TABLE. Estimated* coverage† with measles, mumps, and rubella vaccine (MMR), diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), and varicella vaccines, grace period/provisional enrollment,§ and any exemption¶ among children enrolled in kindergarten, by immunization program — United States, territories, and associated states, 2019–20 school year.
| Immunization program | Kindergarten population** | No. (%) surveyed†† | Coverage (%) |
Grace period/Provisional enrollment (%) | Any exemption (%) | Percentage point change in any exemption, 2018 to 2019 | ||
|---|---|---|---|---|---|---|---|---|
| MMR§§ 2 doses | DTaP¶¶ 5 doses | Varicella*** 2 doses | ||||||
|
National estimate†††
|
4,025,574
|
3,675,882 (91.3)
|
95.2
|
94.9
|
94.8
|
1.6
|
2.5
|
—
|
|
Median†††
|
NA
|
NA
|
94.6
|
94.4
|
94.6
|
1.6
|
2.7
|
0.1
|
| Alabama§§§ |
59,477 |
56,416 (94.9) |
≥86.6 |
≥86.6 |
≥86.6 |
NP |
1.2 |
0.4 |
| Alaska§§§,¶¶¶ |
10,381 |
8,580 (82.7) |
NR |
NR |
NR |
NR |
5.9 |
−1.2 |
| Arizona**** |
83,976 |
82,848 (98.7) |
92.8 |
92.6 |
95.3 |
NR |
5.5 |
−0.5 |
| Arkansas†††† |
39,510 |
37,997 (96.2) |
94.3 |
93.2 |
93.9 |
456 (1.2) |
1.9 |
0.1 |
| California†††† |
566,155 |
554,250 (97.9) |
96.5 |
96.2 |
96.1 |
8,262 (1.5) |
0.8 |
0.2 |
| Colorado§§§§ |
69,088 |
67,876 (98.2) |
91.1 |
92.8 |
90.1 |
500 (0.7) |
4.9 |
— |
| Connecticut§§§,¶¶¶¶ |
38,888 |
38,888 (100.0) |
96.2 |
96.2 |
95.9 |
NP |
2.5 |
−0.2 |
| Delaware§§§ |
NR |
NR |
NR |
NR |
NR |
NR |
NR |
NA |
| District of Columbia§§§ |
NR |
NR |
NR |
NR |
NR |
NR |
NR |
NA |
| Florida§§§,¶¶¶¶,***** |
228,298 |
228,298 (100.0) |
≥93.5 |
≥93.5 |
≥93.5 |
6,737 (3.0) |
3.4 |
0.2 |
| Georgia§§§,¶¶¶¶ |
130,102 |
130,102 (100.0) |
≥93.1 |
≥93.1 |
≥93.1 |
292 (0.2) |
3.0 |
0.5 |
| Hawaii§§§ |
15,695 |
1,403 (8.9) |
89.7 |
91.1 |
91.8 |
0 (<0.1) |
6.1 |
1.7 |
| Idaho |
23,301 |
22,950 (98.5) |
89.1 |
89.0 |
88.5 |
373 (1.6) |
7.6 |
−0.1 |
| Illinois§§§,¶¶¶¶ |
145,891 |
145,891 (100.0) |
96.6 |
96.5 |
96.4 |
925 (0.6) |
2.0 |
0.2 |
| Indiana§§§ |
88,253 |
57,968 (65.7) |
94.4 |
84.0 |
94.0 |
NR |
2.2 |
0.9 |
| Iowa§§§,¶¶¶¶ |
40,812 |
40,812 (100.0) |
≥93.2 |
≥93.2 |
≥93.2 |
1,255 (3.1) |
2.5 |
0.1 |
| Kansas§§§,††††,††††† |
37,865 |
12,996 (34.3) |
90.4 |
90.0 |
89.6 |
NR |
2.1 |
— |
| Kentucky§§§,††††,***** |
59,233 |
55,031 (92.9) |
93.1 |
93.3 |
92.5 |
NR |
1.8 |
0.4 |
| Louisiana¶¶¶¶ |
59,685 |
