By Marie Rosenthal, MS
National vaccination coverage among kindergarten children in the United States dropped to 93% during the 2021-2022 school year—the lowest rate in the past decade, according to Georgina Peacock, MD, MPH, FAAP, the director of the Immunization Services Division, who released two reports about routine childhood vaccinations in this country.
“This marks a one percentage point decline since the 2019-2020 school year and a two percentage point drop since the start of the pandemic,” Dr. Peacock noted. “While this might not sound significant, it means nearly 250,000 kindergartners are potentially not protected against measles alone, and we know that measles-mumps-rubella (MMR) vaccination coverage for kindergartners is the lowest it has been in over a decade.”
The two reports updated the effect of the COVID-19 pandemic on routine childhood immunizations. The first report was based on data collected by state and local immunization programs.
That report found that nationwide coverage with two doses of MMR vaccine was 93.5%; diphtheria, tetanus and acellular pertussis (DTap) was 93.1%; poliovirus was 93.5%; and varicella vaccine was 92.8%. However, there were some concerning disparities, especially among children living below the poverty line, those in rural areas, and among some Black and Hispanic children, according to one report (MMWR Morb Mortal Wkly Rep 2023:72[2]:26-32).
The second report was more encouraging, showing that national coverage by age 24 months remained strong with most vaccines, and even saw increases among children born in 2018 and 2019, compared with those born in 2016 and 2017. This analysis was based on data from the National Immunization Survey (MMWR Morb Mortal Wkly Rep 2023:72[2]:33-38).
“While we continue to monitor the impact of the pandemic, we are encouraged that this report did not identify a national drop in vaccination coverage among children aged 24 months at the beginning of the pandemic,” Dr. Peacock said. “However, these new findings also revealed persistent and in some cases, widening disparities in coverage.”
Although overall coverage remained steady, vaccinations for some children decreased 4% to 5%, according to the report.
“The report also found the percentage of uninsured children not vaccinated by their second birthday was eight times that of privately insured children,” Dr. Peacock said.
Under- or unvaccinated children can cause outbreaks of preventable diseases, as were seen recently in two measles outbreaks and one case of paralytic polio.
“In 2022, two communities in the United States responded to outbreaks of measles, where children have been hospitalized, and one community reported a case of paralytic polio in an unvaccinated person. These outbreaks were preventable,” Dr. Peacock said.
“We know that it benefits all of us if every child in our community is vaccinated,” added Sean O’Leary, MD, FAAP, the chair of the American Academy of Pediatrics’ Committee on Infectious Diseases. “Not only does it mean all of the children in our community are protected, but it also means that all of us are more likely to be healthy. Everyone in our community deserves to be healthy.
“These data show a decline of two percentage points nationwide in a number of fully vaccinated kindergartners since the start of the pandemic that translates to hundreds of thousands of children starting school without being fully protected against measles, mumps, whooping cough and other diseases that can easily spread in classrooms. It's important to emphasize again that this affects everyone in these communities,” he said.
“A particular concern in these reports is the disparities described. Children who are poor, who live in rural areas who lack health insurance, or who are Black or Hispanic were more likely to be unvaccinated by age 24 months. This illustrates that we have significant work to improve access to care.
“We know barriers such as lack of access to transportation, healthcare services, or paid time off work create significant challenges for some families to be vaccinated. These are problems that we can solve as pediatricians.”
The reasons for the drop in vaccinations are varied, they said, and stem from vaccine hesitancy, misinformation, school closings during the pandemic and other issues.
“I think part of it is that well child visits maybe were missed, and people are still trying to catch up on those well child visits,” Dr. Peacock said.
Schools were focused on educating children in a new way through online learning, which was difficult. Twenty-seven states reported that they were allowing a grace period this school year for obtaining vaccinations, whereby children can still attend school for a certain period while they catch up on their vaccinations.
Some of the hesitancy about vaccinating children against COVID-19 also seems to be spilling over into routine vaccinations, which is “something we’re watching very closely,” Dr. Peacock said.
“I think it's complicated why we've seen this drop,” Dr. O’Leary said, adding that the reports contained some encouraging data, particularly that exemptions for non-medical reasons do not appear to be increasing and very young children do appear to be catching up.
The number of those who are 24 months old who have received no vaccinations, “that number has actually gone down,” so the vast majority of parents are still vaccinating their children, he explained.
Dr. O’Leary urged parents to speak with their healthcare provider about vaccinations and making sure that children are protected against diseases.
