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CDC: Kindergarten vaccination rates drop again; disparities found for younger children

January 12, 2023

Kindergarten vaccination rates continued to decline during the 2021-22 school year, likely impacted in part by the ongoing COVID-19 pandemic.

About 93% of kindergartners were fully vaccinated, down one percentage point from the year before and two points from the 2019-’20 school year, according to a new Centers for Disease Control and Prevention (CDC) study published today in the Morbidity and Mortality Weekly Report.

“That translates to hundreds of thousands of children starting school without being fully protected against measles, mumps, whooping cough and other diseases that can easily spread in classrooms,” said Sean O’Leary, M.D., FAAP, chair of the AAP Committee on Infectious Diseases.

Georgina Peacock, M.D., M.P.H., FAAP, director of the CDC’s Immunization Services Division, said declines in vaccination likely are due to multiple factors including children missing health care visits during the COVID-19 pandemic, schools not focusing as much on vaccination as children returned to school, hesitancy about COVID vaccines that may have spilled over into routine vaccines and misinformation about the safety of vaccines.

For measles, mumps and rubella (MMR) vaccine, coverage of 93.5% was the lowest in over a decade, leaving 250,000 kindergarteners potentially vulnerable. Two-dose coverage with MMR ranged from 78% in Alaska to 98% in New York. The data come on the heels of measles outbreaks in at least two communities in 2022 that resulted in children being hospitalized.

“These outbreaks harm children, and cause significant disruptions in their opportunities to learn, grow and thrive,” Dr. O’Leary said. “This is alarming and should be a call to action for all of us.”

Coverage with each of the other vaccines in the report was about 93%. Diphtheria, tetanus toxoids and acellular pertussis (DTaP) vaccine coverage ranged from 78% in Alaska to 98.3% in Virginia. About 77.1% of children in Alaska were vaccinated again poliovirus compared to 97.6% in Louisiana and Nebraska. For varicella vaccine, coverage ranged from 76.1% in Alaska to 98% in West Virginia.

About 2.6% of kindergartners had an exemption for at least one vaccine, most of which were non-medical. About 2.4% of children were enrolled in kindergarten on a provisional basis/grace period.

Vaccination by age 2

Another CDC study published Thursday found the COVID-19 pandemic did not appear to have lowered vaccination rates for children by 2 years of age but showed significant disparities by race and socioeconomic status.

Vaccine coverage for children at 2 years increased for children born in 2018 or 2019 compared to those born in 2016 or 2017. Data from the National Immunization Survey—Child show coverage of

  • 93.4% for at least three doses of poliovirus vaccine,
  • 92.7% for at least three doses of hepatitis B vaccine,
  • 91.6% for at least one dose of MMR vaccine,
  • 91.1% for at least one dose of varicella vaccine,
  • 63.9% for at least two doses of influenza vaccine and
  • 47.3% for at least two doses of hepatitis A vaccine.

For most vaccines, coverage was lowest for children who were uninsured, living below the poverty line, in rural areas, Black or Hispanic. During the pandemic, children living in rural areas or below the poverty line had a decrease in coverage with the seven-vaccine series of four to five percentage points.

About 1% of those born in 2018 or 2019 had received no vaccines by 24 months of age. The unvaccinated rate was eight times higher for children without insurance compared to those with private insurance, according to the report.

“This illustrates that we have significant work to do to improve access to care,” Dr. O’Leary said. “We know barriers such as lack of access to transportation, health care services or paid time off work create significant challenges for some families to be vaccinated. These are problems that we can solve.”

Improving vaccination rates

To improve vaccination rates, authors of the studies called for strong provider recommendations at every health care visit, reminders for parents, alternative vaccination sites including schools and rigorous enforcement of school vaccination requirements. They also pointed to the need for improved awareness of the Vaccines for Children program, which provides free vaccines for Medicaid-eligible, uninsured, underinsured and American Indian/Alaska Native children.

The AAP and CDC each have tools (see resources below) to educate families about vaccines and help clinicians increase vaccination rates.

“As pediatricians, we are ready, willing and eager to answer parents’ questions and work with families to help their children get caught up,” Dr. O’Leary said. “My message to parents is that if you’re not sure what vaccines your child may be due for, call your pediatrician or health care provider, and we can help figure it out together.”


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