Tennessee Kindergarten Immunization Compliance Assessment Report

2020-2021 School Year

Tennessee Department of Health (TDH) | Communicable and Environmental Diseases and Emergency Preparedness (CEDEP) Tennessee Vaccine-Preventable Diseases and Immunization Program (VPDIP) | Aug 2021

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Table of Contents EXECUTIVE SUMMARY ......................................................................................................................................................... 5

2020-2021 SCHOOL YEAR STATEWIDE SUMMARY ............................................................................................................................. 6 Public Schools Statewide Summary ..................................................................................................................................... 7 Private Schools Statewide Summary ................................................................................................................................... 7

TRENDS OVER TIME ...................................................................................................................................................................... 8 IMPACT OF COVID PANDEMIC ....................................................................................................................................................... 8

2020-2021 KINDERGARTEN IMMUNIZATION COMPLIANCE ASSESSMENT RESULTS ........................................................... 12

PUBLIC HEALTH REGIONS SUMMARY .............................................................................................................................................. 12 COUNTY LEVEL SUMMARY ............................................................................................................................................................ 14 PUBLIC AND PRIVATE SCHOOL SUMMARIES BY COUNTY AND SCHOOL DISTRICT ...................................................................................... 19

ANDERSON COUNTY.......................................................................................................................................................... 21 BEDFORD COUNTY ............................................................................................................................................................ 23 BENTON COUNTY .............................................................................................................................................................. 24 BLEDSOE COUNTY ............................................................................................................................................................. 25 BLOUNT COUNTY .............................................................................................................................................................. 26 BRADLEY COUNTY ............................................................................................................................................................. 28 CAMPBELL COUNTY ........................................................................................................................................................... 30 CANNON COUNTY ............................................................................................................................................................. 31 CARROLL COUNTY ............................................................................................................................................................. 32 CARTER COUNTY ............................................................................................................................................................... 33 CHEATHAM COUNTY ......................................................................................................................................................... 34 CHESTER COUNTY.............................................................................................................................................................. 35 CLAIBORNE COUNTY ......................................................................................................................................................... 36 CLAY COUNTY .................................................................................................................................................................... 37 COCKE COUNTY ................................................................................................................................................................. 38 COFFEE COUNTY ................................................................................................................................................................ 39 CROCKETT COUNTY ........................................................................................................................................................... 40 CUMBERLAND COUNTY ..................................................................................................................................................... 41 DAVIDSON COUNTY .......................................................................................................................................................... 42 DECATUR COUNTY ............................................................................................................................................................ 46 DEKALB COUNTY ............................................................................................................................................................... 47 DICKSON COUNTY ............................................................................................................................................................. 48 DYER COUNTY ................................................................................................................................................................... 49 FAYETTE COUNTY .............................................................................................................................................................. 50 FENTRESS COUNTY ............................................................................................................................................................ 51 FRANKLIN COUNTY ............................................................................................................................................................ 52 GIBSON COUNTY ............................................................................................................................................................... 53 GILES COUNTY ................................................................................................................................................................... 54 GRAINGER COUNTY ........................................................................................................................................................... 55 GREENE COUNTY ............................................................................................................................................................... 56 GRUNDY COUNTY .............................................................................................................................................................. 57 HAMBLEN COUNTY ........................................................................................................................................................... 58 HAMILTON COUNTY .......................................................................................................................................................... 60 HANCOCK COUNTY ............................................................................................................................................................ 63 HARDEMAN COUNTY ........................................................................................................................................................ 64 HARDIN COUNTY ............................................................................................................................................................... 65 HAWKINS COUNTY ............................................................................................................................................................ 66 HAYWOOD COUNTY .......................................................................................................................................................... 67 HENDERSON COUNTY ....................................................................................................................................................... 68

