5 Things to Know About Back-to-School Immunizations

Back-to-school season isn’t just about supplies and schedules; it’s also a critical time to review a child’s immunizations. This year, shifting state laws, rising vaccine exemptions, and growing concerns about outbreaks make it more important than ever for families to stay up to date. From catch-up shots to new vaccine recommendations, here are 5 key things every parent should know.

1. Vaccination Rates Are Dropping—And That Matters for School Safety

Routine vaccination rates among US school children have steadily declined since the pandemic, raising concern among public health experts.¹ National coverage for measles, mumps, and rubella (MMR), polio, diphtheria, tetanus, and pertussis (DTaP) all fell to just above 92% in 2024-2025, down from 95% before COVID-19 and below the Healthy People 2030 target of 95%. Exemptions have also increased, especially nonmedical ones, reaching 3.3% nationwide, with more than 5% of kindergartners exempt in 14 states. A total of 39 states now fall below the national MMR target, and in 16 states, vaccination rates have dropped under 90%.² Experts point to rising vaccine hesitancy, fueled by misinformation and declining trust in health authorities, as key drivers of this trend—making it more urgent than ever for families, schools, and providers to close the gaps.

2. State Rules Are Changing—Know What Schools Require

Vaccine requirements are no longer consistent across the country, with states moving in very different directions.³ On the West Coast, California, Oregon, and Washington recently formed the West Coast Health Alliance to issue their own vaccine recommendations after concerns that federal guidance had become politicized. Meanwhile, turmoil at the CDC, including the replacement of its expert vaccine advisory panel and proposed changes to the childhood vaccine schedule without scientific evidence, has fueled concern among public health leaders about political interference and eroding trust.⁴ In sharp contrast, Florida has announced plans to eliminate all school vaccine mandates, a move experts warn could trigger severe outbreaks that put children, immunocompromised individuals, and even tourists at risk.⁵ These shifts highlight why parents need to closely monitor state and local policies, which may now differ from federal recommendations.

3. Catch-Up Shots Can Close the Gaps

When children fall behind on routine immunizations, there are official guidelines to help get them caught up, and it’s especially critical as school starts.⁶ The CDC’s catch-up schedule gives pediatricians clear, evidence-based intervals for late or missing shots, according to age, from 4 months up to 18 years and for special medical situations. Schools also require proof of certain core vaccines, like DTaP, MMR, varicella, polio, hepatitis B, and meningococcal for older children, with deadlines often in the first weeks of the school year.⁷ If a child missed any doses, speaking to a pediatrician early to map the shortest safe path to complete the series will ensure the child is ready and fully protected for the school year.

4. Measles and Whooping Cough Are Making a Comeback

After years of relatively stable rates, cases of whooping cough have surged—alongside growing outbreaks of measles.⁸ In 2024, there were 35,435 reported pertussis cases, over 6 times the number in 2023. Many of these cases are tied to declining vaccination rates. The CDC confirms that this uptick puts case counts above prepandemic levels; cases remain elevated in 2025 despite some recent declines from the November 2024 peak.⁹ Whooping cough is especially dangerous for infants (many of whom require hospitalization) and for older kids as vaccine immunity wanes. Measles, once declared eliminated in the US, is also resurging in areas where MMR vaccine coverage has dipped.^8,9

5. New Vaccines to Keep on the Radar

In addition to routine vaccines, families should know about newer or updated recommendations for COVID-19 and respiratory syncytial virus (RSV). The West Coast Health Alliance now recommends COVID-19 vaccines for all children and adults who want protection, including children aged 6 months to 23 months and older kids who haven’t received previous doses or who have risk factors.¹⁰ Meanwhile, the CDC recommends RSV vaccines for adults 60 years or older and for certain pregnant individuals to help protect newborns.¹¹ These vaccines aren’t always required for school, but staying up to date can prevent serious illness and help families avoid disruptions during the school year. Pediatricians can help determine which of these newer vaccines make sense based on a child’s age and health status.

References

1. Seither R, Yusuf OB, Dramann D, et al. Coverage with selected vaccines and exemption rates among children in kindergarten—United States, 2023–24 school year. CDC. October 17, 2024. Accessed September 18, 2025. https://www.cdc.gov/mmwr/volumes/73/wr/mm7341a3.htm

2. Williams E, Kates J, Michaud J. Kindergarten routine vaccination rates continue to decline. KFF. August 5, 2025. Accessed September 18, 2025. https://www.kff.org/medicaid/kindergarten-routine-vaccination-rates-continue-to-decline/

3. Bonavitacola J. West Coast Health Alliance releases first vaccine guidelines, aiming to replace CDC recommendations. AJMC^®. September 17, 2025. Accessed September 18, 2025. https://www.ajmc.com/view/west-coast-health-alliance-releases-first-vaccine-guidelines-aiming-to-replace-cdc-recommendations

4. Steinzor P. Former CDC director raises alarm on childhood vaccine schedule changes. AJMC. September 17, 2025. Accessed September 18, 2025. https://www.ajmc.com/view/former-cdc-director-raises-alarm-on-childhood-vaccine-schedule-changes

5. Oliphant J, Steenhuysen J. Florida plans to end all state vaccine mandates, including for schools. Reuters. September 4, 2025. Accessed September 18, 2025. https://www.reuters.com/business/healthcare-pharmaceuticals/florida-plans-end-all-state-vaccine-mandates-including-schools-2025-09-03/

6. Catch-up immunization schedule for children and adolescents (addendum updated August 7, 2025). CDC. Updated August 7, 2025. Accessed September 18, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-catch-up.html

7. Here’s what we know: required vaccinations for back to school. Weill Cornell Medicine. September 10, 2025. Accessed September 18, 2025. https://pediatrics.weill.cornell.edu/news/heres-what-we-know-required-vaccinations-back-school

8. Gerlach A. Amid the ongoing measles outbreak, cases of whooping cough are on the rise. Pharmacy Times®. April 22, 2025. Accessed September 18, 2025. https://www.pharmacytimes.com/view/amid-the-ongoing-measles-outbreak-cases-of-whooping-cough-are-on-the-rise

9. Pertussis surveillance and trends. CDC. June 11, 2025. Accessed September 18, 2025. https://www.cdc.gov/pertussis/php/surveillance/index.html

10. West Coast states recommend COVID shots for all adults and children, breaking with federal policy. Reuters. September 17, 2025. Accessed September 18, 2025. https://www.reuters.com/legal/litigation/west-coast-states-recommend-covid-shots-all-adults-children-breaking-with-2025-09-17/

11. Vaccines for adults. CDC. July 8, 2025. Accessed September 18, 2025. https://www.cdc.gov/rsv/vaccines/adults.html