59,685 (100.0) |
95.6 |
97.2 |
95.0 |
NP |
1.5 |
0.3 |
| Maine |
13,450 |
13,395 (99.6) |
94.1 |
94.1 |
96.2 |
NR |
5.9 |
−0.3 |
| Maryland,§§§,†††† |
72,443 |
71,225 (98.3) |
97.9 |
98.2 |
97.5 |
NR |
1.4 |
−0.1 |
| Massachusetts§§§,¶¶¶¶,†††† |
66,756 |
66,756 (100.0) |
97.3 |
97.2 |
97.0 |
NP |
1.3 |
−0.1 |
| Michigan¶¶¶¶ |
120,565 |
120,565 (100.0) |
94.8 |
94.7 |
94.4 |
798 (0.7) |
4.4 |
−0.1 |
| Minnesota§§§§,***** |
71,223 |
70,284 (98.7) |
92.6 |
92.3 |
92.0 |
NR |
3.8 |
0.1 |
| Mississippi§§§,****,¶¶¶¶, |
37,870 |
37,870 (100.0) |
≥99.1 |
≥99.1 |
≥99.1 |
17 (<0.1) |
0.2 |
0.1 |
| Missouri§§§§,¶¶¶¶ |
72,324 |
72,324 (100.0) |
94.6 |
94.5 |
94.2 |
NR |
2.7 |
— |
| Montana§§§,¶¶¶¶ |
12,501 |
12,501 (100.0) |
93.6 |
93.2 |
93.2 |
231 (1.8) |
4.3 |
−0.2 |
| Nebraska§§§,†††† |
26,893 |
26,012 (96.7) |
96.3 |
96.9 |
95.6 |
440 (1.6) |
2.2 |
0.1 |
| Nevada§§§ |
37,724 |
37,678 (99.9) |
95.4 |
94.0 |
94.6 |
896 (2.4) |
4.0 |
0.7 |
| New Hampshire§§§,¶¶¶¶ |
12,447 |
12,447 (100.0) |
≥91.5 |
≥91.5 |
≥91.5 |
561 (4.5) |
3.1 |
−0.2 |
| New Jersey¶¶¶¶,¶¶¶ |
107,900 |
107,900 (100.0) |
≥95.9 |
≥95.9 |
≥95.9 |
958 (0.9) |
2.6 |
0.1 |
| New Mexico§§§ |
23,087 |
23,087 (100.0) |
97.0 |
96.7 |
96.7 |
369 (1.6) |
1.5 |
— |
| New York (incl. New York City)§§§,**** |
234,165 |
234,031 (99.9) |
98.6 |
97.8 |
98.1 |
3,827 (1.6) |
0.1 |
−1.2 |
| New York City§§§,**** |
96,581 |
96,447 (99.9) |
98.1 |
97.3 |
97.7 |
846 (0.9) |
0.1 |
−0.6 |
| North Carolina §§§, ††††,***** |
124,548 |
121,835 (97.8) |
95.5 |
95.5 |
95.3 |
1,499 (1.2) |
1.7 |
0.1 |
| North Dakota |
10,587 |
10,536 (99.5) |
94.8 |
94.4 |
94.8 |
NR |
3.9 |
−0.4 |
| Ohio |
139,103 |
137,441 (98.8) |
92.4 |
92.3 |
91.9 |
8,515 (6.1) |
2.8 |
−0.1 |
| Oklahoma |
55,348 |
47,374 (85.6) |
93.0 |
93.9 |
96.9 |
NR |
2.7 |
0.1 |
| Oregon††††,¶¶¶¶ |
45,959 |
45,959 (100.0) |
93.4 |
92.6 |
94.6 |
NR |
7.1 |
−0.6 |
| Pennsylvania |
140,197 |
138,573 (98.8) |
96.6 |
96.8 |
96.3 |
3,085 (2.2) |
3.0 |
0.1 |
| Rhode Island§§§,††††,***** |
11,219 |
11,054 (98.5) |
97.7 |
97.4 |
97.0 |
NR |
1.3 |
— |
| South Carolina§§§ |
65,938 |
18,104 (27.5) |
95.0 |
95.2 |
94.5 |
174 (0.3) |
2.6 |
— |
| South Dakota§§§ |
12,367 |
12,337 (99.8) |
96.0 |
95.9 |
95.2 |
NR |
2.7 |
0.1 |
| Tennessee§§§,††††,¶¶¶¶ |
80,595 |
80,595 (100.0) |
96.8 |
96.4 |
96.5 |
1,529 (1.9) |
2.0 |
0.1 |
| Texas (including Houston) ††††,***** |
398,680 |
