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What the data show
CDC data released Aug. 17 for the 2025-2026 school year found that 4.2% of U.S. kindergartners had an exemption from one or more required vaccines, up from 3.6% the year before. Exemptions increased in 41 states and the District of Columbia. Coverage declined for every vaccine the CDC reported, and coverage for measles, mumps and rubella, diphtheria, tetanus and pertussis, polio and chickenpox fell in more than half of states. About 280,000 kindergartners started school without documentation of both MMR doses.
Federal guidance is also changing
On Aug. 10, President Trump signed an executive order revising the federal childhood immunization schedule. According to AHA News, the order sorts childhood vaccines into three categories and recommends spacing them across separate visits when feasible. It recommends vaccines against 11 diseases, including measles, mumps and rubella, for all children, while vaccines such as RSV and hepatitis A and B are recommended for high-risk groups or through shared decision-making.
The order directs HHS to draft recommendations within 90 days on giving core vaccines as single-antigen shots, starting with MMR, and asks states to review their own vaccine rules. Practical effects on clinic workflows and supply are not yet clear.
What it means for hospitals
Lower community immunity raises the odds of outbreaks that arrive through the emergency department and pediatric clinics. Measles is the main concern because it spreads through the air and can expose many patients and staff before anyone suspects it. Each exposure event brings contact tracing, staff furloughs and possible lost revenue from closed rooms or units.
Shifting guidance can also confuse families and clinicians. Pediatric practices owned by health systems may see more requests for separate shots or changed timing, which can affect visit volume, supply and documentation.
Readiness checklist
- Screen at the door. Make sure triage asks about rash and fever with recent exposure, and that suspected cases are masked and isolated at once.
- Check airborne isolation capacity. Know how many negative-pressure rooms are available and working in each emergency department.
- Verify staff immunity. Confirm documented measles immunity for all employees and contractors so an exposure does not sideline large numbers of staff.
- Coordinate with public health. Agree in advance on reporting, testing and exposure notification steps.
- Prepare clinicians. Give primary care and pediatric teams clear guidance for conversations with families as recommendations change.
Archive entry for Aug 20, 2026, added Nov. 11, 2026.