Missouri students are heading back to school, but immunization rates continue to lag
COLUMBIA, Mo. (KMIZ)
In less than a month, students across Missouri will be preparing to head back to the classroom for the 2025-2026 school year.
As the new school year approaches in Missouri, state health officials are urging parents and guardians to check their child's vaccination status, warning that falling immunization rates could lead to outbreaks of preventable diseases.
Immunization rates in both private and public schools continue to fall across Missouri, following a national trend. Data from Johns Hopkins University in June shows that in 78% of counties across the country, vaccination rates for the MMR vaccine, which protects against measles, mumps and rubella have fallen more than 2% since before the pandemic.
Health officials say that drop, combined with a rise in exemption requests, has weakened herd immunity protection from vaccine-preventable illnesses, a concern highlighted by a recent measles outbreak in Cedar County and Taney County in Southwest Missouri.
"We've seen a lot of infectious diseases that previously have been prevented and even thought to be eliminated have started to come back," said Dr. Laura Morris, who is a chief medical officer for ambulatory care at MU Health Care and serves as a American Academy of Family Physicians liaison to the Advisory Committee on Immunization Practices. "It's really important to keep students up to date because that's really what helps to protect our schools and to keep kids safe and healthy."
A total of seven cases of measles have been confirmed in Missouri in 2025, though measles was declared eliminated in the United States in 2000, which was achieved through high vaccination rates. As of July 22, the Centers for Disease Control and Prevention reports a total of 1,319 confirmed measles cases across the country, with 29 outbreaks reported, making it the worst measles outbreak in more than 30 years. Those outbreaks resulted in 87% of cases reported
"We have seen cases of measles pop up in Missouri, and in surrounding states," Morris said. "In fact, the United States has already had more measles cases this year in only half of the year than in decades."
Measles is a highly contagious, airborne disease that can spread through coughing, talking, sneezing or touching contaminated surfaces, where it can live for up to two hours. Measles can be very dangerous to babies and immunocompromised people, with one in five people developing pneumonia. In some cases, brain infection, brain swelling or death can occur.
"Measles can make your immune system forget the protection that you have against other infections, so it causes immune system amnesia is what we'll call it," Morris said. And that's really important because now you're at a higher risk after recovering from measles for other infections. Measles can have long-term complications for decades after that."
"When vaccination rates drop, measles is the first one that pops up and pertussis is also on the rise for the same reason, it is the next-most infectious disease, among vaccine-preventable infections," said Dr. George Turabelidze, who is a pediatrician and state epidemiologist. "If we continue that decline, we will start seeing mumps, we will see chicken pox and all those things."
According to data from the Department of Health and Senior Services, there is no specific school-required vaccination rate falling. It's all of them.
"It's a trend nationwide, so not here alone in Missouri, but there is definitely a trend for families to want to opt out or to exempt their students from the vaccine requirements," Morris said.
Kindergarten public school vaccination rates for required immunizations:
| School Year | DTaP | Hep B | IPV/Polio | MMR | Var |
| 19-20 | 94.7% | 96.1% | 95% | 94.9% | 94.4% |
| 20-21 | 92.5% | 95.5% | 93% | 92.7% | 92.4% |
| 21-22 | 91.5% | 94.2% | 92% | 91.9% | 91.3% |
| 22-23 | 91.2% | 93.9% | 91.6% | 91.7% | 91.1% |
| 23-24 | 90.7% | 93.6% | 91.2% | 90.9% | 90.4% |
Data obtained from the Missouri Department of Health and Senior Services.
Kindergarten private school vaccination rates for required immunizations:
| School Year | DTaP | Hep B | IPV/Polio | MMR | Var |
| 19-20 | 93.4% | 94.4% | 93.9% | 91.5% | 91.1% |
| 20-21 | 92.9% | 93.5% | 92.6% | 90.8% | 88.9% |
| 21-22 | 90.6% | 92.1% | 90.9% | 88.9% | 88.4% |
| 22-23 | 89.9% | 91.4% | 90.2% | 87% | 86.7% |
| 23-24 | 88.9% | 90.7% | 89.1% | 85.4% | 85.1% |
Data obtained from the Missouri Department of Health and Senior Services.
