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Vaccination Coverage Among Children Entering School --- United States, 2002--03 School Year

All states require proof of vaccination for children before school entry, and a summary of that coverage is reported to CDC. Rather than reporting vaccination status on school entry, state reports to CDC reflect coverage attained after evaluating students' vaccination status and ensuring that all children receive required vaccines. School vaccination requirements have been credited with ensuring high coverage (1,2), and one of the national health objectives for 2010 is to sustain >95% vaccination coverage among children in kindergarten through the first grade (objective 14-23) (3). This report presents data regarding vaccination coverage from the 50 states and the District of Columbia (DC)* for the 2002--03 school year, which highlight high reporting rates and overall high coverage. Findings indicate that vaccines required by each state and the methods for surveying schools vary. CDC is working with states to standardize data collection procedures.

For the 2002--03 school year, 49 (96.1%) states submitted vaccination coverage levels for children enrolled in kindergarten and/or first grade. All 49 states reported coverage for >3 doses of poliovirus vaccine, >1 dose of measles-containing vaccine, >1 dose of mumps-containing vaccine, and >1 dose of rubella-containing vaccine (Table 1). For diphtheria and tetanus toxoids and acellular pertussis vaccine, 39 (76.5%) states reported coverage for >4 doses, and 10 (19.6%) reported coverage for >3 doses; 39 states also reported coverage for 3 doses of hepatitis B (HepB) vaccine.

Coverage for all vaccines except HepB was reported to be >95% in 29 (56.9%) states and >90% in 45 (88.2%) states. A total of 18 states based reports on a census of children entering kindergarten and first grade, 15 states on surveys of >95% of children, and five states on surveys of <50% of children (range: 5.1%--42.2%). National estimates of coverage were calculated by weighting each state's coverage estimate by the size of the state's birth cohort; all national estimates were >95% (Table).

Reported by: K Shaw, MS, C Stanwyck, PhD, Data Management Div; M McCauley, MTSC, National Immunization Program, CDC.

Editorial Note:

Since the previous report on vaccination coverage for the 2000--01 school year (4), reporting increased from 36 (70.6%) states to 49 (96.1%) states. CDC has increased efforts to support states in collecting and reporting coverage among children entering school. One component of this increased effort is a new online reporting system that automates data management and calculation tasks.

State laws requiring proof of vaccination before entering school have been referred to as a "safety net" for the U.S. vaccination program because they ensure that no child is missed (1). The safety net relies on the efforts of school nurses, teachers, and others to identify children who need >1 dose of vaccine. A recent survey of school nurses in DC indicated that approximately 50% of children needed one or more vaccinations to meet DC's school entry requirements (CDC, unpublished data, 2002). Findings of uniformly high nationwide coverage during the 2002--03 school year underscore the success of school entry requirements in boosting vaccine coverage.

The findings in this report are subject to at least two limitations. First, methods for assessing vaccination coverage among children entering school vary because state and local laws determine which vaccines and doses are required, and sampling methods differ. The resulting variation in sampling methods among states limits the generalizability and comparability of these data. Second, children attending private schools and those who are home-schooled were not surveyed by all states. Population-based vaccination registries might someday provide uniform, reliable data on the vaccination status of children entering school, saving resources now devoted to gathering and processing children's vaccination histories.

The findings in this report supplement those of the National Immunization Survey (5), which describe vaccination coverage among preschool-aged children. Together, these reports provide a comprehensive view of vaccination coverage among U.S. children.

Additional information about assessing and reporting coverage among children entering school is available from the National Immunization Program Immunization Information Hotline, telephone 800-232-2522 (English) or 800-232-0233 (Spanish), or by e-mail,


  1. Orenstein WA, Bernier RH. Surveillance---information for action. Pediatr Clin North Am 1990;37:709--34.
  2. Orenstein WA, Hinman AR. The immunization system in the United States---role of school immunization laws. Vaccine 1999;17:S19--S24.
  3. U.S. Department of Health and Human Services. Healthy People 2010, 2nd ed. With Understanding and Improving Health and Objectives for Improving Health (2 vols.). Washington, DC: U.S. Department of Health and Human Services, 2000.
  4. CDC. Vaccination coverage among children enrolled in Head Start programs, licensed child care facilities, and entering school---United States, 2000--01 school year. MMWR 2003;52:175--80.
  5. CDC. National, state, and urban area vaccination levels among children aged 19--35 months---United States, 2002. MMWR 2003;52:728--32.

* For this report, the District of Columbia is included as a state.

Table 2
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