Immunization requirements for childcare programs. Are they enough?

Background: School immunization legislation has resulted in high vaccination coverage rates and low rates of vaccine-preventable disease among school children. Similar legislation has been directed toward children in licensed and regulated childcare programs. The purpose of this investigation was to compare immunization coverage among children in and not in childcare.

Methods: For 18 months during 2001 and 2002, the National Immunization Survey (NIS), a random-digit-dialing telephone survey, collected information on children aged 19 through 35 months, including data on enrollment in childcare. Data were analyzed retrospectively to determine coverage at 24 months and at the time of the survey. Children were considered up-to-date if they had received all recommended immunizations for their age.

Results: Of the eligible NIS respondents, about 41% had a child in childcare at the time of or before the survey. Retrospective analysis of children at 24 months showed no significant differences in coverage between those in and not in childcare (73.1% vs 71.9%). Likewise, analysis of coverage at the time of the survey revealed no significant differences (76.4% vs 72.6%).

Conclusions: Immunization legislation and regulations have been successful in increasing coverage rates in the school population. Similar legislation for childcare facilities appears not to have been as effective. Given these findings, it seems that new strategies are needed to increase coverage in preschool children.