Exemption Rate from School Vaccination for Kindergartners Unprecedented in 2022-23: CDC Report

The proportion of kindergarten-aged children in the US with an exemption from vaccination requirements* for school entry reached 3% in 2023, the highest rate ever recorded, according to a recent report from the US Centers for Disease Control and Prevention (CDC).¹

While the percentage of kindergartners with a medical exemption from vaccination has been relatively stable over the past decade, at about 0.2%, the proportion of children with nonmedical exemptions has been creeping up, raising the overall rate from 1.6% in the 2011-2012 school year to 2.6% during 2021-22, and to the unprecedented 3% just reported, the nonmedical emptions granted accounting for more than 90% of the national increase, the CDC reported.¹

Exemptions increased in 40 states and DC with 10 states reporting an exemption from at least 1 vaccine for >5% of kindergartners, a level the CDC says, “limits the level of achievable vaccination coverage,” which in turn increases the risk for an outbreak of an otherwise preventable disease.

*Measles, mumps, and rubella (MMR); Diphtheria, tetanus, and acellular pertussis (DTaP);
Poliovirus, Varicella (VAR)

Vaccination coverage for this pediatric population had been steady for nearly 10 years, at approximately 95% nationwide, the report states. The percentage declined by approximately 1% during the 2020-21 school year to 94% and was recorded down by another 1% during the 2021-22 academic year, to 93%. Despite the rise in vaccine exemptions, however, that vaccination rate held steady for 2022-23.¹ That plateau raises concern for some.

“The bad news is that it’s gone down since the pandemic and still hasn’t rebounded,” Dr. Sean O’Leary, a University of Colorado pediatric infectious diseases specialist said in an interview with the Associated Press.² “The good news is that the vast majority of parents are still vaccinating their kids according to the recommended schedule.”²

The rate of 93% for all reported vaccines reflected a range from 92.7% for DTaP to 93.1% for measles, mumps, and rubella and polio.¹

Immunization against vaccine preventable diseases is required in all US states and territories for children attending school and in childcare settings. All states do allow exemptions from vaccination for children with medical conditions that prevent them from receiving a vaccine, the CDC states. All but 3 states also allow nonmedical exemptions for religious, philosophical, or other nonmedical reasons.

Exemption rates varied across the country, according to the report. In the West or Midwest, 10 states reported that more than 5% of kindergartners were exempted from at least 1 type of required vaccine. Idaho had the highest percentage, with 12% of kindergartners receiving at least one exemption. The lowest proportion of children with exemptions, less than 0.1%, was reported in West Virginia.¹

Implications for public health

In their discussion of the findings’ implications for public health practice CDC report authors stress the organization’s concern that nationwide vaccination of this vulnerable young population remains below pre-COVID-19-pandemic levels, particularly, they state, because in years past, “nearly all states had the potential to achieve ≥95% coverage if all nonexempt students were vaccinated.” The number of states with that goal within reach now stands at 40, down from 48 in 2021-22. It is not clear, the authors add, whether the rise in exemptions reflects a true increase in parental opposition to vaccinating their children or whether barriers, such as lack of time or degree of inconvenience to access services, play a significant role.

It is hard not to make a correlation between the pandemic-related rise in misinformation around vaccination and increased vaccine hesitancy, but in the absence of reliable evidence for that connection, the CDC calls for clearer understanding of the reasons for the increase in nonmedical exemptions recorded in 40 states and for translating that knowledge into policies that shift their potential for ≥95% coverage back up.

References: 1. Seither R, Yusuf OB, Dramann D, et al. Coverage with selected vaccine and exemption from school vaccine requirements among children in kindergarten – United States, 2022-23 school year. MMRW Morb Mortal Wky Rep. 2023;72(45):1217-1224. 2. Stobbe M. US childhood vaccination exemptions reach their highest level ever. AP. November 9, 2023. Accessed December 12, 2023. https://apnews.com/article/vaccination-exemptions-children-cdc-951427e55b24c8e7eb3a23b26946f630