The percentage of children in kindergarten in the United States who received routine vaccines to protect against diseases such as measles, whooping cough and polio has declined for 2 consecutive years, a new study found.
Declines in vaccine coverage make communities more susceptible to outbreaks of vaccine-preventable diseases like the one that occurred in 2022, public health officials said.
Cover for four vaccines – measles, mumps and rubella (MMR); diphtheria, tetanus and acellular pertussis (DTaP); poliomyelitis (polio); and varicella (chicken pox) ― among kindergarten students was about 95% in 2019–2020.
The percentage dropped to 94% the following year.
For the 2021-2022 school year, coverage dropped another point to 93 percent, according to the report published online Jan. 12 in the Morbidity and Mortality Weekly Report (MMWR).
Vaccination rates remain high overall, but about 250,000 kindergarten students may not be protected against measles, researchers estimate. Measles, which is highly contagious, can cause serious illness and even death in children who have not been vaccinated against the virus.
“In 2022, two communities in the United States responded to measles outbreaks where children were hospitalized,” said Georgina Peacock, MD, MPH, director of the Centers for Disease Control and Prevention’s (CDC) Division of Immunization Services. media briefing on the report. “One community reported a case of paralytic poliomyelitis in an unvaccinated person. These outbreaks were preventable. The best way to prevent these diseases and their devastating impact on children is through vaccination.”
Robust exceptions
For the new study, Ranee Seither, MPH, of the CDC’s National Center for Immunization and Respiratory Diseases, and her colleagues analyzed data reported by states to estimate nationwide coverage for the four routine vaccines.
The number of students with exemptions remained low at 2.6 percent, but another 3.9 percent who were not exempt were not up to date on the MMR vaccine, the researchers reported.
In a separate study, researchers found that vaccination coverage for 2-year-olds increased. Approximately 70% of children were current with the seven-vaccine series by 24 months of age. The coverage rate is higher for children born in 2018–2019 than for those born in 2016–2017.
Although the COVID-19 pandemic was not associated with reduced vaccination rates in this younger age group overall, coverage fell by 4 to 5 percentage points for children living below the poverty line or in rural areas, according to the study.
In addition, uninsured children were eight times more likely than those with private insurance to not be vaccinated by their second birthday, the researchers found.
Strategies to increase vaccination coverage include enforcing vaccination requirements in schools and holding vaccination clinics in schools, the CDC said.
“Providers should review children’s histories and recommend necessary vaccinations at each clinical encounter and address parental hesitancy to help reduce disparities and ensure all children are protected from vaccine-preventable diseases.” , the agency said.
To that end, the agency launched an initiative this week called Let’s RISE (Routine Scheduled Immunizations for All) to provide clinicians with resources to help patients keep up with their immunizations.
Hundreds of thousands unprotected
MMR vaccination coverage for kindergarten children is the lowest it has been in more than a decade, Peacock noted. Reduced coverage for kindergarten students may be related to pandemic-related disruptions to health systems and schools, she said. School administrators and parents may have been less focused on routine vaccination documentation amid the return to in-person education, for example.
Hesitancy about COVID vaccines may affect routine vaccinations. “It’s something we’re watching very closely,” Peacock said.
A two-point reduction in vaccination coverage “means hundreds of thousands of children start school not fully protected” against preventable diseases that can easily spread in classrooms, Sean O’Leary, MD, Chair of the American Academy of Pediatrics Committee on Infectious Diseases, said.
Despite the decline in coverage, O’Leary said he sees some encouraging signs in the data: Non-medical exemptions for kindergarten students have not increased. And the majority of parents still vaccinate their children. At the same time, the reports highlight the need to address child poverty and improve access to vaccines in rural areas, he said.
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