Kindergarten Vaccination Coverage and Exemptions, 2023–24 School Year

In the United States, states and local jurisdictions decide which vaccines children need to attend school, how families can be exempted, and how long students may attend while catching up. Each year states report to CDC how many kindergartners meet the requirements, are exempt, or are still working toward them. CDC's report on the 2023–24 school year, based on data from 49 states and the District of Columbia, found coverage falling again and exemptions at a record high. (The report was later corrected by an erratum; this page uses the corrected figures.)

The trend

For about 10 years, national coverage with the main school-entry vaccines held near 95%. It dropped to about 93% over the 2020–21 and 2021–22 school years, stayed there in 2022–23, and did not recover after the pandemic's effects faded. The 2023–24 kindergarten class became old enough for most of its required doses during the COVID-19 pandemic, after schools had returned to in-person learning.

Coverage in 2023–24

Coverage fell below 93% for every vaccine measured:

Compared with the year before, coverage fell for MMR in 35 jurisdictions, for DTaP in 32, for polio in 33 and for varicella in 36. It was the fourth year in a row below the Healthy People 2030 target of 95% MMR coverage. About 280,000 kindergartners (7.3%) had no record of two MMR doses and were potentially at risk of measles.

Exemptions

Nationally, 3.3% of kindergartners had an exemption from at least one required vaccine — 0.2% medical and 3.1% nonmedical — up from 3.0% in 2022–23 and 2.6% in 2021–22. It was the highest percentage ever reported. Nonmedical exemptions made up more than 93% of all exemptions and almost all of the increase.

• Exemptions rose in 41 jurisdictions.
• They were above the national rate in 30 states.
• They exceeded 5% in 14 states, up from two in 2020–21. They ranged from under 0.1% in West Virginia to 14.3% in Idaho.
• States with rising exemptions were spread across every U.S. Department of Health and Human Services region.

CDC chart: kindergartners exempt from one or more vaccines, by state, 2023–24.

Could states still reach 95%?

Another 4.0% of kindergartners were neither fully vaccinated with MMR nor exempt — children in a grace period, provisionally enrolled, or simply without complete records. If all of them were vaccinated, national MMR coverage could reach 96.8%.

But in some states exemptions alone now rule out the target. In 2020–21, two jurisdictions could not reach 95% MMR coverage even if every nonexempt kindergartner were vaccinated; in 2023–24, 13 could not. Among the 31 states reporting it, 2.6% of kindergartners were attending under a grace period or provisional enrollment, from 0.3% in Delaware to 8.0% in Arkansas.

Why it matters and what helps

Falling coverage and rising exemptions allow clusters of undervaccinated children to build up, which can lead to outbreaks. In a 2024 survey of parents, 8.3% disagreed that school and child care vaccination requirements are important and necessary, and 15.2% had no opinion. The authors suggest this could reflect hesitancy about COVID-19 vaccines spreading to routine vaccines, or objections to COVID-19 vaccine mandates spreading to requirements generally.

States have tried narrowing the kinds of exemption allowed (for example, to medical only), requiring notarized exemption forms, and making sure school practice matches state law. Approaches known to raise coverage include:

• enforcing school vaccination requirements;
• vaccination clinics at school;
• reminder and recall systems;
• strong recommendations from providers; and
• following up with undervaccinated students.

Schools can help families avoid taking an exemption simply because a deadline was hard to meet, and can share vaccination and exemption data with health departments as state rules and federal law allow. Providers can talk with parents about the safety and effectiveness of the required vaccines and the risks of delaying or skipping them. CDC's Vaccines for Children program helps keep coverage up among children who are uninsured, publicly insured, or American Indian or Alaska Native, and its Let's RISE initiative supports jurisdictions with the largest declines.

Limitations

• Requirements, assessment dates, documentation, data collection and exemption rules differ between jurisdictions, limiting comparison.
• Collection methods may miss some schools or students, such as homeschooled children.
• Inaccurate or missing records could push estimates up or down.
• Montana did not report, and some states reported only lower-bound estimates.

Sources

• Ranee Seither, Oyindamola Bidemi Yusuf, Devon Dramann, Kayla Calhoun, Agnes Mugerwa-Kasujja, Cynthia L. Knighton, Jennifer L. Kriss, Rebecca Miller and Georgina Peacock, "Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2023–24 School Year," Morbidity and Mortality Weekly Report, CDC, with its published erratum: https://www.cdc.gov/mmwr/volumes/73/wr/mm7341a3.htm
• The report's second figure, on jurisdictions unable to reach 95% MMR coverage, predates the correction and disagrees with the corrected text, so it is not reproduced.