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HENRY COUNTY ................................................................................................................................................................. 69 HICKMAN COUNTY ............................................................................................................................................................ 70 HOUSTON COUNTY ........................................................................................................................................................... 71 HUMPHREYS COUNTY ....................................................................................................................................................... 72 JACKSON COUNTY ............................................................................................................................................................. 73 JEFFERSON COUNTY .......................................................................................................................................................... 74 JOHNSON COUNTY ............................................................................................................................................................ 75 KNOX COUNTY ................................................................................................................................................................... 76 LAKE COUNTY .................................................................................................................................................................... 80 LAUDERDALE COUNTY ...................................................................................................................................................... 81 LAWRENCE COUNTY .......................................................................................................................................................... 82 LEWIS COUNTY .................................................................................................................................................................. 83 LINCOLN COUNTY .............................................................................................................................................................. 84 LOUDON COUNTY ............................................................................................................................................................. 85 MACON COUNTY ............................................................................................................................................................... 86 MADISON COUNTY ............................................................................................................................................................ 87 MARION COUNTY .............................................................................................................................................................. 89 MARSHALL COUNTY .......................................................................................................................................................... 90 MAURY COUNTY................................................................................................................................................................ 91 MCMINN COUNTY ............................................................................................................................................................. 93 MCNAIRY COUNTY ............................................................................................................................................................ 94 MEIGS COUNTY ................................................................................................................................................................. 95 MONROE COUNTY ............................................................................................................................................................. 96 MONTGOMERY COUNTY ................................................................................................................................................... 97 MOORE COUNTY ............................................................................................................................................................... 99 MORGAN COUNTY .......................................................................................................................................................... 100 OBION COUNTY ............................................................................................................................................................... 101 OVERTON COUNTY .......................................................................................................................................................... 102 PERRY COUNTY ................................................................................................................................................................ 103 PICKETT COUNTY ............................................................................................................................................................. 104 POLK COUNTY ................................................................................................................................................................. 105 PUTNAM COUNTY ........................................................................................................................................................... 106 RHEA COUNTY ................................................................................................................................................................. 108 ROANE COUNTY .............................................................................................................................................................. 109 ROBERTSON COUNTY ...................................................................................................................................................... 110 RUTHERFORD COUNTY .................................................................................................................................................... 112 SCOTT COUNTY................................................................................................................................................................ 115 SEQUATCHIE COUNTY ..................................................................................................................................................... 116 SEVIER COUNTY ............................................................................................................................................................... 117 SHELBY COUNTY .............................................................................................................................................................. 119 SMITH COUNTY ............................................................................................................................................................... 127 STEWART COUNTY .......................................................................................................................................................... 128 SULLIVAN COUNTY .......................................................................................................................................................... 129 SUMNER COUNTY ........................................................................................................................................................... 131 TIPTON COUNTY .............................................................................................................................................................. 133 TROUSDALE COUNTY ...................................................................................................................................................... 134 UNICOI COUNTY .............................................................................................................................................................. 135 UNION COUNTY ............................................................................................................................................................... 136 VAN BUREN COUNTY ...................................................................................................................................................... 137 WARREN COUNTY ........................................................................................................................................................... 138 WASHINGTON COUNTY ................................................................................................................................................... 139 WAYNE COUNTY .............................................................................................................................................................. 141 WEAKLEY COUNTY .......................................................................................................................................................... 142 WHITE COUNTY ............................................................................................................................................................... 143 WILLIAMSON COUNTY .................................................................................................................................................... 144

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WILSON COUNTY ............................................................................................................................................................. 147

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Executive Summary The Kindergarten Immunization Compliance Assessment (i.e., Kindergarten Assessment) is an annual assessment completed by the Tennessee Department of Health’s (TDH) Vaccine-Preventable Diseases and Immunization Program (VPDIP) in collaboration with the Tennessee Department of Education (TDOE) and Tennessee (TN) public and private schools. The goal of the assessment is to evaluate immunization coverage and exemption levels of state-required vaccines among children entering kindergarten. Children entering kindergarten in TN must be up-to-date with the following vaccines at the time of enrollment:

• Diphtheria-Tetanus-Pertussis vaccine (DTaP) 1 Measles, Mumps, Rubella vaccine (MMR) • Hepatitis A Virus vaccine (HAV)2 Hepatitis B Virus vaccine (HBV) • Poliomyelitis vaccine (IPV or OPV) Varicella (chickenpox) vaccine/credible history of disease

