Learning Objectives for this Presentation:
1. Identify factors influencing estimates of immunization rates among children in day care
2. Compare antigen-specific vaccination rates among day care enrollees within and among states
3. Discuss approaches to improving immunization assessment practices


Background:
Evidence suggests that school entry immunization requirements have contributed to the high rates of childhood immunization in the US. Nevertheless, it is clear from experiences in various communities that the effectiveness of such requirements requires constant vigilance. The effectiveness of immunization requirements for children in day care warrants investigation.

Objectives:
This study examined immunization rates among day care enrollees in each state relative to pre-school immunization requirements and assessment practices.

Methods:
State-specific immunization and immunization exemption rates among day care enrollees were calculated from the CDC's 2003-2004 biannual childcare assessment report. Information about state immunization assessment practices was obtained from the CDC's 2004 survey of preschool assessment practices.

Results:
Immunization rates among day care enrollees vary among states and among antigens within states. In each state, 90.3% or more of the enrollees were age appropriately vaccinated with all but the most recently licensed vaccines. For each vaccine, at least one state and as many as seven had coverage rates below 80%. In 16 (34%) of 47 states reporting assessment data, less than 50% of enrollees were assessed. An average of 2.8% of assessed children, but as many as 17.1%, lacked immunization records. In some states, medical, religious and philosophical exemptions were claimed by as many as 2.7%, 3.4% and 2.6% enrollees, respectively.

Conclusions:
Assessment practices used to determine vaccine coverage among children in day care are inconsistent and, in some states, call into question how well these children are protected against vaccine preventable diseases. More rigorous assessment methods, and their adoption by all states would provide a clearer picture of immunization status among day care enrollees.