(NewsNation) — Routine vaccination rates for kindergarteners haven’t rebounded since the COVID-19 pandemic, according to KFF.

At the same time, exemptions from school vaccination requirements are climbing, possibly contributing to surging measles cases.

Shifts in public opinion and rising vaccine hesitancy rooted in misinformation are contributing to the lower vaccination rates, KFF reported. About three-quarters of states reported measles-mumps-rubella (MMR) vaccination rates below the 95% Healthy People 2030 target during the previous school year. Meanwhile, 10 states had more than 5% of kindergarteners claim a vaccine exemption during the 2022-2023 school year.

Not all vaccination trends are created equal. There are disparities among the vaccines children are receiving. Flu vaccination rates, for example, were more than three times higher than those guarding against COVID-19. However, flu vaccination rates haven’t returned to pre-pandemic levels, either.

Although health misinformation and changing public opinions are factors behind the decline, higher exemption rates and lower vaccination coverage tend to go hand-in-hand. Vaccine coverage refers to the estimated percentage of people who have received a specific vaccine, according to the U.S. Centers for Disease Control and Prevention (CDC).

MMR coverage rates among kindergarteners for the most recent school year ranged from 81.3% in Idaho to 98.4% in Mississippi, KFF reported.

As of 2023, all states and D.C. require children to be vaccinated against certain diseases, including MMR. Failing to get those vaccines could bar a child from attending public school, but each state allows some exemptions.

The CDC recommends that everyone 6 months and older stay current on COVID-19 vaccines and receive a seasonal flu shot.

Outbreaks of preventable diseases come with high costs and place pressure on the health care system.

About one in five unvaccinated people who get measles are hospitalized in the U.S., according to the National Conference of State Legislatures (NCSL). In 2019, New York City spent about $8.4 million responding to a measles outbreak. The highly contagious virus can lead to complications like pneumonia and brain swelling. Measles was eliminated in the United States in 2000, largely due to high MMR vaccination rates, according to the CDC.

Now, cases are rising globally.

Nearly 170 measles cases were reported in the United States this year as of July 11 — the most recent data available through the CDC. It includes 13 outbreaks (three or more related cases) compared to four outbreaks in 2023.

Fifty-seven percent of cases this year resulted in hospitalization, mostly affecting children younger than 5 years old.

Redefining who can vaccinate children has helped some regions expand access. At least 33 states now allow pharmacists to vaccinate children younger than 7 years old.

Rural areas are also less likely to have sufficient health resources. Some states have used legislature to strengthen their health care workforce. For example, a Louisiana program offers $30,000 in annual loan repayments for health professionals who commit to working three years in rural or underserved areas. Alternatively, Georgia allows doctors to receive as much as $5,000 in tax credits for up to five years, according to the NCSL.