A key percentage to note is the falling MMR vaccination rates. Turabelidze said while Missouri's overall protection rate is tolerable for measles, it's barely above the threshold for herd immunity in most counties. That can be achieved when 95% of a community is fully vaccinated by two doses of the MMR vaccine, according to DHSS. Two doses of MMR provide 97% lifetime protection against measles.
Morris said cases of pertussis -- a vaccine-preventable disease also known as whooping cough -- are also on the rise. In 2024, there were six times as many cases reported compared to 2023, according to the CDC. In 2025, the number of cases is trending downward, but remains high.
"The 90% range, that's not enough to provide herd immunity and unfortunately, I think because of that, we will likely see outbreaks in Missouri and potentially, schools are going to be one of those sources," Morris said.
Health officials say multiple factors are contributing to the decline, which Morris said has been going on since the mid-2010s. Those include more families choosing to exempt their child from immunizations, vaccine hesitancy and the spread of vaccine misinformation.
By law in Missouri, any child attending school, either private or public, must have their vaccinations to attend school; however, the state does allow medical and religious exemptions.
A medical exemption is granted when a child's physician determines the child is allergic to a component of the immunization, has an immune deficiency or has an illness (such as cancer). A student would need a signed certification from a licensed medical doctor indicating the immunization would seriously endanger the student's health or life, or the student has documentation of previously having the disease and there is laboratory evidence of immunity.
"In the state of Missouri, we have about a 0.2% rate across kindergarten specifically, of medical exemptions," said Lynelle Paro, who is the chief of the Missouri Bureau of Immunizations. "Vaccine exemptions in Missouri are calculated by antigen or vaccine, rather than by children."
Paro said medical exemptions are not as common, and Turabelidze agreed, saying the exemption typically only is for one vaccination, not the whole lot.
"It's usually one vaccine specifically that is causing the problem for you; you cannot have a blanket medical exemption for everything because it's nearly impossible biologically that you have a problem with every vaccine," Turabelidze said.
A religious exemption requires a signed form stating that the parents or guardians of the child's religious beliefs do not support the practice of immunization. This can be for one specific vaccine or all vaccination requirements.
Paro said in Missouri for the 2024-25 school year, about 4.8% of kindergartners were unvaccinated due to religious exemptions, compared to 2023-24 when that number was 4.3%, and has only continued to rise.
Public School State Level Exemptions:
| School Year | Religious | Medical |
| 2019-20 | 2.3% | 0.2% |
| 2020-21 | 2.2% | 0.1% |
| 2021-22 | 2.6% | 0.1% |
| 2022-23 | 3.4% | 0.1% |
| 2023-24 | 4.1% | 0.1% |
Private School State Level Exemptions:
| School Year | Religious | Medical |
| 2019-20 | 3.5% | 0.2% |
| 2020-21 | 3.2% | 0.2% |
| 2021-22 | 3.9% | 0.3% |
| 2022-23 | 4.8% | 0.2% |
| 2023-24 | 6.3% | 0.3% |
For children in childcare and preschool, there is also a parent/guardian exemption, which needs a signed form on file. This cannot apply to children in kindergarten through 12th grade.
"It's similar to the religious exemption, where if a parent chooses not to vaccinate their child and they are enrolled in child care or preschool, they can choose to do the parental exemption that they put on file with the child care or the preschool," Paro said.
A child can also be categorized as "in-progress," where they are not fully vaccinated, but can still attend school if they are in the middle of getting a vaccine series.
If your child is homeschooled, Paro said, a child should still get vaccinated to prevent a disease outbreak in a community and some extra-curricular activities done at a private or public school require it.
"I do know where some of our bigger districts in the state of Missouri, some of those homeschool students will still come to the district for maybe music or some of those extracurricular classes. And we do ask that schools that have students coming in, that they are at least checking their vaccination status," Paro said.
Turabelidze said a the new generation of parents did not see what happened before vaccinations were introduced, leading to complacency.
"Right before measles vaccination was introduced, 6,500 people, overwhelmingly kids were dying every year in the United States," Turabelidze said. "When you don't see the misery and death, babies choking, to death from pertussis, kids dying from brain damage and measles, then you think that that's normal, but it's not, that's normal because of vaccines."
Another factor coming into play is vaccine hesitancy, which is when a parent or guardian is concerned about side effects, vaccine benefits, not fully trusting medical advice and guidelines and more personal qualms, which were exacerbated by the COVID-19 pandemic.
