School Immunizations

Information about school immunization requirements and data

School immunization requirements exist to protect students and members of their community from serious vaccine-preventable diseases by ensuring high vaccination rates.

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.

Table of Contents

School and camp requirements

Herd immunity and importance of vaccines

Vaccines are one of the great public health advances of the 20th century, and prevent hundreds of thousands of illnesses in the U.S. 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 data

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.

This map shows Rates of Kindergarten Students by Massachusetts County with an Exemption, 2018. These are religious and medical exemptions combined. These data are current as of May 1, 2019 and are subject to change.  State average 1.4% Barnstable 3.4% Berkshire 5.4% Bristol 1.5% Dukes 8.2% Hampden 1.9% Hampshire 1.7% Essex 1.3 % Franklin 4.5% Middlesex 1.1% Nantucket 1.7% Norfolk 1.2% Plymouth: 1.4% Suffolk .4% Worcester 1.4%

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 — the 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 the western and southeast parts of the state, particularly the Cape and Islands. Areas with higher exemption rates may be more susceptible to disease outbreaks because these students are not fully protected.

Unimmunized rates by county

This map shows Rates of Kindergarten Students by Massachusetts County with an Exemption and No Vaccines, 2018. These are religious and medical exemptions combined. These data are current as of May 1, 2019 and are subject to change.   State average .6% Barnstable 1.7% Berkshire 1% Bristol .5% Dukes 0.0% Hampden 1% Hampshire .7% Essex .6% Franklin 2.9% Middlesex .5% Nantucket 0.0% Norfolk .5% Plymouth: .7% Suffolk .2% Worcester .6%

Many students have an exemption to only one or two 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 or two. 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 because they are unprotected from multiple infectious diseases.

Students not meeting school requirements by county

This map shows Rates of Kindergarten Students by Massachusetts County Not Meeting School Requirements, 2018 (not fully vaccinated and does not have an exemption). These data are current as of May 1, 2019 and are subject to change.   State average 3.1% Barnstable 2.8% Berkshire 4.2% Bristol 1.3% Dukes 2.5% Hampden 4.2% Hampshire 2.1% Essex 2.4% Franklin 3.1% Middlesex 1.6% Nantucket 1.7% Norfolk 1.1% Plymouth: .7% Suffolk 13.7% Worcester 2.2%

Policies on exclusion from school are developed and enforced at the local level. Many school districts allow students on a catch-up schedule to attend classes. Other school districts allow students to attend classes while awaiting updated immunization documentation. Beginning in 2016, the Immunization Division 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 face exclusion during a breakout.

Immunization requirements are enforced by the grade the student is entering — parents can do their part to make sure their children are appropriately immunized for their grade level, and that updated immunization records are on file with the school nurse.

Kindergarten data

Past years data

Information for schools and childcare programs

School Immunization Surveys

For information about worksheets to better prepare for the school survey, visit our School Immunizations Surveys page. For kindergarten and Grade 7, MIIS is used to collect these data.

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