U.S. School Vaccination Rates Decline as Nonmedical Exemptions Increase

Why it matters locally: Florida, like many other states, mandates certain vaccinations for school-aged children, and a national decline in vaccination rates could impact public health efforts to prevent outbreaks of vaccine-preventable diseases within the state's school system. The rise in nonmedical exemptions at a national level suggests a trend that could also be reflected in Florida's schools, potentially lowering community immunity thresholds.

Washington D.C. — National vaccination coverage for kindergarten students in U.S. schools experienced a decline for the fourth consecutive year during the 2022-2023 school year. This trend coincided with a record-high national average for vaccine exemptions. Most states mandate vaccinations for children attending public and private schools. However, all states permit medical exemptions, and 47 states allow religious exemptions. Additionally, 15 states authorize philosophical exemptions, which permit parents to decline vaccinations based on personal beliefs. During the 2022-2023 school year, 93.1% of kindergarteners had received the measles, mumps, and rubella (MMR) vaccine. This figure represents a 0.4 percentage point decrease from the previous school year. Coverage for the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine stood at 93.1%, also a 0.4 percentage point reduction. For the varicella vaccine, coverage reached 92.8%, showing a 0.5 percentage point decrease. These vaccination rates fall below the 95% threshold for community immunity, also known as herd immunity. Public health officials consider this level necessary to prevent outbreaks of vaccine-preventable diseases. The percentage of kindergarteners with an exemption from at least one vaccine rose to 3.0% nationally. This represents a 0.4 percentage point increase from the 2021-2022 school year. Nonmedical exemptions accounted for the majority of these waivers. Specifically, nonmedical exemptions increased to 2.3% nationally during the 2022-2023 school year. This marked a 0.4 percentage point rise from the prior year and constituted the highest rate since data collection began. Medical exemptions remained at 0.7%. The number of students considered not up-to-date with their vaccinations, but not formally exempted, also saw an increase. This group grew to 4.1% of kindergarteners, up from 3.9% in the 2021-2022 school year. Public health analyses indicate that approximately 250,000 kindergarteners lacked complete vaccination records for measles, either due to an exemption or being not up-to-date.