Tag: kindergarten

Vaccination Coverage and Exemption Rates

With record numbers of measles cases this year, lots of folks are interested in vaccination coverage and exemption rates.

You are at increased to get sick and can spread diseases if you are unvaccinated.
You are at increased to get sick and can spread diseases if you are unvaccinated.

Even though our own kids are vaccinated and protected, many of us are concerned about vaccination and exemption rates because we understand the risks.

We know that some kids are too young to be vaccinated and some kids can’t be vaccinated, as they have true medical exemptions.

Vaccination Coverage and Exemption Rates

So how are our vaccination and exemption rates doing these days?

Some states have rates of vaccine exemptions that are much higher than others, with rates from ranging from a low of 0.1% in Mississippi to a high of 7.7% in Idaho and Oregon.
Some states have rates of vaccine exemptions that are much higher than others, with rates from ranging from a low of 0.1% in Mississippi to a high of 7.7% in Idaho and Oregon.

According to the latest reports from the CDC:

  • the percentage of kindergartners with a vaccine exemption continues to slowly rise and is now up to 2.5%, up from 2.3% during the 2017-18 school year
  • an additional 2.8% of kindergartners were not up to date for MMR and did not have a vaccine exemption
  • the percentage of kindergartners up to date for MMR ranged from 87.4% in Colorado to 99.2% in Mississippi
  • coverage by age 24 months was ≥90% for ≥3 doses of polio- virus vaccine (92.7%), ≥1 dose of MMR (90.4%), ≥3 doses of HepB (91.0%), and ≥1 dose of varicella vaccine (90.0%), and are all up over previous years by 1 to 3%
  • only 56% of toddlers receive two or more doses of the flu vaccine by age two years
  • only 1.3% of children born in 2015 and 2016 had received no vaccinations by the second birthday, which is up from 1.1%
  • up to 7.4% of uninsured children received no vaccines, even though they qualify for free vaccines under the Vaccines for Children program

This doesn’t tell the whole story though.

“During the 2018–19 school year, national coverage with MMR, DTaP, and varicella vaccines remained near 95%. However, coverage and exemption rates varied by state. Recent measles outbreaks in states with high overall MMR coverage, such as New York, highlight the need for assessing vaccination coverage at the local level. ”

Morbidity and Mortality Weekly Report, Volume 68, Issue Number 41 Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2018–19 School Year

Although vaccination rates are generally high and exemption rates low at the state and national level, it is the pockets of undervaccinated kids that are the problem.

In Texas, for example, although state level exemptions are fairly low (2.4%) and immunization rates high, in some communities and school districts, more than 50% of kids are unvaccinated!

“The importance of achieving and sustaining high vaccination coverage across all communities is illustrated by the 22 measles outbreaks occurring in the United States in 2019, with 1,249 measles cases identified during January 1–October 1, 2019. Most cases have been among persons who were not vaccinated against measles. Pockets of low vaccination coverage, because of lack of access to vaccination services or to hesitancy resulting from the spread of inaccurate information about vaccines, increase the likelihood of a measles outbreak. “

Morbidity and Mortality Weekly Report, Volume 68, Issue Number 41 Vaccination Coverage by Age 24 Months Among Children Born in 2015 and 2016 — National Immunization Survey-Child, United States, 2016–2018

Unfortunately, we don’t see that kind of local data in the latest reports on vaccination coverage and exemption rates.

And while we should certainly work to get everyone vaccinated who doesn’t have an exemption, lots of work needs to be done educate parents that they should vaccinate and protect their kids instead of seeking non-medical exemptions.

More on Vaccination Coverage and Exemption Rates

How Are Australia’s New Vaccine Laws Working?

Have you heard about the No Jab, No Play / Pay laws in Australia?

Did Australia's new vaccine laws prompt anti-vaccine folks to put up these billboards that eventually got vandalized?
Did Australia’s new vaccine laws prompt anti-vaccine folks to put up these billboards that eventually got vandalized?

Unlike the No Pass, No Play rules that we have in Texas, in which kids can’t participate in extracurricular activities unless they pass all of their classes, No Jab, No Play / Pay has to do with getting kids vaccinated.

They were enacted in 2016 due to an increase in outbreaks of vaccine preventable disease, a rise in the spread of anti-vaccine misinformation, and more parents choosing to delay or skip their child’s vaccines. As in the United States, the real problem has been clusters of unvaccinated children in certain regions of the country, as the great majority of people in Australia vaccinate their kids.

How Are Australia’s New Vaccine Laws Working?

As expected, Australia’s new vaccine laws have been a success.

On the national level, No Jab, No Pay has meant that children need to be fully immunized “as a requirement for parents to be eligible to receive the Family Tax Benefit Part A end of year supplement, Child Care Benefit and Child Care Rebate.”

Five-year-olds in Victoria are now better protected against diseases prevented by vaccination than in any other state in Australia, new data shows.

Victoria Leads The Nation When It Comes To Vaccination Rates

But it is only in New South Wales, Queensland, and Victoria that children need to be immunized to attend childcare – No Jab, No Play. Additionally, children need to be immunized to attend kindergarten in Queensland and Victoria.

