We study the direct and spillover effects of state requirements that middle school youths obtain a tetanus, diphtheria, and pertussis (Tdap) booster prior to middle school entry. These mandates significantly increased Tdap vaccine take-up and reduced pertussis (whooping cough) incidence by about 32 percent. We also document cross-vaccine spillovers: the mandates significantly increased adolescent vaccination rates for meningococcal disease and human papillomavirus (HPV)—which is responsible for 98 percent of cervical cancers—by 8–34 percent, with particularly large effects for children from low SES households. We find important roles for both parents and providers in generating these spillovers.

The annual pre-kindergarten (pre-K) through 12th grade school immunization survey collects school-level, grade-specific data on vaccine coverage and exemptions. The survey collects vaccination and exemption status data on children who entered the school system on or before a specified date during the fall semester. Individual vaccine information on each student is not collected. This table shows the statewide vaccination exemptions (medical and religious) and percentage vaccinated and compliant for each school-entry mandated vaccine series reported by school year, grade, and school type. Percentage of students vaccinated is the number of students with the required number of doses of a given vaccine divided by the total number of students. Data for each grade includes all schools who reported with that given grade level. School-mandated vaccine series for students enrolled in kindergarten are inactivated polio, DTaP (diphtheria, tetanus, and acellular pertussis), MMR (measles, mumps, and rubella), hepatitis B, varicella and hepatitis A. Additional mandated vaccines for students enrolled in 7th grade include meningococcal conjugate vaccine (MCV) and Tdap (tetanus, diphtheria, and acellular pertussis). Influenza vaccine is a requirement for pre-K students only, who are 24 through 59 months of age. Each child has 1 of 4 possible vaccination statutes: Vaccinated, Exempt (Religious), Exempt (Medical) or Non-compliant. The criteria shown below are used to assess whether a child is considered vaccinated. • Flu = at least 1 dose of annual influenza vaccine (pre-K only). This is a school entry requirement only for pre-K students 24 through 59 months of age. • Polio = at least 3 doses of inactivated polio vaccine, with the last dose on or after their 4th birthday. This is a school entry requirement starting in kindergarten. • DTaP = at least 4 doses of DTaP vaccine, with the last dose on or after their 4th birthday. This is a school entry requirement starting in kindergarten. • MMR = at least 2 doses of MMR vaccine separated by at least 28 days, with the 1st dose on or after their 1st birthday. This is a school entry requirement starting in kindergarten. • HepB = at least 3 doses of hepatitis B vaccine, with the last dose on or after 24 weeks of age. This is a school entry requirement starting in kindergarten. • Varicella = at least 2 doses of varicella vaccine separated by at least 28 days, with the 1st dose on or after their 1st birthday, or a reliable history of chickenpox disease. This is a school entry requirement starting in kindergarten. • HepA = at least 2 doses of hepatitis A vaccine, given a minimum of six calendar months apart, with the 1st dose on or after their 1st birthday. This is a school entry requirement starting in kindergarten. Starting with the 2019-2020 school year the annual survey included data collection on hepatitis A vaccine for 7th grade students. • MCV = at least 1 dose of meningococcal conjugate vaccine. This is a school entry requirement starting in 7th grade. • Tdap = at least 1 dose of Tdap vaccine. This is a school entry requirement starting in 7th grade. • All = Percentage of students with all above vaccine series required for that grade level. Children without a record of vaccination, but with serologic proof of immunity to certain diseases (measles, mumps, rubella, hepatitis B, hepatitis A, and varicella), meet school entry requirements and may be counted as vaccinated. Data Limitations and Considerations: • The school level data shown here are as tabulated and reported by schools and discrepancies may exist. • The Immunization Program identifies outliers and internally inconsistent data points and works with schools to resolve any data quality issues, when possible. • CT DPH cannot verify the accuracy of vaccine data for individual children or whether the documentation necessary to claim an exemption has been submitted. • Data are collected at the beginning of the school year, by which time vac

Vaccination Coverage among Pregnant Women

• Data on influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination coverage at the state level from the Pregnancy Risk Assessment Monitoring System (PRAMS) for women who had a recent live birth by age and race/ethnicity.

