Vaccines are one of the great public health advances of the 20th century, and prevent hundreds of thousands of illnesses in the US every year. Vaccines protect both the person vaccinated and those around them from serious diseases, a concept known as herd immunity. Herd immunity protects other members of the community, such as babies too young to be vaccinated or those who cannot receive immunizations because of a medical condition.
School immunization requirements exist to protect students and members of their community from serious vaccine-preventable diseases by ensuring high vaccination rates. Students in kindergarten through 12th grade are required to be immunized with DTaP/Tdap, polio, MMR, Hepatitis B, and Varicella vaccines.
School immunization rates provide insight into the vaccine coverage in communities across the state. Since immunization rates are not uniform across the state, school immunization data highlight areas that may be more susceptible to vaccine-preventable diseases. These data also show the importance of maintaining high immunization rates.
Massachusetts students must provide documentation of immunization according to school requirements, or show a medical or religious exemption. Medical exemptions come from the student’s doctor and document a contraindication, which is a reason why an individual cannot medically receive the vaccine. Religious exemptions come from the parent/guardian and state in writing that a vaccine conflicts with his/her sincerely held religious belief.
Rates of students with an exemption to one or more vaccines are captured in the annual immunization survey of kindergartens (and seventh grades/childcare/college). Exemptions presented here are medical and religious exemptions combined, however most exemptions claimed in Massachusetts are religious exemptions. There are pockets of higher exemption rates in areas of Massachusetts, including the western portion of the state as well as the southeast, particularly the Cape and the Islands. Areas with higher exemption rates may be more susceptible to disease outbreaks as these students are not fully protected.
Many students only have an exemption to one or a couple of vaccines and are otherwise immunized. Beginning in 2015, our survey collected numbers of students with an exemption that have no documented vaccines on file. This shows the number of students that have an exemption to all vaccines and are likely unimmunized. This number is much lower than the total with an exemption. The regional clustering of students with no documented vaccines is similar to that of students with an exemption to one or more vaccines. Students that are completely unimmunized pose a greater risk to the community as they are unprotected from multiple infectious diseases.
Policies on exclusion from school are developed and enforced at the local level. Many school districts allow students on a catchup schedule to attend classes. Other school districts allow students to attend classes while awaiting updated immunization documentation. Beginning in 2016, the Immunization Program calculated the number of students that do not meet school requirements (i.e. not having all vaccines required for school with no exemption on file), and this number is often referred to as the “gap.” Students counted in the gap might be appropriately immunized, but the school lacks proper documentation of all received immunizations. However, in the event of a case of vaccine-preventable disease in the school setting, these students would also be subject to exclusion from school due to lack of documentation of immunity. The greater the percentage of the gap, the more significant the potential burden on schools and the community should those students need to be excluded.
Immunization requirements are enforced by the grade the student is entering – parents can do their part to make sure their child is appropriately immunized for their grade level and that updated immunization records are on file with the school nurse.
- Childcare/Preschool Immunization Data by Program 2016 – 2017
- Childcare/Preschool Immunization and Exemption Rates by County 2016 – 2017
- Childcare/Preschool Statewide Immunization Rates 1975 - Current
- Childcare/Preschool Statewide Exemption Rates 1991 - Current
- Childcare/Preschool Immunization Data by Program 2015 - 2016 file size 2MB
- Childcare/Preschool Immunization Data by Program 2014 - 2015 file size 1MB
- Childcare/Preschool Immunization and Exemption Rates by County 2015 - 2016
- Childcare/Preschool Immunization and Exemption Rates by County 2014 - 2015
- Kindergarten Immunization Data by School 2016 - 2017 file size 1MB
- Kindergarten Immunization and Exemption Rates by County 2016 - 2017
- Kindergarten Statewide Immunization Rates 1975-Current
- Kindergarten Statewide Exemption Rates 1984-Current
- Kindergarten Immunization Data by School 2015 - 2016 file size 1MB
- Kindergarten Immunization Data by School 2014-2015
- Kindergarten Immunization Data by School 2013-2014
- Kindergarten Immunization and Exemption Rates by County 2015 - 2016
- Kindergarten Immunization and Exemption Rates by County 2014-2015
- Kindergarten Immunization and Exemption Rates by County 2013-2014
- Grade 7 Immunization Data by School 2016 - 2017
- Grade 7 Immunization and Exemption Rates by County 2016 - 2017
- Grade 7 Statewide Immunization Rates 1991-Current
- Grade 7 Statewide Exemption Rates 1991-Current
- Grade 7 Immunization Data by School 2015 - 2016
- Grade 7 Immunization Data by School 2014-2015
- Grade 7 Immunization Data by School 2013-2014
- Grade 7 Statewide Immunization and Exemption Rates by County 2015 - 2016
- Grade 7 Immunization and Exemption Rates by County 2014-2015
- Grade 7 Immunization and Exemption Rates by County 2013-2014
- College Immunization Data by School 2016 - 2017
- College Statewide Health Science Immunization Rates 1995-Current
- College Statewide Immunization Rates 1987-Current
- College Statewide Exemption Rates 1992-Current
- Immunization Requirements for School Entry
- Document outlining Massachusetts school immunization requirements for each grade level
- School Immunization Regulations
- Link to the regulation language
- Back to School Pup
Parent friendly flyer outlining immunization requirements by grade in both English and Spanish
- FRED Measles Epidemic Simulator
- Model that shows the impact on how low immunization rates for measles can result in large measles epidemics
- Immunization Schedules in Easy to Read Format
- CDC immunization schedules by age
- Vaccine Information for Parents
- Main CDC page on vaccine information for parents