Kindergarten vaccination fell, as policy now shifts

Clinical takeaway: Coverage is slipping across every childhood vaccine rather than any single one. Checking series completion may matter more than counseling on refusal. 

Kindergarten vaccination still covered about 92 in 100 children entering US schools last year. But coverage fell for every vaccine reported, and exemptions rose in 41 states and Washington DC. These data for last school year have come out just as an August federal order asks states to revisit what vaccines they require at school entry. 

Coverage during the 2025-2026 school year ranged from a low of 92.0% for DTaP to a high of 92.4% for MMR and polio, with every reported vaccine below its prior-year level. The spread across vaccines was under half a percentage point, so no single vaccine accounted for the decline. MMR, DTaP, polio, and varicella coverage fell in more than half of states. 

Exemptions from one or more vaccines rose to 4.2% from 3.6% the year before, increasing in 41 states and DC, with 24 states now above 5%. That accounts for about 155,000 kindergartners. A larger group is neither vaccinated nor formally exempt: roughly 280,000 attended school without documentation of a completed MMR series. The two counts are not directly comparable, since exemptions span all vaccines and the documentation figure is MMR-specific, but the gap suggests some under-vaccinated children are incomplete or unrecorded rather than opted out. 

The White House issued an order on August 10 that sorts childhood vaccines into three tiers: universally recommended, recommended for high-risk groups, and subject to shared clinical decision-making. The administration says the tiers align US recommendations with peer countries. A prior memorandum in December ordered a review of the US schedule against peer countries, and a May order asked CDC's Advisory Committee on Immunization Practices (ACIP) to update the schedule based on the resulting assessment. Two scheduled ACIP meetings were canceled this year because of ongoing litigation, with the next set for October. 

The recent order sets specific recommendations at the vaccine level. MMR, DTaP, polio, and varicella stay in the universal tier, so the vaccines behind the coverage decline are not the ones being recategorized. The order advises states to review school-entry requirements and directs the Justice Department to pursue litigation over religious and medical exemption provisions in state law. 

Coverage and exemption estimates come from data that states and DC report to CDC annually, covering children enrolled in kindergarten during the 2025-2026 school year. Collection methods differ by state, and the figures reflect what schools have documented rather than what children actually received.  

The August 10 order also asks that MMR be given as three separate shots once single-disease products are available, and that childhood immunizations be given at separate visits where feasible. Both would raise the number of visits needed to finish a series.  

"Decisions about how and when vaccines are used should be driven by rigorous scientific evidence, patient safety, and independent medical and public health expertise. Altering a proven vaccination schedule without credible evidence risks weakening public confidence and putting children's health at risk," said Willie Underwood III, MD, MSc, MPH, president of the American Medical Association, in a statement immediately after the August 10 order. 

Source: CDC. (2026 Aug 17) Vaccination Coverage and Exemptions among Kindergartners