• Additional information available at https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/index.html and https://www.cdc.gov/flu/fluvaxview/index.htm

We collected data from all US states where school vaccine exemption information was freely available from the Department of Health website in any format. We were able to locate that data in 24 states. Within these states, the number of years available varied relatively widely, between 19 years in California and a single year in 6 states. The most represented year in our dataset was 2017 (corresponding to school year 2017-2018). Because the dataset was compiled in June-July 2019, we note that it is possible that additional data for recent years may not be available, or that data may have become available in additional states not included in our dataset. The data format varied widely between states, and exemptions were reported either as a number of exemptions or as a percentage of the enrolled students. We have elected to use number of students rather than percentages, and have transformed data as needed. For most states included in our dataset, the data are provided at the county level. In several states (Arizona, Colorado, Illinois, Maine, Michigan, South Dakota, Tennessee, Vermont, Oregon, and Washington), the data was provided at the school level, which we aggregated to the county. Additional data processing was necessary in some cases. In Virginia, data was provided by school name, but county or city information was not included. We used a list of public and private schools to match school names with their respective county using fuzzy matching (with the fuzzywuzzy Python package) with an 80\% matching requirement. Our algorithm was unable to find a suitable match for between 3.8\% and 6.8\% of schools (depending on year), and these schools were not included in the final counts at the county level. Similarly, in Idaho, data at the school level included city information but county was not provided. We first matched city and county names, before aggregating the exemption data at the county level. Finally in New York state, exemptions were provided as percentages at the school level but enrollment information was not included. We obtained enrollment for public and private schools separately from the New York State Education Department, and used the school unique code to calculate exemption number from enrollment and exemption percentages. We then aggregated these numbers at the county level. States reported data for exemptions based on varying definitions, so we selected data records based on data availability to make the data comparable cross states. We aimed to achieve parsimonious definitions of total medical exemptions, total non-medical exemptions, and total exemptions, which includes both types of exemptions. We define medical exemptions as reported total medical exemptions. In Florida, permanent medical exemptions were reported separately from temporary medical exemptions, so permanent medical exemptions was chosen to represent total medical exemptions. To define total non-medical exemptions, we considered the state law regarding non-medical exemptions and the data availability. If the state reported total aggregated non-medical exemptions, that was selected as total non-medical exemptions. If the state reported only religious exemptions and only allows religious exemptions, that was selected as total non-medical exemptions. If the state reported only religious exemptions, but also allows philosophical exemptions, that was considered missing data. If the state allows philosophical exemptions and only reports philosophical exemptions, that was selected as total non-medical exemptions, as the state may not differentiate religious from philosophical. If the state allows philosophical exemptions and reports both religious and philosophical exemptions separately, these values were summed for total non-medical exemptions. To define total exemptions, if the state reported a total exemptions value, this value was used. If the state did not report a total exemptions value, but reported values for total medical exemptions and total non-medical exemptions, as defined above, these were summed for total exemptions. If the state was missing either medical or non-medical exemptions, but reported the total number of students with completed vaccinations, the total exemptions was the difference between the number of students enrolled and the number of students completed. We also considered disease-specific exemptions reports. If a state reported the number of exemptions for a vaccine specific to a given infection, that value was used. If the state did not report exemptions, but did provide the total number complete for that disease, the difference between the enrolled students and the completed students was used. For pertussis-specific vaccination, we used DTaP exemptions where available, and TDaP exemptions where DTaP was not available. For measles-specific vaccination, if separate reports were available for measles, mumps, and rubella, the val...

This data set includes monthly counts and rates (per 1,000 beneficiaries) of vaccinations provided to Medicaid and CHIP beneficiaries under age 19 (as of the first day of the month), by state. The following vaccinations are included: Chickenpox, DTaP, HPV, Hepatitis A, Hepatitis B, Influenza, MMR, Meningococcal, Meningococcal B, Pneumococcal conjugate, Pneumococcal polysaccharide, Polio, Rotavirus, Tdap, and all vaccinations. These metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating vaccination measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Procedure Codes - OT Professional, Claims Volume - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of “DQ” indicate that data were suppressed due to unusable data. Some cells have a value of “DS”. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.

This dataset contains immunization status of 7th grade students in California in schools with 10 or more 7th grade students enrolled. Smaller schools were excluded to help protect privacy. Students in 7th Grade were considered to have up-to-date immunizations if they had completed the Tdap immunization requirement to receive one dose of any immunization (Tdap, DTaP or DTP) that protects against pertussis on or after their 7th birthday. The California Health and Safety Code Section 120325-75 requires students to provide proof of immunization for school and child care entry. Additionally, California Health and Safety Code Section 120375 and California Code of Regulation Section 6075 require all schools and child care facilities to assess and report annually the immunization status of their enrollees.

Under Assembly Bill 354 (2010), California Health and Safety Code Section 120335 required students in 7th grade to provide documentation of either having received a booster immunization against pertussis or an exemption to immunization. To review individual school coverage and exemption rates in a separate lookup format, go to the School Lookup page at the Immunization Branch's Shots for School website: http://www.shotsforschool.org/lookup/

To see the PDF reports by year go to: https://www.shotsforschool.org/7th-grade/reporting-data/

See the attached file 'Notes on Methods' for data suppression in 2016-2017 data to present.

