2 tables omitted
One of the national health objectives for 2010 is to sustain ≥95%
vaccination coverage among children in kindergarten through first grade (objective
14-23).1 To determine the percentage of vaccination
coverage among children entering kindergarten, data on vaccination coverage
were analyzed from reports submitted to the National Immunization Program
by states, the District of Columbia (DC),* and eight current or former U.S.
territories for the 2003-04 school year. This report summarizes the results
of that analysis, which determined that coverage for all vaccines except hepatitis
B (HepB) and varicella was reported at >90% in 45 areas. However, the vaccines
required in each reporting area and the methods for surveying kindergarten-aged
children vary substantially; in seven states, <20% of eligible children
were surveyed. The wide variations in survey populations underscore the need
for CDC to continue working with immunization programs in states, DC, and
current or former territories to improve survey methods and automate reporting
For the 2003-04 school year, all states except one submitted reports
of vaccination coverage levels for children entering kindergarten. Fifty reports
included coverage for poliovirus vaccine, diphtheria and tetanus toxoids and
pertussis vaccine, diphtheria and tetanus toxoids and acellular pertussis
vaccine, or diphtheria and tetanus toxoids (DTP/DTaP/DT), measles vaccine,
and rubella vaccines; 49 reports included coverage for mumps vaccine. Coverage
for HepB vaccine was included in 43 reports, and coverage for varicella vaccine
was included in 33 state reports. DC reported on all of the vaccination coverages.
When determining coverage, up-to-date (UTD) status was used rather than number
of doses because the doses required to be UTD vary depending on timing of
vaccinations, area requirements regarding number of doses, and brand of vaccines.
The number of state reports based on 100% of children entering kindergarten
increased from 18 in the 2002-03 school year to 22 in 2003-04.2 In
an additional 21 states, coverage was assessed in surveys of >80% of eligible
children. In the remaining seven states, coverage was assessed in surveys
of <20% of eligible children (range: 0.5%-18.5%). National estimates of
coverage were calculated by weighting each state’s coverage estimate
by the size of the state’s kindergarten enrollment.
Coverage for all vaccines except HepB and varicella was reported at
90%-95% in 16 (31.3%) states and at >95% in 29 (56.9%) states (Table 1). Nationally,
coverage was reported at >95% for all vaccines except varicella, for which
coverage was 93.3%.
Five (63%) of the eight current or former U.S. territories reported
data for the 2003-04 school year. All five reports included coverage for poliovirus
vaccine, DTP/DTaP/DT vaccine, and vaccines for measles, mumps, rubella, and
HepB. Two territories reported coverage for 1 dose of varicella vaccine. The
percentage of children surveyed by the current or former U.S. territories
ranged from 10.0% to 100.0%. Coverage for all vaccines except DTP/DTaP/DT
vaccine was reported to be >86%.
B Lyons, MPH, C Stanwyck, PhD, Immunization Svcs Div; M McCauley, MTSC,
National Immunization Program, CDC.
CDC has increased efforts to help states and current or former U.S.
territories collect and report data on vaccination coverage among children
entering school by providing a new online reporting system, available since
the 2002-03 school year. Anecdotal reports from states indicate that the online
reporting system, which automates data management and calculation tasks, has
made it easier for states to report their coverage. CDC also has encouraged
greater standardization of reporting; unlike previous reports, this report
is based only on coverage among children entering kindergarten, rather than
on a mix of those children and first graders.
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.3 This
safety net relies on the efforts of school nurses, teachers, and others to
identify children who are not UTD. Findings of uniformly high nationwide coverage
during the 2002-03 and 2003-04 school years underscore the success of school
entry requirements in boosting vaccine coverage. Childhood vaccination coverage
is also measured nationally among children aged 19-35 months.4 Higher
percentages of children are UTD at kindergarten entry than at younger ages,
suggesting that school entry laws are a key to ensuring high 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 substantial variation in sampling
methods among states limits the comparability of these data. Second, children
attending private schools and those who are home-schooled were not surveyed
by all states. The difference in vaccination rates between children schooled
at home and children in traditional school environments is unknown.
Additional information about assessing and reporting vaccination 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 at firstname.lastname@example.org.
*For this report, DC is included in state totals.
Vaccination Coverage Among Children Entering School—United States, 2003-04 School Year. JAMA. 2004;292(23):2830–2831. doi:10.1001/jama.292.23.2830