Vaccination Rates for Kindergartners Fall Below Level Needed to Prevent Outbreaks

This level of coverage reflects a decrease from the 95% seen in the 2019-20 school year, before the COVID-19 pandemic.

health security
public health

Information Epidemiology Lab


November 12, 2023

Summary of Findings

  • Vaccination Coverage: In the 2022–23 school year, coverage for state-required vaccines among kindergartners in the U.S. remained near 93%. This coverage included vaccines for measles, mumps, rubella (MMR), diphtheria, tetanus, acellular pertussis (DTaP), poliovirus (polio), and varicella (VAR). This level of coverage reflects a decrease from the 95% seen in the 2019-20 school year, before the COVID-19 pandemic.
  • Exemption Rates: The exemption rate from school vaccine requirements increased to 3.0%, up 0.4 percentage points from the previous year. Exemptions rose in 41 states, with 10 states exceeding a 5% exemption rate.
Figure 1: Change in percentage of kindergartners exempt from one or more vaccinations, 2021–22 and 2022–23 school years
  • Geographical Variance: There were significant state-level variations in both vaccination coverage and exemption rates. See the data: CDC Dashboard.
Figure 2: Source: National Center for Immunization and Respiratory Diseases

Key Takeaways

  • Vaccination Coverage Below Targets: The current national vaccination coverage for kindergartners is below the optimal level (95%) needed to prevent outbreaks of vaccine-preventable diseases.
  • Rising Exemption Rates: The increasing trend in vaccine exemptions, particularly non-medical ones, is a significant concern for public health.
  • Communities Must Act: Efforts are needed from public health authorities, schools, and healthcare providers to ensure higher vaccination rates among children, including addressing the reasons behind rising exemption rates and barriers to vaccination.

Implications for Public Health

  • Risk of Disease Outbreaks: The increase in exemption rates and the slight decrease in vaccination coverage could heighten the risk of outbreaks of vaccine-preventable diseases. Exemptions over 5% in certain states limit the achievable level of vaccination coverage, crucial for maintaining herd immunity. Measles, for example, requires vaccination rates over 90% to prevent the spread of disease.
  • Targeting Pre-School Vaccination: To mitigate this risk, the report suggests strategies like vaccinating children before school entry or during provisional enrollment periods, to address barriers to vaccination, possibly heightened by the COVID-19 pandemic.
  • Public Health Initiatives: The need for public health initiatives, such as school-based vaccination clinics, reminder systems, and policies to address nonmedical exemptions, is emphasized to increase vaccination rates back to pre-pandemic levels.
Figure 3: Potentially achievable coverage with measles, mumps, and rubella vaccine among kindergartners, by jurisdiction — United States, 2022–23 school year


Seither R, Yusuf OB, Dramann D, Calhoun K, Mugerwa-Kasujja A, Knighton CL. Coverage with Selected Vaccines and Exemption from School Vaccine Requirements Among Children in Kindergarten — United States, 202223 School Year. MMWR Morb Mortal Wkly Rep 2023;72:12171224. DOI:


BibTeX citation:
  author = {InfoEpi Lab},
  publisher = {Information Epidemiology Lab},
  title = {Vaccination {Rates} for {Kindergartners} {Fall} {Below}
    {Level} {Needed} to {Prevent} {Outbreaks}},
  journal = {InfoEpi Lab},
  date = {2023-11-12},
  url = {},
  langid = {en}
For attribution, please cite this work as:
InfoEpi Lab. 2023. “Vaccination Rates for Kindergartners Fall Below Level Needed to Prevent Outbreaks.” InfoEpi Lab, November.