Hawaiʻi DOH: vaccination gaps leave schools increasingly vulnerable to disease outbreaks

The Hawaiʻi State Department of Health released its 2025–26 School Immunization and Examination Requirements Report, which found increases in religious exemption rates among kindergarten and seventh grade students.

The assessment also found an increase in the percentage of kindergarten students missing immunizations needed for school attendance, while more than half of seventh graders remained not up to date on these immunizations.

The annual assessment summarizes school-reported data on enrollment, exemptions, missing immunization records and incomplete immunizations. Kindergarten and seventh grade are key points of assessment because students entering these grades must meet specific school health requirements.

The findings point to different challenges across grade levels. Kindergarten saw increases in both missing needed vaccine doses and religious exemptions. Among seventh graders, fewer students had missing immunizations, but the increase in religious exemptions contributed to a higher overall percentage of students not up to date. Reporting by schools was high, with 98% of schools statewide participating in the assessment.

Key findings include:

• Kindergarten:
  • The percentage of students with immunization records showing missing vaccine doses increased from 7.5% in 2024–25 to 9.0% in 2025–26.
  • The religious exemption rate increased from 5.0% to 5.9%.
• Seventh grade:
  • The percentage of students with immunization records showing missing vaccine doses decreased from 45.3% to 44.8%.
  • The religious exemption rate increased from 6.0% to 6.9%.
  • The overall percentage of seventh graders not up to date, including those with medical or religious exemptions, no immunization record, or an immunization record showing at least one missing dose increased from 51.6% to 52.0%.

“With measles, whooping cough and other vaccine-preventable diseases circulating across the continental United States, it is important for families to make sure their children are protected,” said State Epidemiologist Dr. Sarah Kemble. “Staying up to date on recommended immunizations is the best way to protect both your own child and your whole community against illness, severe outcomes and missing days of school and work.”

DOH continues to support evidence-based vaccination recommendations in the American Academy of Pediatrics’ Recommended Child and Adolescent Immunization Schedule, in alignment with the West Coast Health Alliance. Read more about DOH’s alignment with the West Coast Health Alliance and AAP recommendations.

DOH efforts to improve childhood vaccination rates include:

• Working with health care and community partners to answer vaccine questions and share evidence-based information about the benefits and safety of childhood vaccines;
• Identifying and removing barriers to access that make it more difficult for children to receive needed immunizations;
• Improving the completeness, accuracy and timeliness of immunization data so assistance can be directed where it is most needed.
• Collaborating with schools to provide practical training and consistent guidance to school personnel on immunization documentation, exemptions, provisional attendance and related procedures.

Parents and guardians are encouraged to review their child’s immunization records and talk with their healthcare provider about any missing vaccines. For more information, visit the School Health Requirements page or read the full Immunization and Examination Requirements Report Summary, which lists school-level vaccination information.