All required immunizations must be documented on the Tennessee Official Immunization Certificate. Immunizing providers are also strongly encouraged to record immunizations in the Tennessee Immunization Information System (TennIIS). The state recognizes five different types of immunization certificates and exemptions: Complete: All vaccination requirements completed according to the CDC immunization schedule. Temporary: A temporary immunization certificate is issued when a child has not received all required vaccines but is in the process of completing them. A temporary certificate expires one month after the date that the next required immunization is due, according to the minimum acceptable (“catch-up”) dose interval per the CDC/ACIP schedule.3 An expired temporary immunization certificate is not valid proof of immunization. Students with an expired temporary certificate are classified as having an incomplete vaccine record. Transfer: Child has recently transferred from out-of-state and is in the process of obtaining the Tennessee Official Immunization Certificate Religious Exemption: This exemption requires a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices. If the child needs documentation of a health examination for the school, the claimed religious exemption must be noted by the healthcare provider on the immunization certificate. It should be noted that none of the major Christian denominations, including Roman Catholic, Baptist, Methodist, Episcopalian, Presbyterian, Lutheran, Pentecostal, Church of Jesus Christ of Latter-Day Saints, Eastern Orthodox, Jehovah’s Witness, Mennonite, Quaker, and Unitarian-Universalist object to immunizations. Similarly, Judaism, Islam, Hinduism, Jainism, and Scientology also have no objection to immunizations. The number of religious exemptions in the state of Tennessee is likely due to parents filing a religious exemption in lieu of a personal philosophical exemption, despite the Tennessee Code Annotated stating that doing so is subject to penalty of perjury.4 Medical Exemption: Physician (MD, DO) or department Public Health Nurse authorized to indicate specific vaccines medically exempted (because of risk of harm), preferably on the TDH medical exemption form. on the new form. Other vaccines remain required. The medical reason for the exemption does not need to be provided. Children who have incomplete or missing documentation of childhood immunizations are not permitted to attend public school per T.C.A. § 49-6-5001

1 Diphtheria-Tetanus toxoid vaccine (DT), if medically indicated 2 https://www.tn.gov/health/cedep/immunization-program/ip/immunization-requirements/childcare-12th-grade-immunization-requirements.html 3 https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html 4 https://www.vumc.org/health-wellness/news-resource-articles/immunizations-and-religion

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Assessment Process Tennessee uses a census-based approach to collect immunization data for the Kindergarten Assessment. All public schools with kindergarten students enrolled at the time of the assessment are asked to report assessment results, with the exception of public schools where the students must be tested to determine grade level and programs that are distance learning only. Additionally, all TDOE-accredited private schools in Categories 1, 1-SP, 2, and 3 that have kindergarten students enrolled at the time of the assessment are asked to report assessment results. For a description of private school categories please visit https://www.tn.gov/education/school-options/non-public-schools/non-public-school-categories.html. School nurses and/or other trained school personnel review students’ immunization certificates and report aggregate, de-identified data to VPDIP for each school year. To validate schools’ self-reported results, a sample of public and private schools are randomly selected by the Centers for Disease Control and Prevention (CDC) statisticians and audited every spring. Statewide results are published on the TDH website5, shared with TDOE and school districts, and published on the CDC SchoolVaxView website6.

2020-2021 School Year Statewide Summary Statewide, 95.2% of all kindergarten students were fully immunized at the time of survey completion. Of the students who were not fully immunized, 1.0% had a temporary immunization certificate on file, 1.8% had a religious exemption on file, 0.1% of students had a medical exemption on file, 1.3% had an incomplete immunization record, and 0.5% were missing an immunization record. If a student had a valid temporary certificate, a medical exemption, or an incomplete immunization record, schools were asked to report which individual vaccine series the student had completed. Figure 1 shows the percentage of public and private school students who were complete for each vaccine series. Note: The percentages in Figure 1 reflect the sum of public and private school kindergarten students who were complete for an individual vaccine series, regardless of whether they had received all the vaccines required for school enrollment.

5 https://www.tn.gov/health/ceds-weeklyreports.html 6 https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/data-reports/coverage-trend/index.html

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Figure 1. Percentage of public and private school kindergarten students who were complete for each vaccine series, compared to Healthy People 2020 (HP 2020) goal of 95% complete

Public Schools Statewide Summary Of the 1,049 public schools that were asked to complete the 2020-2021 Kindergarten Assessment 1,010 (96%) submitted results. Statewide, 95.4% of public school students were fully immunized at the time of the survey (66,760 of 69,980 students). Of all public school students, 71.2% (n=49,849) had their immunization record completed and validated in TennIIS. Students who were not fully immunized fell into the following categories, in decreasing order of prevalence:

