Vaccine Exemptions Up for Third Year in a Row, CDC Reports

The number of vaccine exemptions has grown for the third year in a row among children entering kindergarten, researchers report in the latest Morbidity and Mortality Weekly Report.

The data, gathered by federally funded immunization programs in conjunction with departments of education, school nurses, and other school personnel, show that a median of 2.2% of students in each state or territory are exempted from one or more vaccines, with the highest rate in Oregon, at 7.6%, and the lowest in Mississippi, at 0.1%.

The report is part of an effort to monitor vaccine coverage and compliance with state and local vaccination requirements. It was written by Jenelle L. Mellerson, MPH, from Certified Technical Experts, in Montgomery, Alabama, and National Center for Immunization and Respiratory Diseases in the Immunization Services Division at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and colleagues.

During the 2017-2018 school year, immunization programs collected coverage data on 3,988,127 kindergartners, exemption data for 3,634,631 kindergartners, and grace period/provisional enrollment data for 2,825,691 kindergartners. Vaccination assessments varied by immunization program because of differences in states' required vaccines and doses, vaccines assessed, assessment methods, and data reported.

The programs found that median vaccination coverage was 94.3% for two doses of the measles, mumps, and rubella (MMR) vaccine (range, 81.3% in the District of Columbia to ≥ 99.4% in Mississippi); 95.1% for the state-required number of doses of the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine (range, 79.7% in the District of Columbia to ≥ 99.4% in Mississippi); and 93.8% for two doses of the varicella vaccine (range, 80.5% in the District of Columbia to ≥ 99.4% in Mississippi).

The exemption rate of 2.2% was an increase from the exemption rates of 2.0% in2016-2017 and 1.9% in 2015-2016. The median percentage of nonmedical exemptions was 2.0% (range, < 0.1% in California to 7.5% in Oregon). Most undervaccinated students did not have an exemption.

The authors have reported no relevant financial relationships.

MMWR. 2018;67:115-1122.

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