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In the beginning of the COVID-19 pandemic, when schools closed and medical care was limited to emergencies, child vaccination rates predictably dropped. But instead of recovering after schools reopened, the rates have worsened, according to data from the Centers for Disease Control and Prevention (CDC).

The CDC's January 13 Morbidity and Mortality Weekly Report notes that the percentage of U.S. children entering kindergarten with their required immunizations fell to 93% for all state-required vaccines in the 2021-22 school year—2 percentage points below the recommended herd immunity levels of 95%.

The data show measles, mumps, and rubella (MMR) vaccination coverage below 90% among kindergartners in nine states and the District of Columbia, including Ohio and Minnesota, two states that experienced measles outbreaks last year. Among the 13 states with MMR vaccination rates at or above 95%, New York, Rhode Island, Maine, and West Virginia had the highest rates.

While the pandemic contributed to the drop in vaccination rates, some experts believe the politicization of public health and increasing distrust of government have changed parents' previously positive attitudes toward vaccines for preventable childhood diseases like measles, chicken pox, tetanus, diphtheria, and polio.

According to a recent Kaiser Family Foundation survey, 35% of parents believe they should be able to decide whether their children receive the routine immunizations needed to attend school. Another poll, conducted by the Harvard Opinion Research Program, showed that support for vaccination requirements to enter school had slipped from 84% in 2019 to 74% in 2022.

Public health officials warn that unless child vaccination rates for these diseases return to prepandemic levels, outbreaks, like the measles outbreaks in Ohio and Minnesota and the case of paralytic polio in New York last summer, may become more common. The CDC suggests increasing follow-up with undervaccinated students to reduce the impact of disruptions to vaccination coverage. School nurses and nurses at well visits can play a role in parent education, urge parents to make plans to catch up on missed vaccines, and help combat misinformation.

“School nurses are crucial in the efforts to increase routine vaccination rates in children,” said Ranee Seither, an epidemiologist and lead author of the CDC report, in an email to AJN. “They are more likely to have direct contact with parents, have the opportunity to follow up on student vaccinations, and ensure the vaccination documentation is complete.” Robin Cogan, a nurse in the Camden City, New Jersey, school district, agrees. “Families trust their school nurse with their children's health care needs,” Cogan told AJN. “One of our many roles is vaccine surveillance and ensuring vaccine compliance for students entering our schools.”—Amy M. Collins, managing editor