• Religious Exemption: 1.7% (n=1,177) • Incomplete Record: 1.2% (n=870) • Temporary Certificate: 1.0% (n=706) • Missing Record: 0.5% (n=322) • Medical Exemption: 0.1% (n=84) • Transfer <30 days: 0.1% (n=62)

Private Schools Statewide Summary A total of 176 private schools (out of 295 schools; 61%) with kindergarten enrollment completed the 2020-2021 Kindergarten Assessment. This represents a 10% decline in school participation compared to that of the 2019-2020 Kindergarten Assessment when 71% of private schools participated. We suspect resource burdens caused by the SARS-CoV-2 pandemic contributed to this decline. Statewide, 92.3% (3,550 of 3,848 students) of private school kindergarten students were fully immunized, which represents a 1.5% decrease in the fully-immunized rate from the previous year. Unlike the public school 2020-2021 Kindergarten Assessment, the private school

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survey does not ascertain how many private school students had immunization certificates that were validated by TennIIS. Students who were not fully immunized fell into the following categories, in decreasing order of prevalence:

• Religious Exemption: 4.0% (n=155) • Incomplete Record: 2.3% (n=90) • Missing Record: 1.0% (n=37) • Temporary Certificate: 0.7% (n=27) • Medical Exemption: 0.1% (n=3) • Transfer <30 days: N/A for private schools based on data collection methods

Trends over Time Kindergarten student enrollment decreased by nearly 10% in 2020-2021, resulting in 73,828 total students surveyed in the Kindergarten Assessment. Enrollment shifted slightly towards private schools, with approximately 5.2% of the state’s total kindergarten enrollment being in private schools compared to 4% last year. The percentage of public and private school students who received all vaccines per Tennessee’s state requirements for kindergarten entry (i.e., were “fully immunized”) has consistently been close to 95% over the past five years (range: 94.8% to 95.3%). For a community to remain at low-risk for a highly infectious vaccine-preventable disease outbreak such as measles or pertussis, this rate must remain above 95%. Although Tennessee continues to rank just above this threshold statewide, there has been a substantial decline in the number of counties that meet this minimum threshold for vaccine-preventable disease immunity. In fact, the number of counties with public schools that meet the minimum threshold of 95% fully-immunized threshold has decreased from 87 to 72 counties representing a decrease of 5.3%. Overall, the number of exemptions has remained relatively consistent over the past five years. For the past four years, temporary records have increased slowly while incomplete records have declined proportionally. This year, these two categories reversed course with temporary certificates decreasing by 0.9% and incomplete records increasing by 0.5%. Although both record types include children who are missing vaccinations, temporary certificates expire one month after the data that the next required immunization(s) is(are) due which indicates they are at least on track to being fully-immunized. We suspect this uncharacteristic trend to be the result of school shutdowns and administrative burden caused by the pandemic. Regardless of the cause more incomplete records indicates unvaccinated children have fallen behind and need to catch-up on their immunizations. Furthermore, the increasing number of kindergarteners who are not fully-immunized indicates Tennessee schools and communities may be more susceptible to vaccine-preventable disease outbreaks.

Impact of COVID Pandemic The CDC noted a decline in overall vaccination rates as soon as one week after the United States declared a national state of emergency due to the SARS-CoV-2 pandemic. The 2020-2021 Kindergarten Immunization Compliance Assessment Report was conducted from November 2020 to February 2021 and affords a unique opportunity to document the impact of the pandemic upon childhood immunization rates in Tennessee. While the overall decline in enrollment was almost certainly the result of pandemic restrictions it is unclear if the same forces contributed to the slight (1.2%) shift in enrollment towards private schools. More granular analysis of the 2020-2021 data showed an 8% increase in counties with public schools that fall below the 95% fully-immunized threshold. This is concerning because only 38% of counties with private school responses exceed 95% of students fully immunized and another 38% failed to achieve even 90% of their students fully immunized. Furthermore, the number of religious exemptions in private schools rose by 1.3% while public school religious exemptions experienced almost no change. These communities are at increased risk of vaccine-preventable disease outbreaks. Data for this report does not reflect the full impact of the pandemic upon kindergarten