An increase in vaccination rates, by 2 to 5%, has been seen nationwide though.

What about the idea that No Jab, No Play has lead to a drop in preschool enrollments?

KATHARINA GORKA, NON-VACCINATING PARENT: I don’t think it is fair, to be honest. It makes me feel like we are a bit excluded from society, yeah.
PETER MCCUTCHEON: Did you ever think, “I’ll get my son vaccinated so I get around this pre-school problem”?
KATHARINA GORKA: No, I never thought about that.
PETER MCCUTCHEON: Why not?
KATHARINA GORKA: Because I have a set opinion on vaccinations and that is not going to change.

Some pre-schools experience drop in enrolments over ‘no jab, no play’ policy

The law about attending daycare and kindergarten just came into effect in New South Wales, in 2018, but has been in effect since 2016 in Victoria.

We will have to wait a few more months for the 2018 numbers, but preschool enrollment in Victoria was way up after they instituted their strict vaccine requirements!

In Australia during 2017, 339,243 children aged 4 or 5 were enrolled in a preschool program, representing an increase of 2.6% on the previous year’s figure. The largest growth rates were in the Australian Capital Territory (6%) and Victoria (5%).

Australian Bureau of Statistics on Preschool Education, Australia, 2017

Maybe folks just don’t want to go to care centers that had been pandering to anti-vaccine parents

Still, some vaccine advocates don’t think that No Jab, No Play / Pay laws are a good idea for Australia. Many also don’t think that it is a good idea that some Australian doctors are starting to refuse to see unvaccinated children, a practice that seems to have been exported from the United States.

Others don’t see alternatives, as they feel that they have been trying for a long time to educate parents that vaccines are safe and necessary, and this is one of the few ways that can reliably improve vaccination rates.

More on Australia’s New Vaccine Laws

Immunization Requirements to Start School and Daycare

If you are following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, or college.

There aren’t usually any extra vaccines that they will need to start school.

Of course, if you have skipped or delayed any vaccines, then they might have to catch up on some immunizations before starting school.

Another situation where you might need to do some catching up is if you move, and instead of following the CDC schedule, you were just getting the minimum number of vaccines that were required to attend school where you used to live. For example, your kids could have been all set to start kindergarten in Arkansas, but if you suddenly moved to Texas, they might need a second MMR, a booster dose of Varivax, and two doses of hepatitis A vaccine, as none of those are required in Arkansas.

Immunization Requirements to Start Daycare and Preschool

Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.
Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.

Since many new parents have to go back to work when their baby is only about two to six weeks old, they won’t have time to get their first set of vaccines at two months.

That won’t keep them out of daycare, but delaying too much longer, usually more than a month, probably will.

To start daycare or preschool, infants and toddlers need to get most of the vaccines on the CDC immunization schedule. This includes DTaP, hepatitis B, Hib, Prevnar, and IPV (polio), and then once they are 12 months old, booster doses of the primary series of vaccines and the MMR, Varivax (chickenpox), and hepatitis A vaccines.

The only vaccine that is missing from many state mandates is the rotavirus vaccine. And that simply has to do with the strict timing requirements of when you need to start (before 15 weeks of age) and finish this vaccine (by 8 months).

Some states do require rotavirus though, and simply state that kids must follow “age appropriate dosing.” That way, if they are too old, they just don’t need to get it.

Immunization Requirements to Start Kindergarten

In addition to most of the vaccines they needed to start daycare or preschool, to start kindergarten, kids need their 4 to 6 year old boosters:

  • the fifth dose of DTaP to protect them against diphtheria, tetanus, and pertussis
  • the fourth dose of IPV to protect them against polio
  • the second dose of MMR to protect them against measles, mumps, and rubella
  • the second dose of Varivax to protect them against chicken pox

If using combination vaccines, these four immunizations can be combined into just two shots – Proquad (MMR + Varivax) and either Kinrix or Quadracel (DTaP + IPV), which your preschooler will appreciate to help reduce the pain from getting these shots.

If your kids were missing any vaccines, they will also need to get caught up on those before starting school.

Immunization Requirements to Start Middle School

Preteens and teens get a few vaccines when they start middle school when they are around 11 to 12 years old, including:

  • a dose of Tdap to protect them against diphtheria, tetanus, and pertussis
  • a dose of Menactra or Menveo to protect them against meningoccocal disease

Although not required by most schools, the HPV vaccine is also usually given around this time.

Immunization Requirements to Start College

And then, before going off to college, at around age 16 years, kids will usually need:

They can also get the MenB vaccine, although it isn’t yet required for all students. This vaccine (Bexsero or Trumenba) has a “permissive” recommendation, in that parents are told they can get it if they want their kids to avoid meningococcal B disease, but it is not required yet.

What about a third dose of MMR?

While an extra dose of the MMR vaccine is now being given in some situations, it is mainly if your child is at high risk because of a current mumps outbreak. A mumps booster shot is not currently recommended just because your child is going off to college.

What to Know About Immunization Requirements for Incoming Students

If you have been following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, and college without needing any extra vaccines.

More on Immunization Requirements for Incoming Students