For earlier years of data: https://www.shotsforschool.org/7th-grade/reporting-data/

The annual pre-kindergarten (pre-K) through 12th grade school immunization survey collects school-level, grade-specific data on vaccine coverage and exemptions. The survey collects vaccination and exemption status data on children who entered the school system on or before a specified date during the fall semester. Individual vaccine information on each student is not collected. This table shows the percentage of kindergarten students vaccinated for each school-entry mandated vaccine series and the percentage with vaccination exemptions (medical or religious) reported by school. Percentage of students vaccinated is the number of students with the required number of doses of a given vaccine divided by the total number of students. Data includes all schools who reported students in kindergarten. School-mandated vaccine series for students enrolled in kindergarten are inactivated polio, DTaP (diphtheria, tetanus, and acellular pertussis), MMR (measles, mumps, and rubella), hepatitis B, varicella, and hepatitis A. Each child has 1 of 4 possible vaccination statuses: Vaccinated, Exempt (Religious), Exempt (Medical) or Not Complete. The criteria shown below are used to assess whether a child is considered vaccinated. • Polio = at least 3 doses of inactivated polio vaccine, with the last dose on or after their 4th birthday. This is a school entry requirement starting in kindergarten. • DTaP = at least 4 doses of DTaP vaccine, with the last dose on or after their 4th birthday. This is a school entry requirement starting in kindergarten. • MMR = at least 2 doses of MMR vaccine separated by at least 28 days, with the 1st dose on or after their 1st birthday. This is a school entry requirement starting in kindergarten. • HepB = at least 3 doses of hepatitis B vaccine, with the last dose on or after 24 weeks of age. This is a school entry requirement starting in kindergarten. • Varicella = at least 2 doses of varicella vaccine separated by at least 28 days, with the 1st dose on or after their 1st birthday, or a reliable history of chickenpox disease. This is a school entry requirement starting in kindergarten. • HepA = at least 2 doses of hepatitis A vaccine, given a minimum of six calendar months apart, with the 1st dose on or after their 1st birthday. This is a school entry requirement starting in kindergarten. • All = Percentage of students with all above vaccine series required for that grade level. Children without a record of vaccination, but with serologic proof of immunity to certain diseases (measles, mumps, rubella, hepatitis B, hepatitis A, and varicella), meet school entry requirements and may be counted as vaccinated. The values for schools with fewer than 30 enrolled kindergarteners are suppressed, and those fields are left blank.   Data Limitations and Considerations: • The school level data shown here are as tabulated and reported by schools and discrepancies may exist. • The Immunization Program identifies outliers and internally inconsistent data points and works with schools to resolve any data quality issues, when possible. • CT DPH cannot verify the accuracy of vaccine data for individual children or whether the documentation necessary to claim an exemption has been submitted. • Data are collected at the beginning of the school year, by which time vaccines are due. As the year progresses, immunization rates may increase as additional children receive required immunizations. Additionally, the student body is dynamic and as students arrive and leave school, the immunization rates are impacted. • Vaccine status is assessed on the level of the child and not on each vaccine. Once a child is listed as exempt, vaccination data is no longer collected in the survey for that child. Therefore, children with exemptions are not counted as vaccinated in the vaccine level assessments although they may have received some vaccines. • One school was excluded due to a data collection error.

In 2022, around 1,029 petitions were filed with the United States National Injury Compensation Program (VICP) seeking compensation for injury or death caused by vaccines. However, just because a petition was filed seeking compensation for injury or death due to a vaccination does not mean that compensation was awarded. Over half of all such petitions filed in the U.S. since 1988 have been dismissed, and in 60 percent of cases in which compensation was awarded it was still not determined whether the alleged vaccine caused the alleged injury.

The impact of vaccinations Vaccinations in the United States have had a significant impact on infectious diseases. For example, as of 2017, there are only about 120 new cases of measles per year, compared to over half a million annual cases before the use of vaccination. Vaccinations in the U.S. have also greatly decreased the number of annual cases of hepatitis A and B, rubella, and tetanus.

COVID-19 vaccination hesitancy Vaccine hesitancy is a persistent issue in the United States. The issue became especially pertinent during the COVID-19 pandemic in which many people in the United States expressed reluctance to getting a COVID-19 vaccination. In December 2020, 59 percent of adults in the United States who stated they would definitely not or probably not get a COVID-19 vaccine said so because they were worried about possible side effects, while 55 percent said they probably wouldn’t get a COVID-19 vaccination because they do not trust the government to make sure the vaccine is safe and effective. Shockingly, one survey found that even 29 percent of health care workers stated they would probably or definitely not get a COVID-19 vaccine.