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immunization rates. Immediate action to increase compliance with recommended childhood immunizations is necessary to decrease the risk of future vaccine-preventable disease outbreaks in our schools in communities. The percentage of public school students with immunization records documented in TennIIS rose from 43.4% in the 2015-2016 school year to 71.2% in the 2020-2021 school year: a 28% increase in just five years. This significant increase is attributed to the efforts of the VPDIP program to increase TennIIS participation among immunizing providers and school nurses statewide. Figure 2. Percentage of public-school students fully immunized, and percentage of public school students whose immunization records were complete in TennIIS, over time

The percentage of all TN kindergarten students who were not fully immunized, by category, over time, are shown in Figure 3. Over the past five years, the percentage of students with an incomplete immunization record decreased until 2020. (see Figure 3, gold line). This change may be due to disruptions caused by the SARS-CoV-2 pandemic, which created barriers to obtaining immunizations as well as administrative challenges in the schools responsible for enforcing the state’s immunization requirements. Until this year, the percentage of children with a temporary immunization certificate had been increasing (see Figure 3, blue line). This change could be due to

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children who may have otherwise been provided a temporary certificate in 2020, who were instead allowed to attend school with an incomplete record. Again, this is likely a reflection of the burden the SARS-CoV-2 pandemic placed upon schools during the academic year. The percentage of students claiming a religious exemption remained relatively unchanged from 2019 to 2020, with 1.8% of children having a religious exemption to immunizations on file. The percentage of kindergarten students claiming medical exemptions from a vaccine remained stable at approximately 0.1% each year (see Figure 3, grey line). This rate is also consistent with the national rate of medical exemptions. The percentage of students with missing vaccine records has also remained stable at approximately 0.5% (not shown in figure). Figure 3. Percentage of all TN kindergarten students not fully immunized, by category, over time

For Tennessee to remain free of vaccine-preventable disease outbreaks, action is needed to provide missed immunizations to children and ensure that public schools are following state immunization requirements.

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Medical providers who deliver health care to children are encouraged to review immunization records and provide catch-up immunizations at every opportunity. Thank you for partnering to protect public health in Tennessee. Questions and comments regarding this report or the Kindergarten Assessment may be directed to School.Imm@tn.gov. Sincerely,

John R. Dunn, DVM, PhD State Epidemiologist Communicable and Environmental Diseases and Emergency Preparedness Tennessee Department of Health

Paul E. Petersen, PharmD Director, Emergency Preparedness Program Interim Director, Vaccine-Preventable Diseases and Immunization Program Communicable and Environmental Diseases and Emergency Preparedness Division Tennessee Department of Health

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2020-2021 Kindergarten Immunization Compliance Assessment Results Public Health Regions Summary The percentage of public school students fully immunized across Tennessee’s public health regions ranged from 91% to 97%, with Chattanooga/Hamilton Region having the lowest percentage of fully immunized students and North East and West Tennessee Regions having the highest percentage of fully immunized students during the 2020-2021 school year (see Figure 4). Figure 5 displays the percentage of public-school students who had a temporary certificate, a religious exemption, an incomplete record, or had a medical exemption, across Tennessee’s public health regions. Figure 4. Percentage of public-school students fully immunized, the number of public-school students fully immunized, and the number of students not fully immunized, by public health region during the 2020-2021 school year

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Figure 5. Percentage of public-school students with a temporary/transfer immunization record, religious exemption, incomplete/missing record, or medical exemption, by public health region during the 2020-2021 school year.

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County Level Summary The percentage of public-school students who were fully immunized, by county, ranged from 84.0% (Haywood County) to 100% (Lauderdale County) (see Figure 6). Among private schools, the range was from 71.4% (Blount County) to 100% (Bedford, Campbell, Greene, Hardin, Lawrence, Loudon, Sullivan, Tipton, and Warren Counties) (see Figure 7). Note that the number of public and private schools within each county varies, and not all counties have private school survey responses. For a detailed breakdown of the number of public and private schools within each “percentage fully immunized” category, and the total number of students in each county, see Tables 1 in this report. Figure 6. Percentage of 2020-2021 Public and Private school students fully immunized, by county

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Figure 7. Percentage of public-school students fully immunized, by county

Figure 8. Percentage of private-school students fully immunized, by county (Note: 176 out of 295 schools completed the 2020-2021 Kindergarten Assessment; this may influence the percentage of students fully immunized within each county)