Turabelidze said the pandemic was a new beast for health officials to take on and mRNA vaccines started getting used on a much larger scale. Without it, Turabelidze said, we could still be in a pandemic.
"We needed to do it real quick and because of that, people were doubting how well those vaccines were studied and there is no new vaccine or medication that won't have any problem, nobody guarantees against that," Turabelidze said. "But looking back, after billions of doses were given worldwide, the number of saved lives versus number of people who had health concerns or health issues because of vaccination, it's not even comparable."
In 2022, then-Pope Francis denounced misinformation regarding the COVID-19 pandemic and vaccinations, with the Vatican saying it was "morally acceptable" for Catholics to receive the vaccination.
Health officials say misinformation is also a big catalyst in a parent or guardian's decision to not vaccinate their child. The Department of Health and Human Services defines misinformation as information that is false, inaccurate or misleading according to the best available evidence at the time.
"When you think about those factors, the biggest piece is that misinformation," Morris said. "There are some groups that actively spread false information and then there's a lot of fear and concern when those stories get amplified."
Health misinformation became so prominent that in 2021, the U.S. Surgeon General released a 22-page guide educating and explaining how health misinformation is spread and what Americans can do to combat it.
Vaccine misconceptions
DHSS has identified several vaccine safety misconceptions.
Certain diseases are rare in the United States because of vaccinations, but in other parts of the world, they could be more common. Traveling abroad puts a person at risk of not only getting the disease but also bringing it back to the United States. Vaccines protect not only one person, but those around you as well.
Those with medical exemptions, in a way, rely on their community to be vaccinated from the disease because they are unable to. Children can still get their immunizations if they are experiencing mild illness, low fever or are taking antibiotics.
While those who have been immunized can get the disease, it's much less likely they will compared to someone who is unvaccinated. Most childhood vaccines are effective for 85-95% of those who get them, according to DHSS.
Morris said if enough unvaccinated people contract a vaccine-preventable illness like measles, that's when vaccinated individuals become at risk.
"If there is a case of measles in a school and there are children who are not vaccinated, and they've been exposed, there's a high likelihood that they will get sick," Morris said. "Even people who have been vaccinated, if exposed to enough cases, and in enough proximity, it's not a perfect vaccine, it's a very, very, effective vaccine. But it's not perfect, so in a large outbreak situation, even some people who have been vaccinated could potentially get sick."
If a person who has received both doses of the MMR vaccine does contract measles, they may have very mild or no symptoms at all because their body's immune system is already familiar with how to fight the disease from getting the vaccination.
DHSS reports there is fewer than a 1% chance of someone having severe side effects from getting a vaccination. Turabelidze said you could experience some side effects from a vaccine, but they are very mild and will go away within a matter of days.
"Overall, [the] majority of vaccines that are -- especially mandatory at school -- have extremely rare side effects, and that's been proven through decades of practice," Turabelidze said. " I personally have given thousands and thousands of vaccinations and I don't recall anybody having any serious consequences other than fevers, rashes and and sore muscles because of the injection."
Turabelidze and Morris said the reaction someone may have after getting a vaccine is their body getting familiar with the disease, not their body actually getting the disease, so if they do run into it in their daily life, their body is prepared.
"It is a good sign that your immune system is reacting to the vaccine," Morris said. "You have seen it, your immune system has been activated, but you're not infected and you're not contagious, so those are important considerations that even if you don't feel great for a day or two while your immune system, reacts to you and creates immunity against that vaccine product, it's not the same thing as being sick and most people generally have very mild symptoms.
"Most vaccines are inactivated or protein-based vaccines that contain pieces of the virus or the bacteria we're trying to protect against, but don't actually contain a live active form that can cause an infection."
DHSS says several studies show that giving multiple vaccines in one visit is safe and effective. Combination vaccines like DTaP, which protects against diphtheria, tetanus, and pertussis (whooping cough), are just as effective if administered in a combination vaccine versus individual doses.
There is also the misconception that vaccines contain harmful ingredients. Morris said that's a myth that has been circulating for decades and studies back in the 1990s put that theory to rest when it came to vaccines with added thimerosal. Morris said thimersol has been removed from all vaccines given to children and pregnant women and is only present with a trace amount in multi-dose vials of a handful of vaccines, most of which are not used in the United States.
