BQ Journal Vol 48 - Q3 2022 - 18

Morbidity and Mortality Weekly Report
FIGURE 1. Change in measles, mumps, and rubella vaccine coverage,
any exemption, grace period or provisional enrollment, and no
documentation* among kindergartners, by state - 47 states,†
2019-20 to 2020-21 school year
National estimate
Median
Maryland
Wisconsin
Georgia
Wyoming
Kentucky
Ohio
Minnesota
Idaho
Oklahoma
Missouri
New Jersey
Texas
North Dakota
California
South Dakota
Massachusetts
Indiana
New Mexico
Utah
Pennsylvania
Arkansas
Connecticut
Arizona
Nebraska
Oregon
New Hampshire
Rhode Island
Montana
Colorado
South Carolina
Vermont
North Carolina
New York
Michigan
Florida
Tennessee
Mississippi
Washington
Maine
Iowa
Louisiana
Nevada
Hawaii
Virginia
Kansas
Alabama
Alaska
−15 −10 −5 05 10 15
Percentage point change
100
MMR coverage
Any exemption
Grace period or
provisional enrollment
No documentation
Summary
What is already known about this topic?
State immunization programs conduct annual kindergarten
vaccination assessments to monitor school entry vaccination
coverage with all state-required vaccines.
What is added by this report?
For the 2020-21 school year, coverage was approximately 94%
for all required vaccines, approximately one percentage point
lower than the previous school year. The exemption rate
remained low at 2.2%.
What are the implications for public health practice?
Disruptions caused by COVID-19 reduced reported enrollment,
school response rates, and documentation for the 2020-21
school year. Schools and immunization programs can increase
follow-up with undervaccinated students to reduce the impact
of COVID-19-associated disruptions on vaccination coverage to
protect students during the return to in-person learning.
year, 10% of school principals reported that fewer students were
fully vaccinated in that school year.§§§ Twenty-seven percent of
school nurses reported that fewer students were fully vaccinated
in the 2020-21 school year, and 46% of school nurses reported
that school vaccination requirements were a somewhat lower
or much lower priority compared with previous years (CDC,
Impact of the COVID-19 Pandemic on K-12 School Nurses
2020/2021 School Year, unpublished data, 2021). Decreases in
vaccine ordering and administration during 2020 also support
the measured decreases in coverage (5-8).
The findings in this report are subject to at least five limitaAbbreviation:
MMR = measles, mumps, and rubella vaccine.
* States are sorted from lowest to highest by change in MMR coverage (n = 46),
any exemption (n = 47), grace period or provisional enrollment (n = 28), and
no documentation (n = 29). Not all states reported data for all categories.
† Delaware and District of Columbia did not report for any categories for the
2019-20 school year, and Illinois and West Virginia did not report for any
categories for the 2020-21 school year. All were excluded from this analysis.
566
MMWR / April 22, 2022 / Vol. 71 / No. 16
tions. First, comparison between states is limited because of
variation in states' requirements such as vaccine required, number
of doses required, date required, and type of documentation
accepted; data collection methods; exemptions allowed; and
definitions of grace period and provisional enrollment. Second,
representativeness might be negatively affected because of data
collection methods that assess vaccination status at different
times or miss some schools or students, such as students who
were homeschooled. Third, vaccination coverage, exemption
rates, or both might be underestimated or overestimated
because of inaccurate or absent documentation or missing
schools. Fourth, national coverage estimates for the 2020-21
school year include only 47 of 50 states and DC but use lowerbound
estimates for nine states; exemption estimates include
48 states and DC but use lower-bound estimates for four
states, and grace period or provisional enrollment estimates
include only 28 states. Finally, the COVID-19 pandemic
response created various barriers that limited the amount and
quality of student vaccination data collected and reported
§§§ https://www.cdcfoundation.org/vaccine-triangulation-report?inline
US Department of Health and Human Services/Centers for Disease Control and Prevention
Diagnostics I Pharmaceuticals I DxRx Solutions I Continuing Education I News
18
A Henry Schein Publication
https://www.cdcfoundation.org/vaccine-triangulation-report?inline
BQ Journal Vol 48 - Q3 2022

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