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High immunization coverage rates are critical to avoiding vaccine-preventable disease (VPD) outbreaks (e.g., measles, pertussis). A VPD outbreak may occur when community members are inadequately immunized against a disease. To remain at low risk for a VPD outbreak the immunization rate should remain at or above 95%. In the maps above and tables below, an immunization rate of at least 95% meets this immunization goal, an immunization rate of 90% to 94.9% needs improvement, and an immunization rate below 90% places the community at increased risk for vaccine-preventable disease outbreaks. For detailed Kindergarten Assessment results at the county, school districts, and school levels, please see the Public School Districts (SD) by County Summary section below. Table 1. Percentage of public and private school students fully immunized, total # students, and the number of schools with students fully immunized within each color category, by county, in descending order by “% students fully immunized” (Color Key: <90%; 90-94.9%; 95-100%)

County % students Fully

Immunized in County

Total # Students in County

# Schools with <90% Students in

County

# Schools with 90-94% Students in

County

# Schools with 95-100% Students in

County LAUDERDALE 100.0% 237 0 0 2 SMITH 99.5% 213 0 0 5 HARDIN 99.3% 276 0 0 6 CROCKETT 99.1% 214 0 0 5 SCOTT 99.0% 296 0 0 6 MARSHALL 98.9% 278 0 0 2 COCKE 98.4% 387 0 2 8 HARDEMAN 98.4% 257 0 1 5 SEQUATCHIE 98.4% 124 0 0 1 DYER 98.3% 460 0 0 6 GREENE 98.2% 609 0 0 12 GRAINGER 98.1% 209 0 0 4 MARION 98.1% 316 0 0 5 BENTON 98.0% 153 0 1 2 TIPTON 97.9% 761 0 0 8 TROUSDALE 97.9% 97 0 0 1 CANNON 97.8% 134 0 2 4 UNICOI 97.7% 132 0 1 3 MACON 97.4% 386 0 1 2 CLAIBORNE 97.3% 329 0 3 5

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County % students Fully

Immunized in County

Total # Students in County

# Schools with <90% Students in

County

# Schools with 90-94% Students in

County

# Schools with 95-100% Students in

County DICKSON 97.3% 562 0 2 8 FRANKLIN 97.3% 400 0 3 7 HENRY 97.3% 296 1 1 3 BLEDSOE 97.2% 106 0 1 2 HENDERSON 97.2% 326 0 1 7 WARREN 97.2% 425 0 1 8 CUMBERLAND 97.1% 488 0 1 8 LAKE 97.0% 66 0 0 1 HAWKINS 96.9% 482 0 4 8 LINCOLN 96.9% 327 0 2 4 MCNAIRY 96.9% 290 0 0 5 SEVIER 96.9% 1,048 1 4 11 WAYNE 96.9% 159 0 1 2 CARROLL 96.8% 316 0 1 4 ANDERSON 96.7% 828 1 4 12 CHEATHAM 96.7% 459 1 0 6 COFFEE 96.5% 636 0 3 9 DECATUR 96.5% 114 0 0 2 LOUDON 96.5% 372 1 0 6 WILSON 96.5% 1,734 2 3 18 LEWIS 96.4% 137 0 0 1 MADISON 96.4% 995 0 4 12 WASHINGTON 96.4% 1,197 2 1 21 WEAKLEY 96.4% 278 0 2 3 MCMINN 96.2% 526 1 2 7 OVERTON 96.1% 205 0 2 3 RUTHERFORD 96.1% 4,257 1 17 26 SHELBY 96.1% 11,465 12 37 133 SULLIVAN 96.1% 1,337 2 6 18

