Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Vaccination Coverage & Exemption Rates in Children

MMWR; 2018 Oct 12; Mellerson, Maxwell, et al

Among US children, median kindergarten vaccination coverage was nearly 95% for measles, mumps, and rubella (MMR), diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP), and varicella vaccine during the 2017‒2018 school year, a new study found. The report from the Centers for Disease Control and Prevention (CDC) summarized vaccination coverage and exemption estimates for children in kindergarten in 49 states and the District of Columbia and those provisionally enrolled or in a grace period for 28 states. Among the key findings:

  • Median vaccination coverage was 94.3% for 2 doses of MMR vaccine; 95.1% for the state-required number of doses of DTaP vaccine; and 93.8% for 2 doses of varicella vaccine.
  • The median exemption rate gradually increased for the third consecutive year to 2.2%.
  • However, most undervaccinated children did not have exemptions.


Mellerson JL, Maxwell CB, Knighton CL, Kriss JL, Seither R, Black CL. Vaccination coverage for selected vaccines and exemption rates among children in kindergarten—United States, 2017–18 school year. MMWR Morb Mortal Wkly Rep. 2018;67:1115–1122. doi:10.15585/mmwr.mm6740a3.


Herd immunity is a critical part of population health for vaccine preventable diseases. There are children in our elementary schools that might be unable to get certain vaccines because of medical illnesses. They rely upon going to school amongst a vaccinated population for protection. R0 (R-naught) is the number of people that a person with an infectious illness would infect. Influenza is about 1.5, Ebola is 2, but measles is between 12 and 18. So it is very important to vaccinate every child that is able since 2 doses of the MMR is 97% effective in preventing measles. — John Russell, MD

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Influenza Vaccination Safety During Hospitalization, Mayo Clin Proc; ePub 2019 Jan 8; Tartof, et al

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