397,093 (99.6) |
96.9 |
96.6 |
96.4 |
5,507 (1.4) |
2.5 |
0.1 |
| Houston††††,***** |
38,868 |
38,655 (99.5) |
96.3 |
96.4 |
95.2 |
415 (1.1) |
1.5 |
— |
| Utah¶¶¶¶ |
49,208 |
49,208 (100.0) |
92.7 |
92.2 |
92.4 |
1,144 (2.3) |
5.4 |
−0.3 |
| Vermont§§§,¶¶¶¶ |
6,293 |
6,293 (100.0) |
94.5 |
94.1 |
93.9 |
262 (4.2) |
3.7 |
−1.0 |
| Virginia§§§,††††† |
99,399 |
1,200 (1.2) |
94.6 |
97.6 |
93.3 |
NR |
1.7 |
— |
| Washington***** |
87,757 |
80,623 (91.9) |
94.4 |
92.8 |
92.7 |
1,234 (1.4) |
5.7 |
0.7 |
| West Virginia§§§,****,§§§§§ |
17,114 |
8,481 (49.6) |
98.2 |
98.8 |
97.8 |
16 (0.1) |
0.1 |
−0.7 |
| Wisconsin††††,*****,††††† |
67,391 |
1,777 (2.6) |
92.8 |
94.5 |
91.6 |
68 (0.1) |
5.7 |
−0.2 |
| Wyoming¶¶¶¶ |
7,913 |
7,913 (100.0) |
94.5 |
94.4 |
85.6 |
152 (1.9) |
3.5 |
0.6 |
|
Territories and associated states
| ||||||||
| American Samoa§§§,¶¶¶¶,§§§§§ |
781 |
781 (100.0) |
91.9 |
71.4 |
21.0 |
NP |
— |
NA |
| Federated States of Micronesia¶¶¶¶ |
1,532 |
1,532 (100.0) |
90.7 |
76.8 |
NReq |
NR |
— |
— |
| Guam§§§ |
2,513 |
2,492 (99.2) |
93.7 |
92.9 |
NReq |
NR |
0.1 |
— |
| Marshall Islands§§§,****,¶¶¶¶ |
1,115 |
1,115 (100.0) |
92.0 |
90.3 |
NReq |
NR |
— |
— |
| Northern Mariana Islands¶¶¶¶ |
895 |
895 (100.0) |
95.3 |
97.3 |
95.0 |
NR |
— |
— |
| Palau¶¶¶¶,¶¶¶¶¶ |
273 |
273 (100.0) |
90.1 |
90.1 |
NReq |
NR |
— |
— |
| Puerto Rico |
26,980 |
1,266 (4.7) |
93.5 |
89.9 |
93.0 |
NR |
2.0 |
0.4 |
| U.S. Virgin Islands | NR | NR | NR | NR | NR | NR | NR | NA |
Abbreviations: NA = not available; NP = no grace period/provisional policy; NR = not reported to CDC; NReq = not required for school entry.
* Estimates are adjusted for nonresponse and weighted for sampling where appropriate.
† Estimates based on a completed vaccine series (i.e., not vaccine-specific) use the “≥” symbol. Coverage might include history of disease or laboratory evidence of immunity.
§ A grace period is a set number of days during which a student can be enrolled and attend school without proof of complete vaccination or exemption. Provisional enrollment allows a student without complete vaccination or exemption to attend school while completing a catch-up vaccination schedule. In states with one or both of these policies, the estimates represent the number of kindergartners within a grace period, provisionally enrolled, or some combination of these categories.