"None of these ingredients have shown to be harmful. Vaccines have been well studied, millions of people with millions of doses over time have proven that to us, that you're safer being vaccinated than not being vaccinated," Morris said. "That's where misinformation and misunderstanding makes people feel uncertain and fearful and then leads them to make decisions that ultimately mean they're missing out on protection and immunization, that they really don't need to be worried about."
Choosing not to immunize a child can cause bigger problems down the road, if they contract the disease.
"If you have recovered from an infection, you have immunity from that, but you also have risk," Morris said. "You have the risk, particularly with diseases like chickenpox or measles, which used to be commonplace, there's a real risk of respiratory complications, Pneumonia, meningitis, inflammation in the brain and the spinal cord, there's a significant risk of needing to be hospitalized and there's actually a risk of death, and it is small, but it's there."
Turabelidze said misinformation regarding vaccines and health care in general has become so prominent, health officials almost have to start from the beginning to prove the advantages vaccines have in regards to public health.
"Public Health, we did not fight back well enough and now it is so strong that fighting that misinformation is not easy at all," Turabelidze said. "Those people who oppose vaccinations, they're very good at using social media to promote their messages and we're kind of always behind this, we're always late and we have to improve our communications."
"They [parents] want the best for their child, they want the best for themselves, they want best for their families and unfortunately, we are not still messaging well enough to provide the counterbalance to that misinformation," said Turabelidze. "It's frustrating, sometimes you feel almost guilty that you didn't do enough to prevent that."
Paro said to start getting immunization rates back up, confidence needs to be restored in public health.
"I know that coming out of COVID specifically, parents are concerned about vaccines and the safety of vaccines and I think that building that trust back in public health and in spreading the benefits of the vaccine, even if there is a small reaction, outweighs the risks of getting the vaccine-preventable disease," said Paro.
How to check your child's vaccination status and where to get them
For those still needing vaccinations ahead of school, there are options a parent or guardian can utilize to get their child immunized.
A child can get their vaccines at a checkup with their primary care provider, your local health department, Federally Qualified Health Centers, certain pharmacies and community health centers.
DHSS offers a program called The Vaccines for Children Program. Funded by the CDC, the program provides free vaccinations to children who qualify at participating medical providers. Children are eligible if they are Medicaid-eligible, do not have health insurance, are American Indian or Alaskan Native or are underinsured. Underinsured children have health insurance coverage, but the plan does not cover vaccine costs, does not cover certain vaccines or covers vaccines but has a fixed dollar cap for vaccines.
DHSS has an interactive map showing where parents or guardians can take their child to get vaccinations through the program.
Any vaccination given in Missouri gets reported to the ShowMeVax Registry for health care providers, childcare facilities and schools to keep track of vaccinations. If a record of a vaccine is in the registry, any clinic you decide to go to can access and see that information. ShowMeVax is voluntary for health care providers to use.
"Just because Missouri has a registry, it does not mean that an individual's immunization record is going to be captured in there, but it does capture immunizations that are administered," Paro said.
Paro said Missouri shares vaccination data with seven states, with one being Arkansas.
"If a patient gets vaccinated in Arkansas and they have a Missouri address in that Arkansas registry, that data comes over to Missouri, so it also gets captured in Missouri as well," Paro said.
While ShowMeVax is for health care providers and schools, Paro says a new public dashboard called Docket was launched in Missouri just over a week ago, where parents can access their child's vaccination records for school right from their phones.
"We're really excited to get this off the ground because we do, especially around this time of year, get lots and lots of requests for immunization records for children who are being registered for school," Paro said.
Federal cuts are affecting vaccine outreach and awareness. Morris said the MU School of Medicine secured a $2 million grant in May 2024 to increase immunization rates in children and teens, but that funding has since been stripped.
This year, for the first time in more than 15 years, Columbia/Boone County Public Health and Human Services will not be offering flu shots in local schools during the fall semester, due to losing $800,000 in federal funding in March.
As more vaccine-preventable diseases begin to reemerge, more people have more questions.
"Sometimes that's a wake-up call as we see across the country more and more cases popping up that definitely have triggered families and parents, some of my own patients, to ask more questions," Morris said. "It's been our life's work to make sure we understand this and we want to take care of you and your family, so asking those questions and reaching out right now is a great time."