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County % students Fully

Immunized in County

Total # Students in County

# Schools with <90% Students in

County

# Schools with 90-94% Students in

County

# Schools with 95-100% Students in

County SUMNER 96.0% 2,123 3 5 24 MEIGS 95.9% 123 0 0 2 JEFFERSON 95.8% 481 0 3 5 OBION 95.8% 385 0 2 4 HICKMAN 95.7% 230 0 1 1 DEKALB 95.6% 228 0 0 2 CAMPBELL 95.5% 374 1 3 5 HUMPHREYS 95.5% 220 0 0 3 GIBSON 95.4% 669 1 2 7 HAMBLEN 95.1% 771 2 3 8 WILLIAMSON 95.1% 3,035 5 11 28 BEDFORD 95.0% 624 0 4 5 FAYETTE 95.0% 278 0 3 3 ROBERTSON 95.0% 906 1 4 8 RHEA 94.8% 386 0 1 4 CARTER 94.7% 550 2 4 6 GRUNDY 94.7% 131 1 2 3 KNOX 94.7% 4,716 10 22 44 MONTGOMERY 94.7% 2,820 2 13 13 BLOUNT 94.3% 1,362 4 6 10 HOUSTON 94.3% 87 0 1 1 DAVIDSON 94.0% 6,907 21 25 61 LAWRENCE 93.9% 477 1 4 5 JOHNSON 93.8% 129 0 3 1 CHESTER 93.2% 207 0 1 2 MOORE 93.2% 59 0 1 0 MAURY 93.0% 1,104 4 6 8 MONROE 93.0% 471 0 4 2 MORGAN 93.0% 200 1 0 4

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County % students Fully

Immunized in County

Total # Students in County

# Schools with <90% Students in

County

# Schools with 90-94% Students in

County

# Schools with 95-100% Students in

County STEWART 93.0% 128 0 2 0 PUTNAM 92.6% 797 3 6 3 ROANE 92.6% 433 3 2 2 CLAY 92.5% 80 0 1 1 POLK 92.3% 130 1 1 2 GILES 92.1% 290 0 4 0 PICKETT 92.0% 50 0 1 0 HANCOCK 91.7% 60 0 1 0 HAMILTON 91.6% 3,689 21 18 22 BRADLEY 91.3% 1,114 8 9 4 FENTRESS 90.7% 172 1 3 0 PERRY 90.0% 70 1 0 2 WHITE 89.4% 302 3 1 2 JACKSON 88.8% 107 1 1 0 UNION 85.3% 401 4 2 0 VAN BUREN 84.7% 59 1 0 0 HAYWOOD 84.0% 194 1 0 0

Public and Private School Summaries by County and School District The following series of tables and graphs capture information at two different levels: 1) at the county-level, featuring information for both public and private schools within the county; and 2) at the school district level, featuring information for all schools within the school district. Data are presented by county in alphabetical order, with school districts nested under each respective county in alphabetical order, and schools nested under each respective school district in alphabetical order.

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Below are descriptions of each vaccine type shown in the county tables and graphs.

• Diphtheria-Tetanus-Pertussis vaccine (DTaP) 7 Measles, Mumps, Rubella vaccine (MMR) • Hepatitis A Virus vaccine (HAV)8 Hepatitis B Virus vaccine (HBV) • Poliomyelitis vaccine (IPV or OPV) Varicella (chickenpox) vaccine (or credible history of disease)

Below are descriptions of each category shown in the county tables and graphs. All table percentages on a given row are the percentage of the “Total Students” number on that row.

County Tennessee county name. School districts are grouped into their corresponding county.

School District Department of Education school district name. Schools are grouped into their corresponding school district. Private schools are listed under a “private” district name within each county where applicable.

School Name School name, listed alphabetically within each school district.

Total Students Total number of enrolled kindergarten students at the time of immunization record assessment.

Fully Immunized Number and percentage who meet state school entry requirements by being fully immunized.

Religious Exemption Number and percentage with a valid religious exemption.

Medical Exemption Number and percentage with a valid medical exemption to one or more vaccines.

Temporary Certificate

Number and percentage with a valid temporary certificate.

Excluded Transfer Students exempt from assessment because records are unavailable due to a recent transfer from another TN school (within 30 days of the assessment). N/A for private schools based on data collection methods.

Incomplete Record Number and percentage who do not meet requirements because they have an incomplete vaccination record.

Missing Record Number and percentage who do not meet requirements because the school has no official immunization certificate on record.

