State Health Department: Number of keiki without up-to-date immunizations increases

The number of Hawaiʻi students not up to date with immunizations is increasing, according to new data from the Hawaiʻi State Department of Health.

Twenty-one percent of students from public, charter and private schools (39,583 individuals) were not up to date on their school-required immunizations for the 2023-24 school year.

“We are already seeing increased cases of pertussis and are at risk for a measles outbreak,” said Department of Health director Dr. Kenneth Fink. “Immunizations are necessary to protect infants, children and adults from potentially serious and contagious diseases.”

The data show a 25% increase from the 2022-23 school year. This number includes those claiming exemptions, those without immunization records, or students missing individually required vaccines.

The majority of this increase in missing school-required immunizations is from 7th grade school requirements that were implemented in 2020 during COVID. For the 2023-2024 school year, 16% of kindergarteners were not up to date with school-required vaccinations compared to 55% of seventh graders.

“An increase in the number of students without up-to-date immunizations is a cause for concern,” Fink said.

Of the 382 schools reporting for the 2023-24 year, 282 schools reported more than 5% of their student populations were not up to date with Hawaiʻi’s school immunization requirements. Thirty-six schools reported having more than 50% of their student body not up to date.

For Hawaiʻi public schools, the Hawaiʻi Department of Education reported that 36,026 students were missing one or more required immunizations for the 2023-24 school year. Preliminary data for the 2024-25 school year shows 28,300 students missing one or more vaccinations, the Department of Education said.

Schools have until Jan. 10, 2025, to report to the Department of Health on the number of students not up-to-date on immunizations.

“High vaccination rates help protect those who are unable to receive certain vaccines due to medical reasons and those with a non-medical exemption through what’s called herd immunity,” Fink said.

Fink continued: “Low vaccination rates mean unvaccinated keiki are at increased risk of infection, especially at schools with a high rate of the student population not being up to date.”

Hawaiʻi has two forms of vaccination exemptions for schools, medical and religious. Department of Health data indicates a religious exemption rate of 4.1% for the 2023-24 school year when averaged across the entire state. This is an upward trend compared to prior years starting in 2019-20 at 2.1%. Medical exemptions have increased from 0.07% in 2019-20 to 0.16% in 2023-24 but continue to remain low overall.

The federal Centers for Disease Control have also confirmed a similar upward trend in Hawaiʻi’s religious exemption rate over the last few years through a separate analysis.

Nationwide, including Hawaiʻi, there has been an increase in vaccine hesitancy since the COVID-19 pandemic.

According to the Department of Health, the volume of misinformation about vaccines continues to grow and has contributed to this trend. Also, a continuing challenge with missing vaccinations is difficulty in accessing healthcare, particularly in rural areas.

The Department of Health is working with educational partners and healthcare providers to address ongoing challenges that may be contributing to this trend. This work includes educating families that vaccination is the best defense against certain life-threatening diseases; working with pharmacies and physician practices to increase access; and making it easier to collect, analyze and report accurate data on student immunizations by modernizing the Hawaiʻi Immunization Registry.

To view the immunization data by school, click here.