School vaccination requirements set by state and local jurisdictions promote vaccination to reduce the risk for vaccine-preventable diseases (1). After 10 years of near 95% nationwide vaccination coverage, coverage with measles, mumps, and rubella vaccine (MMR)*; diphtheria, tetanus, and acellular pertussis vaccine (DTaP)†; poliovirus vaccine (polio)§; and varicella vaccine (VAR)¶ declined to approximately 93% over the 2020-21 and 2021-22 school years and remained essentially unchanged during the 2022-23 school year (2). These declines persisted after impacts of the COVID-19 pandemic diminished. This analysis summarizes state and local immunization program** data on vaccination coverage and exemptions from vaccination among kindergartners as reported to CDC by 49 states†† and the District of Columbia (DC), and provisional enrollment or grace period status for kindergartners reported by 31 states§§ for the 2023-24 school year.

In compliance with state and local school entry requirements, parents provide children's vaccination or exemption documents to schools, or schools obtain records from the state immunization information system (IIS). Federally funded immunization programs work with departments of education, local health departments, and school personnel to assess the vaccination and exemption status of children enrolled in public and private kindergartens. Programs report unweighted counts, aggregated by school type, to CDC via a questionnaire in the Secure Access Management System, a federal, web-based platform that provides authorized personnel access to public health applications operated by CDC. CDC uses these data to produce state- and national-level estimates of vaccination coverage among children in kindergarten. During the 2023-24 school year, 49 states and DC reported coverage with all state-required vaccinations and exemption data for public school kindergartners; 48 states and DC reported data for private school kindergartners. Data from cities were included with their state data. State-level, national, and median coverage with the state-required number of DTaP, MMR, polio, and VAR doses are reported. Hepatitis B vaccination coverage is not included in this report and is available at SchoolVaxView (2). Thirty-one states reported the number of kindergartners attending school under a grace period (attendance without proof of complete vaccination or exemption during a set number of days) or provisional enrollment (attendance while completing a catch-up vaccination schedule). All counts were current at the time of the assessment by the immunization program.***

National estimates, medians, and summary measures include only 49 U.S. states and DC. Coverage and exemption estimates were adjusted based on survey type and response rate. Results for U.S. territories and freely associated states are reported separately. National estimates measure coverage and exemptions among all kindergartners, whereas medians indicate the midpoint of state-level estimates. During the 2023-24 school year, immunization programs reported 3,823,472 children enrolled in kindergarten. Reported estimates are based on 3,559,990 (93.1%) children who were surveyed for vaccination coverage, 3,709,432 (97.0%) for exemptions, and 2,748,251 (71.9%) for grace period and provisional enrollment. Potentially achievable coverage with MMR (the sum of the percentage of children who were up to date with 2 MMR doses and those not up to date but nonexempt) was calculated for each jurisdiction. Students who were not up to date and did not have medical or nonmedical exemptions included those who were provisionally enrolled in kindergarten, in a grace period, or otherwise without documentation of complete vaccination. Required vaccines and required numbers of doses, methods and timing of data collection, and data reported varied by jurisdiction. Kindergartners were considered up to date with a given vaccine if they received all doses of that vaccine required for school entry, except in nine states that reported kindergartners as up to date for any vaccine only if they had received all doses of all vaccines required for school entry. All but four states**** reported the number of kindergartners with an exemption from one or more vaccine. SAS software (version 9.4; SAS Institute) was used for all analyses. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.