7 Diphtheria-Tetanus toxoid vaccine (DT), if medically indicated 8 https://www.tn.gov/health/cedep/immunization-program/ip/immunization-requirements/childcare-12th-grade-immunization-requirements.html

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ANDERSON COUNTY

22

ANDERSON COUNTY continued

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BEDFORD COUNTY

24

BENTON COUNTY

25

BLEDSOE COUNTY

26

BLOUNT COUNTY

27

BLOUNT COUNTY continued

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BRADLEY COUNTY

29

BRADLEY COUNTY continued

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CAMPBELL COUNTY

31

CANNON COUNTY

32

CARROLL COUNTY

33

CARTER COUNTY

34

CHEATHAM COUNTY

35

CHESTER COUNTY

36

CLAIBORNE COUNTY

37

CLAY COUNTY

38

COCKE COUNTY

39

COFFEE COUNTY

40

CROCKETT COUNTY

41

CUMBERLAND COUNTY

42

DAVIDSON COUNTY

43

DAVIDSON COUNTY continued

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DAVIDSON COUNTY continued

45

DAVIDSON COUNTY continued

46

DECATUR COUNTY

47

DEKALB COUNTY

48

DICKSON COUNTY

49

DYER COUNTY

50

FAYETTE COUNTY

51

FENTRESS COUNTY

52

FRANKLIN COUNTY

53

GIBSON COUNTY

54

GILES COUNTY

55

GRAINGER COUNTY

56

GREENE COUNTY

57

GRUNDY COUNTY

58

HAMBLEN COUNTY

59

HAMBLEN COUNTY continued

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HAMILTON COUNTY

61

HAMILTON COUNTY continued

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HAMILTON COUNTY continued

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HANCOCK COUNTY

64

HARDEMAN COUNTY

65

HARDIN COUNTY

66

HAWKINS COUNTY

67

HAYWOOD COUNTY

68

HENDERSON COUNTY

69

HENRY COUNTY

70

HICKMAN COUNTY

71

HOUSTON COUNTY

72

HUMPHREYS COUNTY

73

JACKSON COUNTY

74

JEFFERSON COUNTY

75

JOHNSON COUNTY

76

KNOX COUNTY

77

KNOX COUNTY continued

78

KNOX COUNTY continued

79

KNOX COUNTY continued

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LAKE COUNTY

81

LAUDERDALE COUNTY

82

LAWRENCE COUNTY

83

LEWIS COUNTY

84

LINCOLN COUNTY

85

LOUDON COUNTY

86

MACON COUNTY

87

MADISON COUNTY

88

MADISON COUNTY continued

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MARION COUNTY

90

MARSHALL COUNTY

91

MAURY COUNTY

92

MAURY COUNTY continued

93

MCMINN COUNTY

94

MCNAIRY COUNTY

95

MEIGS COUNTY

96

MONROE COUNTY

97

MONTGOMERY COUNTY

98

MONTGOMERY COUNTY continued

99

MOORE COUNTY

100

MORGAN COUNTY

101

OBION COUNTY

102

OVERTON COUNTY

103

PERRY COUNTY

104

PICKETT COUNTY

105

POLK COUNTY

106

PUTNAM COUNTY

107

PUTNAM COUNTY continued

108

RHEA COUNTY

109

ROANE COUNTY

110

ROBERTSON COUNTY

111

ROBERTSON COUNTY continued

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RUTHERFORD COUNTY

113

RUTHERFORD COUNTY continued

114

RUTHERFORD COUNTY continued

115

SCOTT COUNTY

116

SEQUATCHIE COUNTY

117

SEVIER COUNTY

118

SEVIER COUNTY continued

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SHELBY COUNTY

120

SHELBY COUNTY continued

121

SHELBY COUNTY continued

122

SHELBY COUNTY continued

123

SHELBY COUNTY continued

124

SHELBY COUNTY continued

125

SHELBY COUNTY continued

126

SHELBY COUNTY continued

127

SMITH COUNTY

128

STEWART COUNTY

129

SULLIVAN COUNTY

130

SULLIVAN COUNTY continued

131

SUMNER COUNTY

132

SUMNER COUNTY continued

133

TIPTON COUNTY

134

TROUSDALE COUNTY

135

UNICOI COUNTY

136

UNION COUNTY

137

VAN BUREN COUNTY

138

WARREN COUNTY

139

WASHINGTON COUNTY

140

WASHINGTON COUNTY continued

141

WAYNE COUNTY

142

WEAKLEY COUNTY

143

WHITE COUNTY

144

WILLIAMSON COUNTY

145

WILLIAMSON COUNTY continued

146

WILLIAMSON COUNTY continued

147

WILSON COUNTY

148

WILSON COUNTY continued

149

Department of Health Authorization No. 355684. This Electronic publication was promulgated at zero cost. August 2021