Kindergartners with All Required Immunizations
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- Definition: Percentage of children in kindergarten with all required immunizations (e.g., in 2020, 94.3% of California kindergarteners had all required immunizations).Number of children in kindergarten with all required immunizations (e.g., in 2020, 522,581 California kindergarteners had all required immunizations).
- Data Source: California Dept. of Public Health, Immunization Branch, Reporting Data for Kindergarten and 7th Grade (Feb. 2022).
- Footnote: Years presented are the final year of a school year (e.g., 2019-20 is shown as 2020). The following immunizations are required: 5 doses of DTP vaccine (4 doses if at least one was given on or after the fourth birthday), 4 doses of polio vaccine (3 doses if at least one was given on or after the fourth birthday), 2 doses of MMR vaccine (given on or after the first birthday), and 3 doses of hepatitis B vaccine. One dose of varicella vaccine (or physician-documented varicella history or immunity) was required prior to 2020; for years 2020 and later, two doses of varicella vaccine are required (history of the disease is to be reported as a permanent medical exemption to immunization). Data exclude kindergarteners whose immunization status is not reported. The notation 95%+ indicates that at least 95% of kindergarteners had all required immunizations. The notation >n means that more than n kindergarteners had all required immunizations. The notation S refers to percentages that have been suppressed because fewer than 20 kindergarteners had all immunizations, and to numbers and percentages that have been suppressed because (beginning in 2017) fewer than 20 children were enrolled in kindergarten, or (beginning in 2018) data for at least one school in the district were suppressed. N/A means that data are not available.
Learn More About Immunizations
- Measures of Immunizations on Kidsdata.org
On kidsdata.org, immunizations are measured by the number and percentage of kindergartners who receive all required immunizations by the time they enter school, along with the number and percentage of kindergartners who are exempt from immunization requirements, by type of exemption.
Also provided are numbers and rates of reported cases of vaccine-preventable childhood diseases—diphtheria, hepatitis A, hepatitis B (acute), measles, meningococcal disease, mumps, pertussis, polio, rubella, tetanus, and varicella—in the total population.
- Health Care
- Health Insurance Coverage, by Type and Age Group
- Health Insurance Coverage Status, by Race/Ethnicity
- Medicaid (Medi-Cal) or Children's Health Insurance Program (CHIP) Coverage
- Medicaid (Medi-Cal) or CHIP Coverage, by Age Group (California & U.S. Only)
- Medicaid (Medi-Cal) and CHIP Yearly Enrollment (California & U.S. Only)
- Medi-Cal Average Monthly Enrollment
- Uninsured at Any Point in Past Year
- Medical Care Delayed or Forgone in Past Year
- Length of Time Since Teen's Last Check-Up
- Receipt of Care Within a Medical Home
- School Health Centers
- School Provides Adequate Health Services (Staff Reported)
- Why This Topic Is Important
Immunizations are among the most successful and cost-effective preventive health care interventions, protecting millions of children worldwide from serious and potentially fatal infectious diseases (1, 2). For U.S. children born between 1994 and 2021 who receive recommended vaccinations, it is estimated that more than a million lives will be saved and 472 million illnesses prevented, at a savings of nearly $2.2 trillion in direct and indirect social costs (2). Current immunization schedules recommend that children receive vaccinations for diseases such as measles, mumps, whooping cough (pertussis), polio, chickenpox (varicella), and hepatitis (3). Annual immunization against influenza also is recommended. Vaccinations are important for the protection of the individual child as well as for the protection of others with whom an infected child might come into contact, as most vaccine-preventable diseases are spread through air or direct contact (3).
Vaccine hesitancy—identified by the World Health Organization among its top public health threats—has been linked to an increase in vaccine-preventable disease outbreaks in the U.S. (1). Equitable access to vaccines is another major issue, with U.S. data showing persistent disparities in children's vaccination coverage by region, income level, health insurance status, and race/ethnicity (4).For more information, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Olson, O., et al. (2020). Addressing parental vaccine hesitancy towards childhood vaccines in the United States: A systematic literature review of communication interventions and strategies. Vaccines, 8(4), 590. Retrieved from: https://www.mdpi.com/2076-393X/8/4/590
2. Centers for Disease Control and Prevention. (2022). Vaccines for children: Protecting America's children every day. Retrieved from: https://www.cdc.gov/vaccines/programs/vfc/protecting-children.html
3. Centers for Disease Control and Prevention. (2023). Recommended vaccinations for infants and children. Retrieved from: https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html
4. Hill, H. A., et al. (2021). Vaccination coverage by age 24 months among children born in 2017 and 2018 — National Immunization Survey-Child, United States, 2018–2020. Morbidity and Mortality Weekly Report, 70(41), 1435-1440. Retrieved from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7041a1.htm
- How Children Are Faring
In 2020, 94.3% of California kindergartners had received all state-required immunizations by the time they entered school, up from a low of 90.2% in 2014. Across counties with data in 2020, the share of kindergarteners with all required immunizations ranged from more than 97% to less than 80%. In some school districts, fewer than half of children entering kindergarten had completed all immunization series.
