Routine vaccine uptake among US kindergartners continues to fall amid a rising rate of exemptions, according to the latest data from the Centers for Disease Prevention and Control (CDC).
The data, posted yesterday on the CDC website, show that vaccination coverage for all children entering kindergarten in the 2024-25 school year declined for all reported vaccines from the year before, continuing a multiyear trend that is raising concerns among public health experts. Uptake of the measles, mumps, rubella (MMR) vaccine fell to 92.5%, down from 92.7% last year and 95.2% in the 2019-20 school year. The vaccine exemption rate rose to 4.1%.
The continued decline in MMR vaccine coverage comes amid the worst year for measles in the United States since the disease was declared eliminated in 2000. According to the CDC's most recent update, there have been 1,333 confirmed measles cases this year, surpassing the previous post-elimination high of 1,274, set in 2019. National MMR vaccine coverage needs to be at least 95% to prevent outbreaks and maintain elimination status.
Other vaccines that saw declining uptake include the diphtheria, tetanus, and acellular pertussis (DTaP) shot, which fell to 92.1%, down from 92.3% last year and 94.9% in 2019-20. The percentage of children with who received two doses of the varicella vaccine also fell to 92.1%, down from 92.3% in 2023-24 from 94.8% in 2019-20. Uptake of the polio vaccine dropped to 92.5%, down from 92.7% last year and 95% in 2019-20.
The CDC noted that coverage with the MMR, DTaP, polio, and varicella vaccines declined from the previous year in more half of states. But unlike last year's CDC report on vaccine coverage among US kindergartners, which was published in Morbidity and Mortality Weekly Report and contained a discussion on the implications of declining vaccination rates, the new data are not accompanied by any messaging on the importance of routine vaccine coverage.
That omission appears to have been noticed by the president of the American Academy of Pediatrics (AAP).
"As pediatricians, we know that immunizing children helps them stay healthy, and when everyone can be immunized, it's harder for diseases to spread in our communities," Susan Kressly, MD, said in statement. "At this moment when preventable diseases are on the rise, we need clear, effective communication from government leaders recommending immunizations as the best way to ensure children’s immune systems are prepared to fight dangerous diseases."
Rising rate of vaccine exemptions
The CDC data also show that vaccine exemptions, for the fourth year in a row, have hit a new record high. The percentage of kindergartners with an exemption from one or more vaccine rose from 3.3% in 2023-24 to 3.6% in 2024-25. In the 2020-21 school year, 2.5% of children entering kindergarten had an exemption.
The number of children with exemptions for one or more vaccines in 2024-25 was about 138,000, the CDC said. Exemptions increased in 36 states and the District of Columbia, with 17 states reported exemption rates exceeding 5%. The highest vaccine exemption rate (15.4%) was in Idaho.
The vast majority of exemptions from school immunization requirements were for nonmedical reasons, an issue that was addressed by the AAP earlier this week in a revised policy statement. While all states and territories allow medical exemptions, 45 states also allow religious exemptions from immunization requirements, and 15 of those states additionally allow exemptions for personal beliefs and philosophical or conscientious objections.
At this moment when preventable diseases are on the rise, we need clear, effective communication from government leaders recommending immunizations as the best way to ensure children’s immune systems are prepared to fight dangerous diseases.
The AAP said that while there continues to be a place for legitimate medical exemptions from immunization, exempting children for nonmedical reasons is "problematic for medical, public health, and ethical reasons and creates unnecessary risk to both individuals and communities."
AAP is among the groups that have been critical of Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. over changes he's made to US vaccine policy since taking the helm at HHS, including his decision to fire all 17 members of the CDC's Advisory Committee on Immunization Practices. AAP and several other medical groups also last month filed suit against Kennedy for making unilateral changes to COVID-19 vaccine recommendations for children and pregnant women.
But as the CDC data show, declining vaccine coverage among US kindergartners predates Kennedy and appears to have picked up speed since the beginning of the COVID-19 pandemic. In last year's MMWR paper, authors from the CDC's National Center for Immunization and Respiratory Services noted that in a 2024 survey of US parents, 8.3% disagreed with the statement that school and childcare vaccine requirements are "important and necessary." Another 15% had no opinion.
"These results could indicate changes in attitudes toward routine vaccination transferring from hesitancy about COVID-19 vaccination, or toward any vaccine requirements arising from objections to COVID-19 vaccine mandates, as well as a potential for larger decreases in coverage or increases in exemptions," the authors wrote.
