Variation in Vaccination Data Available at School Entry Across the United States

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Objectives. To compile substate-level data on US school-age children’s vaccination rates.

Methods. For states that did not have suitable data online, in 2015 we submitted information requests to the state health department and followed up with the state’s Freedom of Information Act when necessary.

Results. The accessibility, scale, and types of vaccination data varied considerably. Whereas 26 states provided data online, 14 released data only after a Freedom of Information Act request. School or school-district data were available for 24 states, 19 at the county level, 2 at the health department level, and 6 provided no substate-level data.

Conclusions. Effective vaccination policy requires a robust understanding of vaccination behavior. Some states make it difficult to access data or provide low-resolution data of limited value for identifying vaccination behavior.

The relationships among vaccination recommendations and policies, vaccine uptake, and the rates of exemptions from school-entry vaccination requirements are of great interest to public health officials. This information is especially valuable when it allows the identification of specific communities where vaccination coverage rates are below recommended thresholds and populations may be more vulnerable to outbreaks.

State-level data are helpful for identifying national trends in kindergarten vaccination and exemption rates,1 but they do not allow examinations of within-state differences in vaccination coverage. Vaccination-related behavior has proven to be highly spatially variable within states or larger regions.2–4 Communities with very low vaccination rates are often located in close proximity to communities with much higher vaccination rates. State-level data, or even county-level data, on vaccination coverage and exemption rates may not allow the identification of the most at-risk communities. Our ability to improve scientific knowledge about of the links between vaccination coverage rates and infectious disease outbreaks is dependent on having access to data at a fine spatial resolution. The challenges associated with accessing spatial data about immunization have been described for some individual states,4,5 but the availability of data has not been systematically examined across the country.