Statewide, 31,669 kindergartners (5.7%) were exempt from immunization requirements in 2020. Among these children, 5,268 (1%) had permanent medical exemptions, 8,227 (1.5%) were overdue for one or more required doses, and 9,188 (1.7%) were conditional entrants, i.e., children who have temporary medical exemptions or are missing (but not overdue for) required doses. Personal belief exemptions peaked in 2014 at 3.2%, but are no longer permitted as of 2017. The share of California kindergartners overdue for one or more required immunizations jumped from 0.2% to 1% between 2016 and 2017, and from 1.1% in 2019 to 1.5% in 2020—the first year a second dose of varicella vaccine was required.
In 2020, 1,073 cases of vaccine-preventable childhood diseases—hepatitis A, hepatitis B (acute), measles, meningococcal disease, mumps, pertussis, tetanus, and varicella (hospitalizations and deaths only)—were reported to the state department of public health. Pertussis (whooping cough) accounts for a majority of infections reported each year—698 (65%) in 2020, a rate of 1.8 cases per 100,000 Californians of all ages. These figures are down from 2019, when there were 4,849 cases—12.2 per 100,000 Californians. Statewide rates of pertussis in the total population peaked in 2014 (29 cases per 100,000) and 2010 (24.5 cases per 100,000). Pertussis outbreaks are cyclic, with peaks every three to five years.
- Policy Implications
Infectious diseases continue to be a major cause of illness and death in the U.S., despite overall improvements in immunization rates in recent decades (1, 2). Because California law requires proof of vaccinations as a condition of entry into licensed child care, preschool, and public or private elementary and secondary schools, immunization rates are relatively high for children in those settings (3, 4). Outside of those settings, it is critical to ensure that young children receive routine vaccinations and that adolescents complete all recommended vaccination series (1, 5). While progress has been made, immunization coverage continues to vary by geographic, socioeconomic, and other demographic factors, indicating ongoing issues of access, education, and confidence in vaccines (4, 5, 6, 7). Policymakers can address these issues by helping to ensure that all children have a regular source of high-quality health care, making vaccinations affordable and accessible, promoting science-based vaccine information, and supporting complementary evidence-based strategies to increase immunization rates (5, 8, 9).
Policy, system, and practice options to improve immunization rates include:
For more information, see kidsdata.org’s Research & Links section or visit the California Immunization Coalition and Shots for School. Also see Policy Implications under kidsdata.org's Health Care topic.
- Ensuring that all young people have affordable, continuous health insurance coverage and access to a medical home (5, 10)
- Reducing out-of-pocket costs for vaccinations, expanding clinic accessibility, and offering vaccinations in alternative settings such as WIC sites or child care facilities (9)
- Maintaining and strengthening programs—such as Vaccines for Children—and other efforts to increase vaccination among low-income and uninsured children, and for women during pregnancy (5, 8, 11)
- Supporting efforts to identify and advance effective strategies to improve immunization rates among adolescents, such as text message reminder systems and vaccine administration at school-based locations (7, 10)
- Equipping health care providers with the tools and training to improve immunization compliance while addressing vaccine hesitancy; strategies include establishing patient trust, presenting vaccinations as the social norm, and personalizing dialogue to address patients’ individual concerns (6, 10)
- Supporting broad public education efforts to counter misinformation and restore confidence in vaccines, ensuring that communication materials and approaches are based in science yet approachable, tailored to specific groups, and linguistically and culturally appropriate (1, 6, 8)
- Expanding and improving electronic immunization information systems in order to improve communication across providers, address unmet needs, and plan future efforts (8, 11)
- Allocating adequate funding for public health services at the federal, state, and local levels so that agencies can effectively respond to vaccine-preventable disease outbreaks, conduct public education, maintain immunization infrastructure, and carry out other critical services (8, 11)
Sources for this narrative:
1. Roper, L., et al. (2021). Overview of the United States’ immunization program. The Journal of Infectious Diseases, 224(Suppl. 4), 1. Retrieved from: https://academic.oup.com/jid/article/224/Supplement_4/S443/6378087
2. U.S. Department of Health and Human Services. (n.d.). Healthy People 2030: Infectious disease. Retrieved from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/infectious-disease
3. California Department of Public Health, Immunization Branch. (2022). California school immunization law. Retrieved from: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/School/laws-california-law.aspx
4. California Department of Public Health, Immunization Branch. (n.d.). 2019-2020 kindergarten immunization assessment. Retrieved from: https://eziz.org/assets/docs/shotsforschool/2019-2020CAKindergartenSummaryReport.pdf
