Vaccine exemptions and the kindergarten vaccination coverage gap

Volume 35, Issue 40, Pages 5309-5434 (25 September 2017)

Original Research Article
Vaccine exemptions and the kindergarten vaccination coverage gap
Original Research Article
Pages 5346-5351
Philip J. Smith, Jana Shaw, Ranee Seither, Adriana Lopez, Holly A. Hill, Mike Underwood, Cynthia Knighton, Zhen Zhao, Megha Shah Ravanam, Stacie Greby, Walter A. Orenstein
Vaccination requirements for kindergarten entry vary by state, but all states require 2 doses of measles containing vaccine (MCV) at kindergarten entry.
To assess (i) national MCV vaccination coverage for children who had attended kindergarten; (ii) the extent to which undervaccination after kindergarten entry is attributable to parents’ requests for an exemption; (iii) the extent to which undervaccinated children had missed opportunities to be administered missing vaccine doses among children whose parent did not request an exemption; and (iv) the vaccination coverage gap between the “highest achievable” MCV coverage and actual MCV coverage among children who had attended kindergarten.
A national survey of 1465 parents of 5–7 year-old children was conducted during October 2013 through March 2014. Vaccination coverage estimates are based provider-reported vaccination histories. Children have a “missed opportunity” for MCV if they were not up-to-date and if there were dates on which other vaccines were administered but not MCV. The “highest achievable” MCV vaccination coverage rate is 100% minus the sum of the percentages of (i) undervaccinated children with parents who requested an exemption; and (ii) undervaccinated children with parents who did not request an exemption and whose vaccination statuses were assessed during a kindergarten grace period or period when they were provisionally enrolled in kindergarten.
Among all children undervaccinated for MCV, 2.7% were attributable to having a parent who requested an exemption. Among children who were undervaccinated for MCV and whose parent did not request an exemption, 41.6% had a missed opportunity for MCV. The highest achievable MCV coverage was 98.6%, actual MCV coverage was 90.9%, and the kindergarten vaccination gap was 7.7%.
Vaccination coverage may be increased by schools fully implementing state kindergarten vaccination laws, and by providers assessing children’s vaccination status at every clinic visit, and administering missed vaccine doses.