To identify areas of under-vaccination for measles and other vaccine-preventable diseases, state and local health departments monitor compliance with school immunization requirements using annual school vaccination assessment reports, supported as a CDC immunization funding objective for the 64 grantees, including the 50 states, the District of Columbia (DC), five cities, and eight other reporting areas. CDC also monitors progress toward meeting Healthy People 2020 objectives for the vaccination of children entering kindergarten.
Median coverage with 2 doses of measles, mumps, and rubella (MMR) vaccine was 94.8% among 47 reporting states and DC. Total exemption rates, including medical, religious, and philosophic exemptions, among 49 reporting states and DC, ranged from <0.1% to 7.0% (median: 1.5%). Although statewide levels of vaccination coverage are at or very near target levels, locally low vaccination coverage for extremely transmissible diseases such as measles remains a threat to health.
All reporting grantees allowed medical exemptions, 47 allowed religious exemptions, and 20 allowed philosophic exemptions; two grantees (Mississippi and West Virginia) did not allow exemptions for religious or philosophic reasons.
Overall, among grantees in the 47 states and DC that reported 2011–12 school vaccination coverage, median MMR vaccination coverage was 94.8%, with a range of 86.8% in Colorado to 99.3% in Texas.
The median MMR and 2-dose varicella vaccination coverage levels for children entering kindergarten for the 2011–12 school year were below the Healthy People 2020 target of ≥95%. The high number of measles cases reported in Europe in 2011 contributed to record numbers of imported cases in the United States. Among the U.S. measles cases in persons aged 16 months through 19 years reported in 2011, 76% were in persons not vaccinated for a nonmedical reason.
Estimated percentage of children enrolled in kindergarten who have been exempted from receiving one or more vaccines — United States, 2011–12 school year. Credit:CDC
MMR vaccination coverage and exemptions aggregated at national or state levels can mask substantial vulnerability at the local level, since exemptions cluster geographically. See:
Sugerman D, Barskey AE, Delea MG, et al., 'Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated', Pediatrics 2010;125:747–55
Omer SB, Enger KS, Moulton LH, Halsey NA, Stokley S, Salmon DA, 'Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis', Am J Epidemiol 2008;168:1389–96
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