By Ethan Covey
Childhood vaccination rates have declined substantially across most of the contiguous United States, increasing the risk for outbreaks of vaccine-preventable diseases.
Analysis of state and school immunization records from 2019 through 2024 showed that 77% of U.S. counties experienced decreased vaccination coverage for routine pediatric vaccines, according to data released by NBC News and Stanford University.
Mean county-level vaccination rates fell from nearly 94% before the COVID-19 pandemic to approximately 91% in 2024.
For the measles, mumps, and rubella vaccine, 68% of counties with available data are now below the 95% threshold generally required to maintain herd immunity. Rates of exemptions—medical, religious, or personal belief—have also increased: In more than half of the counties, exemption rates have more than doubled compared with the first year of reporting.
“These findings in children mirror what we are seeing in adults—declining rates of vaccination across populations,” said Robert M. Rodriguez, MD, a professor of medicine and the associate dean of Clinical and Population Health Research, University of California, Riverside School of Medicine.
Recent infectious disease outbreaks—such as measles outbreaks in Texas, Arizona, and Utah—underscore the public health consequences of declining immunization rates. of Oct. 7, 1,563 cases of measles have been confirmed in 41 states and New York City, which is its own jurisdiction for surveillance, according to the CDC.
“There is little doubt that these are linked [to lack of vaccination and increased measles cases],” Dr. Rodriguez said. “Unless we reverse those trends, we’re going to see more and more outbreaks.”
Even modest declines in national averages may mask concentrated areas of susceptibility. Localized clusters of under-immunization pose a particular risk, especially for highly transmissible diseases such as measles, which requires vaccination coverage higher than 95% coverage to prevent sustained transmission.
Dr. Rodriguez highlighted that the data should be used to identify opportunities for intervention and as a call for action.
“This should be seen as an opportunity to try to reverse these trends, which really begins with combating misinformation about vaccines,” he said.
While federal efforts to counter vaccine misinformation remain limited, regional and local initiatives, such as the West Coast Health Alliance (WCHA), are emerging. The WCHA, which was created in September, is a coalition of leaders from California, Oregon, Washington, and Hawaii, and has stated a goal of providing unified, science-based vaccine recommendations.
“If efforts to combat misinformation are not led federally, then that becomes a call for state, local, and regional groups to step in and reverse the situation,” Dr. Rodriguez said.
In related and more positive news from an August report, coverage of tetanus, diphtheria, and acellular pertussis vaccine (Tdap), quadrivalent meningococcal conjugate vaccine (MenACWY), meningococcal B vaccine, and hepatitis B vaccine increased among adolescents aged 13-17 years in 2024 compared with 2023 (MMWR Morb Mortal Wkly Rep 2025;74:466–472).
The study used data from the 2024 National Immunization Survey-Teen, which included 16,325 adolescents aged 13–17 years with adequate provider data included in the survey. Among this group, coverage with ≥1 Tdap dose increased from 89.0% in 2023 to 91.3% in 2024; coverage with ≥1 MenACWY dose increased from 88.4% to 90.1%. Additionally, coverage of ≥2 doses of measles, mumps, and rubella (MMR) vaccine increased from 91.3% to 92.6%; coverage with ≥1 dose of meningococcal B vaccine rose from 32.4% to 36.9%; and receipt of ≥3 doses of the hepatitis B vaccine increased from 90.9% to 92.2%.
Coverage with at least one Tdap dose 90% or more in 39 states, with at least one dose of MenACWY was 90% or more in 30 states, and with at least one dose of HPV vaccine was 80% or more in 26 states and the District of Columbia.
These findings, the authors of the report wrote, “highlight progress in public health activities to improve vaccination coverage.”
However, human papillomavirus (HPV) vaccination coverage did not increase for the third consecutive year and continues to vary by state and local area.
“For the last nine years (2016-2024), HPV vaccination coverage has remained lower among adolescents living in mostly rural areas compared with adolescents living in mostly urban areas,” said Gabriel Alvarado, CDC Public Affairs Specialist, Office of Communications, Office of the Director.
Other differences were seen between adolescents in rural and urban areas, with coverage of ≥1 dose of MenACWY lower among those living in mostly rural areas compared with those living in mostly urban areas.
“It’s important to mention that CDC continues to track teen vaccinations to determine increases and decreases in vaccination coverage to help address any gaps in coverage,” Mr. Alvarado said.
