BQ Journal Vol 48 - Q3 2022 - 19

Morbidity and Mortality Weekly Report
FIGURE 2. Potentially achievable coverage*,† with measles, mumps, and rubella vaccine
among kindergartners, by state - 47 states§ and District of Columbia, 2020-21 school year
Wisconsin
Idaho
South Dakota
Montana
Hawaii
Colorado
Arizona
Utah
Oregon
North Dakota
Maine
Wyoming
Florida
Nevada
New Hampshire
Georgia
Pennsylvania
Michigan
South Carolina
Connecticut
New Jersey
Minnesota
Delaware
Missouri
Oklahoma
Iowa
Vermont
Kansas
Tennessee
Texas
Washington
Indiana
Ohio
North Carolina
Alabama
Nebraska
Virginia
Arkansas
Massachusetts
Rhode Island
Maryland
New Mexico
Kentucky
Louisiana
District of Columbia
California
Mississippi
New York
0708090100
Percentage of coverage
Abbreviation: MMR = measles, mumps, and rubella vaccine.
* States are ranked from lowest to highest by potentially achievable coverage. Potentially achievable
coverage was estimated as the sum of the percentage of students with up-to-date MMR and the
percentage of students without up-to-date MMR and without a documented vaccine exemption.
† The exemptions used to calculate the potential increase in MMR coverage for Arizona, Arkansas,
Colorado, District of Columbia, Idaho, Maine, Massachusetts, Michigan, Minnesota, Missouri,
Nebraska, Nevada, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island,
Texas, Utah, Vermont, and Wisconsin were the number of children with exemptions specifically for
MMR vaccine. For all other states, numbers were based on an exemption to any vaccine.
§ Alaska, Illinois, and West Virginia did not report kindergarten vaccination coverage for the 2020-21
school year and are excluded from this analysis.
MMR coverage
MMR not up to
date and no
vaccine
exemption
Target MMR
coverage of
95%
by local health departments. These barriers
included schools closing or shifting to virtual
learning, many states effectively easing vaccination
requirements, and the reassigning of state
and local health departments' staff members to
response activities.
Among children aged 4-6 years, vaccination
coverage is higher among those in kindergarten
than among those not yet in kindergarten (9).
Although coverage among kindergartners was
lower in the 2020-21 school year than in 2019-
20 for all reported vaccines, vaccination coverage
might be lower among kindergarten-age
children whose school entry has been delayed.
Vaccination coverage could be improved by
increased outreach by schools and immunization
programs to first-time students, including
kindergartners and first graders, and by followup
with undervaccinated students. As schools
return to in-person learning, high vaccination
coverage is necessary to continue protecting
students from vaccine-preventable diseases.
Acknowledgment
CDC Foundation's COVID-19 Emergency Response.
Corresponding author: Ranee Seither, rseither@cdc.gov,
404-639-8693.
1Immunization Services Division, National Center for
Immunization and Respiratory Diseases, CDC; 2Association
of Schools & Programs of Public Health, Washington, DC.
3Certified Technical Experts, Inc., Montgomery, Alabama.
All authors have completed and submitted the
International Committee of Medical Journal Editors
form for disclosure of potential conflicts of interest.
No potential conflicts of interest were disclosed.
References
1. Omer SB, Salmon DA, Orenstein WA, deHart MP,
Halsey N. Vaccine refusal, mandatory immunization,
and the risks of vaccine-preventable diseases. N Engl J
Med 2009;360:1981-8. PMID:19420367 https://doi.
org/10.1056/NEJMsa0806477
2. CDC. SchoolVaxView. Atlanta, GA: US Department
of Health and Human Services, CDC; 2019. https://
www.cdc.gov/vaccines/imz-managers/coverage/
schoolvaxview/data-reports/index.html
3. Seither R, McGill MT, Kriss JL, et al. Vaccination
coverage with selected vaccines and exemption rates
among children in kindergarten-United States,
2019-20 school year. MMWR Morb Mortal Wkly Rep
2021;70:75-82. PMID:33476312 https://doi.
org/10.15585/mmwr.mm7003a2
US Department of Health and Human Services/Centers for Disease Control and Prevention
MMWR / April 22, 2022 / Vol. 71 / No. 16
567
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A Henry Schein Publication

https://doi.org/10.1056/NEJMsa0806477 https://doi.org/10.1056/NEJMsa0806477 https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/data-reports/index.html https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/data-reports/index.html https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/data-reports/index.html https://doi.org/10.15585/mmwr.mm7003a2 https://doi.org/10.15585/mmwr.mm7003a2

BQ Journal Vol 48 - Q3 2022

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