U.S. Children Still at Risk for Vaccine-Preventable Diseases

The reduction in morbidity and mortality associated with vaccine-preventable diseases in the United States has been described as one of the ten greatest public health achievements of the first decade of the 21st century. A recent analysis concluded that routine childhood vaccination will prevent 322 million cases of disease and about 732,000 early deaths among children born during 1994–2013, for a net societal cost savings of $1.38 trillion.


Vaccine exemption levels for kindergarteners are low for most states and infant vaccination rates are high nationally, according to data from two reports recently published by the CDC.


The first report looked at vaccination coverage and exemption levels among children entering kindergarten for the 2014-2015 school year. Every state allows medical exemptions, while many states allow religious or philosophical or personal belief exemptions or both religious and philosophical or personal belief exemptions. Nationally, exemption levels remain low with a median level of 1.7 percent. However, state exemption levels ranged from a low of less than 0.1 percent in Mississippi to a high of 6.5 percent in Idaho. Additionally, five states did not meet the reporting standards for providing exemption data.


The second report examined vaccination rates among children ages 19 months through 35 months for 2014. Vaccination coverage remained high: over 90 percent for measles-mumps-rubella (MMR); polio; hepatitis B; and varicella vaccines. The percentage of children who do not receive vaccinations also remained low, at less than 1 percent.


The 2014 data indicate that coverage remains consistently high for most vaccinations, although variation by poverty status and geographic area was observed. For some vaccines and population subgroups, improvement in coverage is necessary to achieve optimal protection (herd immunity). For all vaccines, maintaining high coverage is critical to sustain progress in reducing the impact of vaccine-preventable diseases.


“Collaborative efforts are the reason our nation has been able to achieve such high coverage nationally, but much work is still needed to shield our schools and communities from future outbreaks,” said Anne Schuchat, MD (RADM, USPHS), director of the CDC’s National Center for Immunization and Respiratory Diseases.


One important change from 2013 to 2014 was the number of states that provided local coverage and exemption data online. There was an increase from 18 states providing such data in 2013 to 21 states providing this data in 2014. Making this information available publicly keeps parents informed, guides vaccination policies, and strengthens immunization programs. Knowing the vaccination rates in your community is important. Unvaccinated people tend to cluster and put communities at risk for outbreaks of diseases like measles.


When a disease like measles reaches a community with large numbers of unvaccinated people, it can spread very quickly. Therefore, local pockets of people who are missing vaccinations can leave communities vulnerable to outbreaks. During 2015, measles outbreak cases have included 68 unvaccinated U.S. residents, among whom 29 (43%) cited philosophic or religious objections to vaccination. Maintaining high vaccination coverage levels is important for measles control and elimination.


The CDC recommends that all children be vaccinated according to the recommended schedule. Parents with questions or concerns should talk with their child’s doctor or visit CDC’s vaccine website for parents.


See the CDC Announcement


See the CDC Report, “Vaccination Coverage Among Children in Kindergarten — United States, 2014–15 School Year”


See the CDC Report, “National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2014”


See also Medical Law Perspectives, August 2015 Report: Pediatrician Liability for Childhood Disease Complications


See also Medical Law Perspectives, January 2013 Report: Vaccines: An Ounce of Prevention May Lead to a Pound of Injury