Vaccine exemptions and the kindergarten vaccination coverage gap. Issue 40 (25th September 2017)

• Record Type: Journal Article
• Authors: Smith, Philip J.; Shaw, Jana; Seither, Ranee; Lopez, Adriana; Hill, Holly A.; Underwood, Mike; Knighton, Cynthia; Zhao, Zhen; Ravanam, Megha Shah; Greby, Stacie; Orenstein, Walter A.
• Is Part Of: Vaccine. Volume 35:Issue 40(2017)
• Page Start: 5346
• Page End: 5351
• Publication Date: 2017-09-25
• Subjects: Attributable risk -- Exemption -- Vaccination coverage gap; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2017.08.036
• Languages: English
• ISSNs: 0264-410X

Abstract

Abstract: Background: Vaccination requirements for kindergarten entry vary by state, but all states require 2 doses of measles containing vaccine (MCV) at kindergarten entry. Objective: To assess (i) national MCV vaccination coverage for children who had attended kindergarten; (ii) the extent to which undervaccination after kindergarten entry is attributable to parents' requests for an exemption; (iii) the extent to which undervaccinated children had missed opportunities to be administered missing vaccine doses among children whose parent did not request an exemption; and (iv) the vaccination coverage gap between the "highest achievable" MCV coverage and actual MCV coverage among children who had attended kindergarten. Methods: A national survey of 1465 parents of 5–7 year-old children was conducted during October 2013 through March 2014. Vaccination coverage estimates are based provider-reported vaccination histories. Children have a "missed opportunity" for MCV if they were not up-to-date and if there were dates on which other vaccines were administered but not MCV. The "highest achievable" MCV vaccination coverage rate is 100% minus the sum of the percentages of (i) undervaccinated children with parents who requested an exemption; and (ii) undervaccinated children with parents who did not request an exemption and whose vaccination statuses were assessed during a kindergarten grace period or period when they were provisionally enrolled in kindergarten. Results: Among all children undervaccinated for MCV, 2.7% were attributable to having a parent who requested an exemption. Among children who were undervaccinated for MCV and whose parent did not request an exemption, 41.6% had a missed opportunity for MCV. The highest achievable MCV coverage was 98.6%, actual MCV coverage was 90.9%, and the kindergarten vaccination gap was 7.7%. Conclusion: Vaccination coverage may be increased by schools fully implementing state kindergarten vaccination laws, and by providers assessing children's vaccination status at every clinic visit, and administering missed vaccine doses.