Immunization Lags for Children in Childcare

More than 20 percent of preschool children lack required immunizations, placing them and their classmates at risk for illness, according to a new study based on the federal National Immunization Survey.

Whether the children were in day care made no difference in immunization rates, say Carol A. Stanwyck, Ph.D., and two colleagues from the Centers for Disease Control and Prevention. Their work appears in the American Journal of Preventive Medicine.

“School entry legislation in the United States has been a critical factor in keeping coverage rates high among kindergartners and first-graders,” Stanwyck says. “Immunization regulations related to childcare facilities have not had a similar impact.” Current school laws have resulted in vaccination rates of more than 95 percent among those older children. But similar laws or regulations in all states and the District of Columbia applying to childcare settings have not proven so successful.

For children 19 months to 35 months old, the rates were only 76 percent for those in childcare and 73 percent for those never in childcare. The difference between those in or not of childcare was statistically insignificant, Stanwyck says. Of the preschoolers who were not up to date on vaccinations, more than 90 percent were missing more than one dose. Vaccines in the survey included diphtheria, tetanus, pertussis, polio, measles, hepatitis B and Haemophilus influenzae type b.

Unlike the laws governing school entry, regulations for child care immunization lack standard assessment and enforcement policies, says Stanwyck. “For example, some monitor only licensed centers, while others include family childcare programs as well,” she says. Some states record the status of all children in day care, while others check only those age 2 or older.

Vaccine-preventable diseases are on the decline in the United States but outbreaks still occur, Stanwyck says. Preventing future outbreaks depends on maintaining proper levels of immunization. “Revised strategies and more effort are needed to improve coverage of children who attend and do not attend childcare programs.”