Vaccination Rates for 2012-2013 Kindergarteners High Overall

Laurie Barclay, MD

August 01, 2013

Median vaccination coverage in the United States continued to be high among kindergarten enrollees for the 2012-2013 school year, with low overall level of exemptions, according to a report by the Centers for Disease Control and Prevention (CDC), published online August 1 in the Morbidity and Mortality Weekly Report.

"Vaccine-preventable diseases continue to be transmitted despite high levels of vaccination at the national and state levels," write Ranee Seither, MPH, from the Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, and colleagues. "School vaccination assessment can help local health officials determine the risk for vaccine-preventable disease transmission at the local level."

Awardees of federally funded immunization programs include 50 states and the District of Columbia (DC), 5 cities, and 8 US-affiliated jurisdictions. This CDC report summarizes vaccination coverage data from 48 states and DC and exemption rates from 49 states and DC for children entering kindergarten for the 2012-2013 school year.

In the 48 states and DC, median vaccination coverage continued to be high:

  • 94.5% for 2 doses of the measles, mumps, and rubella vaccine, with a range of 85.7% in Colorado to ≥99.9% in Mississippi; 20 awardees reported coverage ≥95%;

  • 95.1% for the diphtheria, tetanus toxoid, and acellular pertussis vaccine, with a range of 82.9% in Colorado and Arkansas to ≥99.9% in Mississippi; 25 reported coverage ≥95%; and

  • 93.8% for 2 doses of the varicella in the 36 states and DC that have a 2-dose requirement; with a range of 84.6% in Colorado to ≥99.9% in Mississippi; 14 reported coverage ≥95%.).

The overall median level of exemptions remained low, at 1.8%. For 4 awardees, children with exemptions in the 2012-2013 school year decreased by more than 1 percentage point.

Public Health Implications

An accompanying editorial note called the findings "reassuring" but noted that vaccination exemptions have been shown to cluster geographically, which could result in transmission of vaccine-preventable diseases in a school or community with high exemption levels.

Limitations of the findings in this report include cross-sectional data collection and variation of data collection methodology by awardee, and even by school year for the same awardee.

In addition, the data reported to the CDC are state-level data and do not show potential geographic clusters of exemptions. Therefore, despite this good overall report, the investigators express concern about potentially low local coverage rates.

"High vaccination coverage levels at the national and state levels might mask clustering of unvaccinated children at local levels where vaccine-preventable diseases might be transmitted," the report authors conclude. "Health departments and school systems can use local-level school vaccination assessment data to identify schools with low vaccination coverage and high exemption levels. This local-level evidence can be used to develop local-level health communication campaigns and other strategies to ensure parents understand vaccine-preventable disease risks and vaccination benefits."

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2013:62:607-612. Full text

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