Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2023–24 School Year

In the United States, states and local jurisdictions set vaccination requirements for school attendance, conditions and procedures for exemptions from these requirements, grace periods for submitting documentation, and provisional enrollment for students who need more time to be vaccinated.States annually report data to CDC on the number of children in kindergarten who meet, are exempt from, or are in the process of meeting requirements.Data reported by 49 states and the District of Columbia (DC) for the 2023-24 school year were used for national-and state-level estimates of the following measures: complete vaccination with required doses of measles, mumps, and rubella vaccine (MMR), diphtheria, tetanus, and acellular pertussis vaccine (DTaP), poliovirus vaccine (polio), and varicella vaccine (VAR); exemptions from vaccination; and school attendance while meeting requirements.The 2023-24 kindergarten class became age-eligible to complete most staterequired vaccinations during the COVID-19 pandemic, after schools had returned to routine in-person learning.Compared with approximated national coverage levels across all reported vaccines for the 2019-20 (95%) and 2022-23 (93%) school years, coverage dropped below 93% for the 2023-24 school year, ranging from 92.3% for DTaP to 92.7% for MMR.Exemptions increased to 3.3%, compared with those during the 2022-23 (3.0%) and 2021-22 school years (2.6%).Coverage with MMR, DTaP, polio, and VAR decreased in 35, 32, 33, and 36 jurisdictions, respectively, compared with the 2022-23 school year.Exemptions increased in 41 jurisdictions, with 14 reporting that >5% of kindergartners had an exemption from one or more vaccine.Efforts by health departments, schools, and providers are needed to ensure that students begin school fully vaccinated.* Jurisdictions reported coverage with all doses of MMR required by the jurisdiction.All states except Wyoming require 2 doses of a measles-containing vaccine.Seven states (Alaska, Georgia, New Jersey, New York, North Carolina, Oregon, and Virginia) require only 1 dose of rubella vaccine.Alaska, New Jersey, and Oregon require only 1 dose of mumps vaccine; mumps vaccine is not required in Iowa.Wyoming requires 1 dose of MMR for kindergarten entry, allowing students until the day before their seventh birthday to receive their second dose.pertussis vaccine (DTaP) ; poliovirus vaccine (polio) ; and varicella vaccine (VAR) declined to approximately 93% over the 2020-21 and 2021-22 school years and remained essentially unchanged during the 2022-23 school year (2).These declines persisted after impacts of the COVID-19 pandemic diminished.This analysis summarizes state and local immunization program** data on vaccination coverage and exemptions from vaccination among kindergartners as reported to CDC by 49 states and the District of Columbia (DC), and provisional enrollment or grace period status for kindergartners reported by 31 states for the 2023-24 school year.