Analysis and Dissemination of School-based Immunization Data to Improve Public Health Outcomes in Missouri

In Missouri, immunization is required for both public and private school students against common vaccine-preventable diseases (VPDs) including polio, pertussis, varicella, measles, mumps, and rubella; however, parents may forego vaccination for their child by claiming medical or religious exemptions. Like many states across the US, Missouri is experiencing increasing vaccine exemption rates. However, health officials lack adequate and reliable means of accessing local vaccination data to inform health priorities and interventions. A partnership between the University of Missouri and the Missouri Department of Health and Human Services (DHSS) was formed to 1) better understand temporal and geographic variation in vaccine exemptions and 2) provide accessible data to public health departments and the Missouri public.

School and district-level vaccine exemption data obtained from Missouri’s DHSS were aggregated by geographic region and by school characteristics. These data were analyzed to generate current and historic exemption rates. Analysis of the immunization exemption rates revealed a spatial distribution of vaccine exemption “hot spots.” Using linear regression, the existence of a significant trend (p<0.05) of increasing exemptions for all VPDs in Missouri between 2014-15 and 2018-19 was verified. Statistical tests for variation in vaccine exemption rates by groupings found significance results by school control; tests for urban/rural status and district poverty level did not yield significant results.

As a result of this analysis, aggregated data meeting DHSS suppression criteria were made publicly available through a new, interactive report ( This report provides immunization data, maps, and trends for multiple levels of geography, including legislative districts, toward informing immunization policy.

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