School immunizations

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

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.

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.

Total Exemption Rates by County

Image of Rates of Kindergarten Students with an Exemption, By County 2017

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.


Unimmunized Rates by County

Imagew of Unimmunized Rates by County 2018

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.

Students Not Meeting School Requirements by County

Image of Rates of Kindergarten Students Not Meeting School Requirements, By County, 2017

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.

School Requirements and Other Resources

  • Immunization Requirements for School Entry | (DOC) resource outlines the required vaccines by child care/preschool, grades K-6, grades 7-12, and college. While MDPH outlines the required vaccines, local school districts are responsible for ensuring compliance to the stated requirements.
  • Parents can use the Back to School Pup (DOC) as an easy to read resource outlining immunization requirements by grade in both English and Spanish.
  • The FRED Measles Epidemic Simulator shows the impact on how low immunization rates for measles can result in large measles epidemics.
  • Keep in mind that students should be vaccinated according to the recommended immunization schedule. The CDC Immunization Schedules in Easy to Read Format show when children should get recommended vaccines.
  • Parents and caregivers should visit the CDC page, Vaccine Information for Parents, to learn more about childhood vaccines and the recommended immunization schedule.
  • Camp directors and parents sending their children to camp may refer to the memo, Recommended Immunizations for Children Attending Camp (DOC), for immunization requirements and recommendations for children attending camp.

School Immunization Data

The resources below include the actual data from the school immunization surveys conducted by MDPH each year. You can look up your individual school to see immunization rates, exemption rates, and other related information.



Past Years



Past Years

7th Grade


Past Years



If you are a school nurse, please visit School Immunization Information for School Nurses for more information.

Additional Resources for School Immunization Data


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