Skip directly to local search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home

State Vaccination Requirements

State and local vaccination requirements for daycare and school entry are important tools for maintaining high vaccination coverage rates, and in turn, lower rates of vaccine-preventable diseases (VPDs).

State laws establish vaccination requirements for school children. These laws often apply not only to children attending public schools but also to those attending private schools and day care facilities. All states provide medical exemptions, and some state laws also offer exemptions for religious and/or philosophical reasons. State laws also establish mechanisms for enforcement of school vaccination requirements and exemptions.

There is a growing body of evidence regarding the impact of state vaccination requirements for school age children on vaccination coverage and the association of non-medical exemption rates with increased disease incidence (Wang et al).  Some recent findings include:

  • Use of philosophical exemptions and under immunization tend to cluster geographically, making some communities at greater risk for outbreaks (Lieu et al; other clustering references).
  • This geographic clustering of exemptions is associated with increased local risk of vaccine-preventable diseases, such as pertussis and measles (Omer et al).

Practices suggested in the literature to reduce non-medical exemptions include:

  • States can consider strengthening the rigor of the application process, frequency of submission, and enforcement as strategies to improve vaccination rates (Yang and Silverman; also Gostin; Stadlin et al.).
  • In addition to state vaccination requirements, stronger health care practices such as more in-depth discussions with hesitant parents and establishing vaccination as the default are strategies to improve vaccination coverage rates (Opel and Omer; Yang and Silverman).

In summary, vaccination requirements that reach more children through a broad range of facilities, that have more requirements for receiving an exemption, that require parental documentation of exemption requests, and that are implemented with strong enforcement and monitoring may help promote higher rates of vaccination coverage, and in turn, lower rates of VPDs. Ongoing provider outreach and public education about vaccines and the diseases they prevent may also lead to such an increase. 

CDC’s Public Health Law Program (PHLP) has compiled state statutes and regulations regarding school vaccinations.  For more information, please visit the State School and Childcare Vaccination Laws.

See selected references.


  • Improving Vaccination Coverage Fact Sheet [3 pages]
    There is some evidence suggesting vaccination requirements that have broad reach, limited exemption criteria, and strong enforcement may help promote higher rates of vaccination coverage along with complementary actions such as monitoring VPD cases, vaccination coverage, and exemption rates; and also reporting on recent VPD outbreaks.
  • Childcare and School Vaccination Requirements, Exemptions & Web Links
    This tool provides state vaccination requirements, state exemptions, and links to state web sites reporting requirements.
  • State Immunization Laws for Healthcare Workers and Patients
    This database tool displays results from a 50-state legislative review of laws requiring assessment of vaccination status and vaccine administration for healthcare workers and patients/residents. Data on laws for various healthcare facilities (hospitals, ambulatory care facilities, individual providers' practices, correctional facilities, and facilities for the developmentally disabled) were compiled in 2005 and most recently updated in November 2014.
  • Immunization requirements, by disease
    Lists vaccine-preventable diseases, and then shows state mandates (prenatal, daycare, childcare, kindergarten, elementary, secondary, K-12, colleges and universities, long-term care facilities) on immunization requirements
    Immunization Action Coalition (IAC)
  • Also see SchoolVaxView School Vaccination Requirements and Exemptions


Top of Page


Images and logos on this website which are trademarked/copyrighted or used with permission of the trademark/copyright or logo holder are not in the public domain. These images and logos have been licensed for or used with permission in the materials provided on this website. The materials in the form presented on this website may be used without seeking further permission. Any other use of trademarked/copyrighted images or logos requires permission from the trademark/copyright holder...more

External Web Site Policy This graphic notice means that you are leaving an HHS Web site. For more information, please see the Exit Notification and Disclaimer policy.

Contact Us:
  • Centers for Disease Control and Prevention
    1600 Clifton Rd
    Atlanta, GA 30333
  • 800-CDC-INFO
    TTY: (888) 232-6348
    Contact CDC-INFO The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #