Routine vaccinations drop among U.S. kindergartners for the third year in a row

The percentage of U.S. kindergartners who’ve received standard childhood vaccines took a small but notable dip into the 2021-2022 school year, health officials said Thursday, amid disruptions related to Covid-19 and fears that anti-vaccine sentiment stirred up by the pandemic could be spreading to other shots.

Vaccinations among children remain high, but the trend — with coverage dropping from about 95% in the 2019-2020 school year to 94% in 2020-2021 to 93% in 2021-2022, according to the data released Thursday — has health officials concerned. Having that rate of kindergartners vaccinated against measles, for example, means that at least 250,000 kindergarteners could be unprotected.

“This is alarming and should be a call to action to all of us,” said Sean O’Leary, the chair of the American Academy of Pediatrics’ Committee on Infectious Diseases.

The new data, published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, looked at uptake of routine childhood vaccinations, including the measles, mumps, and rubella (MMR) shot; the diphtheria, tetanus, and acellular pertussis (DTaP) shot; and the shots against poliovirus and varicella (chickenpox). Overall, the CDC recommends routine vaccination against 14 diseases during the first two years of a child’s life.

Though there was some variation in uptake among the different vaccinations, all the shots saw a 0.4 to a 0.9 percentage point drop in coverage from 2020-2021 to 2021-2022, the CDC reported.

Currently, all states and Washington, D.C., require children to be vaccinated against certain diseases to go to public school, with limited exemptions. The new survey found that although 2.6% of kindergartners had an exemption for at least one vaccine, an additional 3.9% of kids who did not have an exemption were not up to date with their MMR shots.

MMR coverage is as low as it’s been in a decade, officials said.

The fear is that such a drop could leave more children vulnerable to vaccine-preventable conditions — and in turn lead to outbreaks. Last year, officials in several New York counties detected polioviruses in wastewater, for example. The Columbus, Ohio, area has been experiencing a measles cluster.

“Outbreaks like this are entirely preventable,” O’Leary said, noting such a public health issue “affects everyone in these communities.”

Part of the issue with the drop in vaccination rates seems to stem from pandemic-related interruptions in children’s medical visits as well as in-person schooling. The CDC released another report on Thursday that found, for example, that vaccination coverage of certain shots dropped by 4 to 5 percentage points among babies living in poverty or in rural areas during the pandemic. That report also found that Black and Hispanic children were more likely to be unvaccinated or undervaccinated compared to white children at 24 months, and that the proportion of unvaccinated children was 8 times higher among uninsured kids than kids with private insurance.

It’s also possible that anti-vaccine sentiment, inflamed during the Covid-19 pandemic, is widening. A survey released last month from the Kaiser Family Foundation found that a third of parents oppose public school vaccine requirements, up from 23% in 2019.

Covid-19 vaccine hesitancy “in some cases has translated over to routine vaccinations, and that’s something we’re watching very closely,” said Georgina Peacock, the director of CDC’s Immunization Services Division.

Health officials said they haven’t seen an increase in vaccine exemptions nationally, but noted that amid the return to in-person teaching, many families and schools are still catching up on documentation — whether it’s proof of vaccination or exemption requests. Because of the disruption caused by the pandemic, many children have been allowed to attend public schools without showing proof of vaccination during a sort of grace period.

To improve vaccine uptake, health officials recommended that schools and officials enforce vaccination requirements, start school-based vaccine clinics, and follow up with unvaccinated students and their families.

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