1 table omitted
All states require proof of vaccination for children before school entry,
and a summary of that coverage is reported to CDC. Rather than reporting vaccination
status on school entry, state reports to CDC reflect coverage attained after
evaluating students' vaccination status and ensuring that all children receive
required vaccines. School vaccination requirements have been credited with
ensuring high coverage,1,2 and one of the national health objectives
for 2010 is to sustain ≥95% vaccination coverage among children in kindergarten
through the first grade (objective 14-23).3 This report presents
data regarding vaccination coverage from the 50 states and the District of
Columbia (DC)* for the 2002-03 school year, which highlight high reporting
rates and overall high coverage. Findings indicate that vaccines required
by each state and the methods for surveying schools vary. CDC is working with
states to standardize data collection procedures.
For the 2002-03 school year, 49 (96.1%) states submitted vaccination
coverage levels for children enrolled in kindergarten and/or first grade.
All 49 states reported coverage for ≥3 doses of poliovirus vaccine, ≥1
dose of measles-containing vaccine, ≥1 dose of mumps-containing vaccine,
and ≥1 dose of rubella-containing vaccine. For diphtheria and tetanus toxoids
and acellular pertussis vaccine, 39 (76.5%) states reported coverage for ≥4
doses, and 10 (19.6%) reported coverage for ≥3 doses; 39 states also reported
coverage for 3 doses of hepatitis B (HepB) vaccine.
Coverage for all vaccines except HepB was reported to be ≥95% in
29 (56.9%) states and ≥90% in 45 (88.2%) states. A total of 18 states based
reports on a census of children entering kindergarten and first grade, 15
states on surveys of >95% of children, and five states on surveys of <50%
of children (range: 5.1%-42.2%). National estimates of coverage were calculated
by weighting each state's coverage estimate by the size of the state's birth
cohort; all national estimates were >95%.
K Shaw, MS, C Stanwyck, PhD, Data Management Div; M McCauley, MTSC,
National Immunization Program, CDC.
Since the previous report on vaccination coverage for the 2000-01 school
year,4 reporting increased from 36 (70.6%) states to 49 (96.1%)
states. CDC has increased efforts to support states in collecting and reporting
coverage among children entering school. One component of this increased effort
is a new online reporting system that automates data management and calculation
State laws requiring proof of vaccination before entering school have
been referred to as a "safety net" for the U.S. vaccination program because
they ensure that no child is missed.1 The safety net relies on
the efforts of school nurses, teachers, and others to identify children who
need ≥1 dose of vaccine. A recent survey of school nurses in DC indicated
that approximately 50% of children needed one or more vaccinations to meet
DC's school entry requirements (CDC, unpublished data, 2002). Findings of
uniformly high nationwide coverage during the 2002-03 school year underscore
the success of school entry requirements in boosting vaccine coverage.
The findings in this report are subject to at least two limitations.
First, methods for assessing vaccination coverage among children entering
school vary because state and local laws determine which vaccines and doses
are required, and sampling methods differ. The resulting variation in sampling
methods among states limits the generalizability and comparability of these
data. Second, children attending private schools and those who are home-schooled
were not surveyed by all states. Population-based vaccination registries might
someday provide uniform, reliable data on the vaccination status of children
entering school, saving resources now devoted to gathering and processing
children's vaccination histories.
The findings in this report supplement those of the National Immunization
Survey,5 which describe vaccination coverage among preschool-aged
children. Together, these reports provide a comprehensive view of vaccination
coverage among U.S. children.
Additional information about assessing and reporting coverage among
children entering school is available from the National Immunization Program
Immunization Information Hotline, telephone 800-232-2522 (English) or 800-232-0233
(Spanish), or by e-mail, firstname.lastname@example.org.
References: 5 available
*For this report, the District of Columbia is included as a state.
Vaccination Coverage Among Children Entering School—United States, 2002-03 School Year. JAMA. 2003;290(11):1446. doi:10.1001/jama.290.11.1446