In 2000, measles was declared eliminated from the U.S. With the 2019 outbreaks, the U.S.’s measles elimination status (defined by the World Health Organization as “the absence of endemic measles virus transmission in a defined geographical area, e.g. region or country, for at least 12 months in the presence of a surveillance system that has been verified to be performing well”) was on the brink of being revoked.
According to the Centers for Disease Control and Prevention (CDC), there were 1,261 cases of measles confirmed in 31 states from January 1 to November 7, 2019. However, most measles cases can be prevented by administration of the measles-mumps-rubella vaccine (MMR). The MMR vaccine is routinely given to children twice: first, at 12-15 months and then again at 4-6 years. Prior to entering kindergarten, children should have received their second dose of MMR vaccine.
Every year, the Assessment Branch, which lies within the Immunization Services Division of the National Center for Immunization and Respiratory Diseases (NCIRD), provides support to awardees to collect vaccination and exemption data on children entering kindergarten. As a second-year participant in the ASPPH/CDC Public Health Fellowship Program on the School Assessment team, Ms. Caitlin Loretan, from Emory University Rollins School of Public Health, was integrally involved with the analysis and publication of the 2018-19 school report. Every spring, each state and select large cities and U.S.-affiliated islands complete the survey through an online system. The data are then analyzed to assess the median and national coverage rate for each vaccine required for school entry: MMR, diphtheria/tetanus/acellular pertussis (DTaP), and varicella (chicken pox); and state-allowed exemptions: medical, religious, philosophic, and grace period/provisional enrollment. Nationally, 94.7 percent of kindergartners received 2 doses of MMR by kindergarten entry, a slight decrease from 95 percent in the 2017-18 school year. Among states, MMR vaccine coverage ranged from a low of 87.4 percent to a high of 99.2 percent.
This year, additional analyses were performed to look at the number and percent of kindergartners that were neither vaccinated nor reported with an exemption. This includes students within a grace period or provisional enrollment, and kindergarteners with missing or unreported vaccinations. The team found that “Forty-four states could potentially achieve ≥95 percent MMR coverage if all nonexempt kindergartners, many of whom are within a grace period or provisionally enrolled, were vaccinated.” State or school follow-up with these children “…could assure all missing vaccinations are completed and all missing documentation of vaccination is provided to schools.”
Results from the kindergarten assessment survey are reported through multiple outlets. These include an annual MMWR publication, the interactive SchoolVaxView dashboards, and through individual reports sent to all awardees who submitted data for that year. The states are then able to use the data to compare their coverage and exemption rates to other states and see where they stand nationally.
This assessment is particularly important this year. Due to the increase in number of measles cases across the country, some states have changed their exemption policies. Washington state enacted House Bill 1638, which removed personal belief exemptions for MMR vaccine requirement for public schools, private schools, and day cares. New York Senate Bill 2994 removed the religious exemption for public school vaccination requirements. It remains to be seen whether there are changes in coverage and exemption rates among the awardees. Be on the lookout for these data in October 2020!
Applications are being accepted until January 27, 2019.