-’21 school year, according to the Centers for Disease Control and Prevention (CDC).

Although 2.2% of kindergartners had an exemption from at least one vaccine, an additional 3.9% who did not have a vaccine exemption were behind on MMR.

“As schools continue to return to in-person learning, enforcement of vaccination policies and follow-up with undervaccinated students are important to improve vaccination coverage,” researchers wrote in the study published Thursday in Morbidity and Mortality Weekly Report.

For two-dose coverage with MMR, vaccination rates ranged from 78.9% in Washington, D.C., to 99% in Mississippi. Coverage of more than 95% was reported by 16 states, while seven states and Washington, D.C., reported coverage rates of less than 90%.

For DTaP, Washington, D.C., (78.5%) and Indiana (83.9%) had the lowest reported percentage of kindergartners vaccinated, while Mississippi had more than 98.9% of its kindergartners vaccinated. Sixteen states reported more than 95% of its kindergartners were vaccinated for DTaP, while eight states and Washington, D.C., reported vaccination rates of less than 90%.

Rates of required varicella vaccination ranged from 78% in Washington, D.C., to more than 98.9% in Mississippi. Seventeen states reported varicella vaccination rates of more than 95%, while nine states and Washington, D.C., reported less than 90% of kindergartners were vaccinated.

Information for the study was collected using 2020-’21 school year data gathered by state and local immunization programs on vaccination coverage among children in kindergarten in 47 states and Washington, D.C.; exemptions for kindergartners in 48 states and Washington, D.C.; and provisional enrollment or grace period status for kindergartners in 28 states.

When the 2019-’20 figures were released, researchers predicted vaccination rates would drop in 2020-’21 due to the COVID-19 pandemic, which resulted in some families delaying visits to see their pediatricians. The AAP and CDC have been urging families to get caught up on vaccines to prevent a host of diseases.

During a media briefing Thursday, CDC researchers expressed concern at the decrease in vaccination rates. They called for vaccination policies to follow up with undervaccinated students to maintain a high level of coverage among the country’s youngest students.

“Today’s findings support previous data showing a concerning decline in childhood immunizations that began in March 2020,” said Shannon Stokley, Dr.P.H., CDC deputy division director of the Immunizations Services Division. “For example, CDC provides vaccines for nearly half of America’s children through the Vaccines for Children program, and over the last two years, orders for distribution of routine vaccines are down more than 10% compared to before the COVID-19 pandemic. We are concerned that missed routine vaccinations could leave children vulnerable to preventable diseases like measles and whooping cough, which are extremely contagious and can be very serious, especially for babies and young children.”

Researchers also revealed kindergarten enrollment in the U.S. dropped by 10% (about 400,000 students) from the 2019-’20 to 2020-’21 school years.

“Those children also might not be up to date on their routine vaccinations,” said Georgina Peacock, M.D., M.P.H., FAAP, acting director of the CDC’s Immunization Services Division. “This is further evidence of how the pandemic-related disruptions to education and health care could have lingering consequences for children. The good news is vaccination coverage remains high, and we can recover ground lost during the pandemic. With most schools back to in-person learning, extra effort is needed to catch up children who missed vaccines.”

Limitations of the report included reduced amounts and quality of student vaccination data collected and reported by local health departments due to the COVID-19 pandemic. In addition, vaccine requirements varied in each state, including number of doses, date required and type of documentation accepted, as well as definitions of grace period and provisional enrollment.


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