KEYWORDS:
Kindergarten, Vaccination Coverage Rates

BACKGROUND:
California law requires proof of vaccination before admission to any school. Exemptions from vaccination can be granted for medical reasons, or religious or personal beliefs.

OBJECTIVE(S):
To assess vaccination coverage levels among preschool-aged children in Los Angeles County (LAC) by ethnicity.

METHOD(S):
In 1996 and 1999 the Los Angeles County Immunization Program reviewed 100% of the vaccination records for kindergarteners entering over 46 LAC schools during the 1995-1996 and 1998-1999 school years. Series completion rates were calculated for the poliovirus (OPV) vaccine, diphtheria and tetanus toxoids and pertussis (DTP/DTaP) vaccine, measles-mumps-rubella (MMR) vaccine, and hepatitis B vaccine at selected age milestones. Race/ethnicity information was collected from school records.

RESULT(S):
Forty percent of children in the 1996 survey and 55% in the 1999 survey had four DTP/DTaP, three OPV/IPV, and one MMR by 24 months of age. In both surveys coverage levels were lowest for blacks (32% in 1996, 38% in 1999) and highest for Asians (50% in 1996, 61% in 1999). At 24 months, hepatitis B vaccine coverage levels were less than 1% in 1996 and 65% in 1999.

CONCLUSIONS(S):
Coverage levels have improved between 1996 and 1999. The increase in hepatitis B coverage levels can be attributed to the 1997 California law requiring the hepatitis B vaccination for school entry. Although the basic DTP/DTaP, OPV/IPV, and MMR series should be completed by 18 months of age, nearly half of the children in the surveys did not complete the series until kindergarten entry. Vaccination coverage estimates for LAC are high at kindergarten entry but are below the national goal of vaccinating 90% of children by 24 months. Targeted interventions are needed to improve coverage levels in black children, who have substantially lower coverage levels.

LEARNING OBJECTIVES:
Expanding on routine activities is an efficient way of obtaining race-specific estimates of vaccine coverage.