US kindergarten vaccination rates decline again

Key takeaways:

• MMR coverage was 92.5% and DTaP coverage was 92.1% during the 2024-2025 school year.
• Seventeen states reported exemption rates greater than 5%, three more than the previous year.

Kindergarten vaccination coverage for measles and other infectious diseases declined in the United States again last school year, according to the CDC.

Coverage for MMR and DTaP vaccines fell two-tenths of a percentage point each from 92.7% and 92.3%, respectively, during the 2023-2024 school year to 92.5% and 92.1% for the 2024-2025 school year, the CDC reported. The rates also declined during the previous year.

Although medical exemptions have remained steady at 0.2% since 2020, nonmedical exemptions rose from 3.1% to 3.4%. Additionally, the number of states with exemption rates above 5% grew from 14 to 17. The overall exemption rate of 3.6% is a record, according to the AAP.

Twenty states reported MMR coverage below 91%, and 27 states reported coverage below the national average of 92.5%.

Jesse M. Hackell, MD

“[These data are] from kids who were entering kindergarten in September of last year, and that likely underestimates … the severity of the current situation,” Jesse M. Hackell, MD, retired pediatrician and assistant clinical professor at New York Medical College, told Healio. “The political situation changed, and we are seeing more and more resistance, more and more hesitancy, more and more public media and social media stuff about not vaccinating. I am afraid that when they do the same survey a year from now, the numbers are going to be significantly worse.”

With measles outbreaks occurring across the country, Hackell said he is worried about cases spreading once children return to school this fall. MMR coverage of 95% or higher is widely cited as the threshold to prevent outbreaks.

According to the latest CDC data, there have been 1,333 confirmed cases of measles in 39 states since the beginning of 2025. Out of these cases, 87% were associated with one of 29 outbreaks that have been reported to the CDC.

The largest outbreak began in Gaines County, Texas, in January, and spread rapidly because of low vaccination rates in the area. One school district in the county reported that 46.36% of students had exemptions during the 2024-2025 school year. The outbreak has led to 762 cases in Texas and 96 cases in New Mexico. Three unvaccinated people have died in the outbreak — two children and one adult — the first measles deaths in the U.S. in a decade.

“I do worry about these communities with low vaccination rates,” Hackell said. “It is a disaster waiting to happen if a case does get imported.”

Hackell stressed that vaccination is the best way to protect children from communicable diseases.

“If you are in an area with low vaccination rates, you should be absolutely sure that your child is fully vaccinated on a timely basis,” he said. “But that really applies in every area.”

References:

• AAP. Kindergarten vaccine exemption rates hit record high. https://publications.aap.org/aapnews/news/32769/Kindergarten-vaccine-exemption-rates-hit-record. Published July 31, 2025. Accessed Aug. 1, 2025.
• CDC. Measles cases and outbreaks. https://www.cdc.gov/measles/data-research/index.html. Updated July 30, 2025. Accessed Aug. 1, 2025.
• CDC. Vaccination coverage and exemptions among kindergarteners. https://www.cdc.gov/schoolvaxview/data/index.html. Updated July 31, 2025. Accessed Aug. 1, 2025.
• NM Health. 2025 measles outbreak guidance. https://www.nmhealth.org/about/erd/ideb/mog/. Updated July 31, 2025. Accessed Aug. 1, 2025.
• Texas Department of State Health Services. Conscientious exemptions filed at the district level by county. https://www.dshs.texas.gov/sites/default/files/LIDS-Immunizations/pdf/2024-2025_K-12_Conscientious_Exemptions_by_District.pdf. Accessed Aug. 1, 2025.
• Texas Department of State Health Services. Measles outbreak — July 29, 2025. https://www.dshs.texas.gov/news-alerts/measles-outbreak-2025. Updated July 29, 2025. Accessed Aug. 1, 2025.

For more information:

Jesse M. Hackell, MD, can be reached at pediatrics@healio.com.