The states with the highest childhood vaccine exemption rates

Utilizing data from CDC's National Center for Immunization and Respiratory Diseases, which was last updated on Aug. 17, KFF determined the percentage of kindergarteners in each state who had exemptions for at least one vaccine required by the state. Data for Montana was not reported.

In total, 30 states reported vaccine exemption rates above the national average of 4.2%, with Idaho recording the highest exemption rate at 17.5%, more than four times the national average.

Meanwhile, five states reported vaccine exemption rates below 1%, including California, Connecticut, New York, Maine, and West Virginia. All five states restrict non-medical vaccine exemptions; however, West Virginia's status is currently contested as a gubernatorial executive order to permit religious and personal belief exemptions for vaccines is currently on hold pending a decision from the state's Supreme Court.

Medical groups issue vaccine guidance

Meanwhile, major medical groups around the United States have issued their own vaccine guidance for the upcoming respiratory virus season. These groups have aimed to fill the gaps in vaccine recommendations from the federal government, as CDC has yet to issue any and the vaccine guidance the agency previously issued has been in legal limbo.

In January, CDC reduced the number of vaccinations recommended for children from 17 to 11; however, that decision was blocked by a federal judge who said that HHS Secretary Robert F. Kennedy Jr.'s decision to fire all 17 members of CDC's Advisory Committee on Immunization Practices and replace them with eight new appointees and CDC's overhaul of the childhood vaccine schedule were both likely illegal.

Then, in August, President Donald Trump signed an executive order to reduce the number of universally recommended vaccines for children and called for splitting up the measles, mumps, and rubella vaccine into three shots administered at separate medical visits.

A single dose of an age-appropriate COVID-19 vaccine for children and adolescents ages two to 18 years regardless of prior COVID-19 vaccination status was recommended for:

• Those at high risk of severe COVID-19
• Residents of long-term care facilities or other congregate settings
• Those who have never been vaccinated against COVID-19
• Those whose household contacts are at high risk for severe COVID-19

"Every year, the American Academy of Pediatrics comes out with a recommended schedule of vaccines for children," said AAP president Andrew Racine. "The difference is that in the past couple of years we've done that independently of the CDC, where we used to do it in conjunction with the CDC."

Separately, a number of major medical groups, including AAP alongside the American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and the Infectious Diseases Society of America issued guidance on COVID-19, RSV, and influenza vaccines. The guidance was developed in collaboration with the American Medical Association and followed an independent review by the Vaccine Integrity Project.

Generally, the new guidance for RSV and COVID-19 vaccination for children aligns with AAP's separately issued guidance. The guidance also recommends the annual flu vaccine for all children ages six months or older.

For adults, the new guidance recommends adults ages 19 to 64 years receive the annual flu vaccine and the annual updated COVID-19 vaccine. Adults ages 65 or older are recommended to receive the annual flu vaccine at a high dose if possible and the annual updated COVID-19 vaccine followed by a second dose six months later to boost protection.

A one-time RSV vaccine is recommended for adults ages 50 to 74 at increased risk of severe RSV.

For pregnant women, the new guidance recommends receiving the annual flu vaccine (not in nasal spray form) and receiving the annual updated COVID-19 vaccine. A one-time RSV vaccine is also recommended in the first eligible pregnancy if the woman is 32-36 weeks pregnant, given between Sept. 1 and March 1.

"Immunization continues to be one of our best tools for preventing severe illness from respiratory viruses," said Michael Osterholm, executive director of the Vaccine Integrity Project. "This year's review confirms that the newest evidence remains consistent with research showing these immunizations reduce the risk of hospitalization and death among the people most likely to experience serious disease."