5. Hill, H. A., et al. (2021). Vaccination coverage by age 24 months among children born in 2017 and 2018 — National Immunization Survey-Child, United States, 2018–2020. Morbidity and Mortality Weekly Report, 70(41), 1435-1440. Retrieved from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7041a1.htm
6. Olson, O., et al. (2020). Addressing parental vaccine hesitancy towards childhood vaccines in the United States: A systematic literature review of communication interventions and strategies. Vaccines, 8(4), 590. Retrieved from: https://www.mdpi.com/2076-393X/8/4/590
7. Elam-Evans, L. D., et al. (2020). National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years — United States, 2019. Morbidity and Mortality Weekly Report, 69(33), 1109-1116. Retrieved from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6933a1.htm
8. Vaccinate Your Family. (2022). State of the ImmUnion: A report on vaccine-preventable diseases in the U.S. Retrieved from: https://vaccinateyourfamily.org/get-involved/take-action/take-action-federal/state-of-the-immunion-report
9. The Community Guide. (2021). What works: Vaccination. Community Preventive Services Task Force. Retrieved from: https://www.thecommunityguide.org/resources/what-works-increasing-appropriate-vaccination.html
10. Bernstein, H. H., et al. (2017). Practical approaches to optimize adolescent immunization. Pediatrics, 139(3), e20164187. Retrieved from: https://publications.aap.org/pediatrics/article/139/3/e20164187/53206/Practical-Approaches-to-Optimize-Adolescent
11. California Department of Public Health. (2018). The immunization status of young children in California. Retrieved from: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/2014-16IZReportLegislature.pdf
- Research & Links
- Websites with Related Information
- American Academy of Pediatrics: Immunizations
- California Immunization Coalition
- Centers for Disease Control and Prevention: Vaccines and Immunizations
- Healthy People 2030: Vaccination. U.S. Dept. of Health and Human Services.
- MedlinePlus: Childhood Vaccines. U.S. National Library of Medicine.
- Shots for School. California Dept. of Public Health, Immunization Branch.
- Vaccinate Your Family
- Vaccines.gov. U.S. Dept. of Health and Human Services, et al.
- Voices for Vaccines
- World Health Organization: Immunization, Vaccines and Biologicals
- Key Reports and Research
- Addressing Parental Vaccine Hesitancy Towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies. (2020). Vaccines. Olson O., et al.
- Benefits from Immunization During the Vaccines for Children Program Era — United States, 1994–2013. (2014). Morbidity and Mortality Weekly Report. Whitney, C. G., et al.
- Immunization in the United States: Recommendations, Barriers, and Measures to Improve Compliance, Part 1: Childhood Vaccinations. (2016). Pharmacy and Therapeutics. Ventola, C. L.
- Interventions to Reduce Inequalities in Vaccine Uptake in Children and Adolescents Aged <19 Years: A Systematic Review. (2017). Journal of Epidemiology and Community Health. Crocker-Buque, T., et al.
- National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2019. (2020). Morbidity and Mortality Weekly Report. Elam-Evans, L. D., et al.
- Overview of the United States’ Immunization Program. (2021). The Journal of Infectious Diseases. Roper, L., et al.
- State of the ImmUnion: A Report on Vaccine-Preventable Diseases in the U.S. Vaccinate Your Family.
- The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy. (2021). National Academies Press. National Academies of Sciences, Engineering, and Medicine.
- The Need to Optimize Adolescent Immunization. (2017). Pediatrics. Bernstein, H. H., et al.
- U.S. National Vaccine Plan. U.S. Dept. of Health and Human Services.
- Vaccination Coverage by Age 24 Months Among Children Born in 2017 and 2018 — National Immunization Survey-Child, United States, 2018–2020. (2021). Morbidity and Mortality Weekly Report. Hill, H. A., et al.
- Vaccination Coverage for Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2017–18 School Year. (2018). Morbidity and Mortality Weekly Report. Mellerson J. L., et al.
- Vaccine-Preventable Diseases Annual Report. California Dept. of Public Health, Immunization Branch.
- Vaccines Are Not Associated with Autism: An Evidence-Based Meta-Analysis of Case-Control and Cohort Studies. (2014). Vaccine. Taylor, L. E., et al.
- What Works: Vaccination. (2021). The Community Guide.
- County/Regional Reports
- 2023 California County Scorecard of Children's Well-Being. Children Now.
- Annual Report on the Conditions of Children in Orange County. Orange County Children's Partnership.
- Community Health Improvement Plan for Los Angeles County. Los Angeles County Dept. of Public Health.
- Key Indicators of Health by Service Planning Area. (2017). Los Angeles County Dept. of Public Health.
- Live Well San Diego Report Card on Children, Families, and Community. The Children’s Initiative.
- Orange County Community Indicators Report. Orange County Business Council, et al.
- San Mateo County All Together Better. San Mateo County Health.
- Santa Monica Youth Wellbeing Report Card. Santa Monica Cradle to Career.
- More Data Sources For Immunizations
- California Health Interview Survey. UCLA Center for Health Policy Research.
- Childstats.gov. Federal Interagency Forum on Child and Family Statistics.
- National Immunization Surveys (NIS). Centers for Disease Control and Prevention.
- Shots for School: Child Care/Preschool Reporting Data. California Dept. of Public Health.
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