¶ Exemptions, grace period/provisional enrollment, and vaccination coverage status might not be mutually exclusive. Some children enrolled under a grace period/provisional enrollment might be exempt from one or more vaccinations, while children with exemptions might be fully vaccinated with one or more required vaccines.
** The kindergarten population is an approximation provided by each program.
†† The number surveyed represents the number of kindergartners surveyed for vaccination coverage. For Alaska, this number represents the number surveyed for exemptions as coverage was not reported. The national total excludes the 10,381 kindergartners from Alaska. Exemption estimates are based on 34,011 kindergartners for Kansas, 65,938 kindergartners for South Carolina, 97,236 kindergartners for Virginia, and 67,391 kindergartners for Wisconsin.
§§ Most states require 2 doses of MMR; Alaska, New Jersey, and Oregon require 2 doses of measles, 1 dose of mumps, and 1 dose of rubella vaccines. California, Georgia, New York, New York City, North Carolina, and Virginia require 2 doses of measles and mumps and 1 dose of rubella vaccines. Iowa requires 2 doses of measles and 2 doses of rubella vaccines.
¶¶ Pertussis vaccination coverage might include some diphtheria, tetanus toxoids, and pertussis vaccine (DTP) vaccinations if administered in another country or by a vaccination provider who continued to use DTP after 2000. Most states require 5 doses of DTaP for school entry, or 4 doses if the fourth dose was received on or after the fourth birthday; Illinois, Maryland, Virginia, and Wisconsin require 4 doses; Nebraska requires 3 doses. The reported coverage estimates represent the percentage of kindergartners with the state-required number of DTaP doses, except for Kentucky, which requires ≥5 but reports ≥4 doses of DTaP.
*** Most states require 2 doses of varicella vaccine for school entry; Alabama, Arizona, Hawaii, Maine, New Jersey, Oklahoma, and Oregon require 1 dose. Reporting of varicella vaccination status for kindergartners with a history of varicella disease varied within and among states; some were reported as vaccinated against varicella and others as medically exempt.
††† National coverage estimates and medians calculated from data from 48 states (i.e., do not include Alaska, Delaware, and the District of Columbia). National grace period/provisional enrollment estimates and medians were calculated from data from 28 states that have either a grace period or a provisional enrollment policy and that reported relevant data to CDC. National exemption estimates and medians were calculated from data from 49 states (i.e., do not include Delaware and the District of Columbia). Other jurisdictions excluded were Houston, New York City, American Samoa, Guam, Marshall Islands, Federated States of Micronesia, North Mariana Islands, Palau, Puerto Rico, or U.S. Virgin Islands. Data reported from 3,675,882 kindergartners assessed for coverage, 3,914,961 for exemptions, and 2,955,220 for grace period/provisional enrollment. Estimates represent rates for populations of 4,015,193; 4,025,574; and 3,056,534 kindergartners for coverage, exemptions, and grace period/provisional enrollment, respectively.
§§§ Philosophical exemptions were not allowed.
¶¶¶ Alaska did not report kindergarten vaccination coverage because of problems with data collection. Vaccination coverage among children aged 6 years in VacTrAK, Alaska's Immunization Information System, was 75.5% for MMR, 85.1 for DTaP, and 73.0 for varicella vaccine.
**** Religious exemptions were not allowed.
†††† Counted some or all vaccine doses received regardless of Advisory Committee on Immunization Practices—recommended age and time interval; vaccination coverage rates reported might be higher than those calculated using only valid doses.
§§§§ Program did not report the number of children with exemptions, but instead reported the number of exemptions for each vaccine, which could count some children more than once. Lower bounds of the percentage of children with any exemptions were estimated using the individual vaccines with the highest number of exemptions.
¶¶¶¶ The proportion surveyed likely was <100% but is reported as 100% based on incomplete information about the actual current enrollment.
***** Did not include some types of schools, such as online schools or those located in military bases or correctional facilities, or tribal lands.
††††† Kindergarten vaccination coverage data were collected from a sample, and exemption data were collected from a census of kindergartners.
§§§§§ Reported public school data only.
¶¶¶¶¶ For Palau, estimates represent coverage among children in first grade.