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Immunization Rate for Toddlers Needs Booster

Study sees lack of enforcement among preschoolers

MONDAY, July 12, 2004 (HealthDayNews) -- Almost one quarter of preschool children have not received the required immunizations, putting both themselves and other children at risk for various preventable illnesses.

Vaccination rates were about the same regardless of whether the children were in day care, according to a new study appearing in the August issue of the American Journal of Preventive Medicine.

"The children who are not up to date are at risk for development of those infections which vaccines can prevent," said Dr. Joseph Bocchini, chief of pediatric infectious diseases at Louisiana State University Health Sciences Center and a member of the American Academy of Pediatrics' committee on infectious diseases. "And because they are in a group with other children, they can not only become infected themselves but they can pass it on to other children. It presents a problem for them and for the community of children that they're around."

Legislation and regulations requiring school-aged children in kindergarten and first grade to have their vaccinations before enrolling have resulted in rates that exceed 95 percent in that age group. As a result, related disease rates, too, are low.

Similar rules are in place for child-care facilities, which have an estimated 3.5 million preschool-aged children enrolled nationwide, but it has been unclear how effective these regulations have been.

This study set out to see if child-care immunization requirements were enforced in the preschool population as effectively as they are in the school-aged population.

The researchers relied on survey information collected in 2001 and 2002 on children aged 19 to 35 months. Respondents were asked if their child attended child care on a regular basis and whether they were in child care at age 2. Information was also collected on whether the child had received vaccines for diphtheria, tetanus, pertussis (whooping cough), polio, measles, hepatitis B and Haemophilus influenzae type B.

About 41 percent of the respondents said they had had or currently had a child in day care. Two-year-old children in child care had a 73.1 percent vaccination rate, vs. 71.9 percent of those not in child care, not a significant difference. When data on all children (aged 19 to 35 months) was analyzed, 76.4 percent of those who had been in child care and 72.6 percent of those who had not been in child care had been vaccinated. More than 90 percent of preschoolers who were not up to date on vaccinations were missing more than one dose.

What accounts for the difference in vaccination rates?

The study authors suggest that lack of monitoring and enforcement might be the culprit. It's also possible that a child may be up to date when entering preschool but then fall behind while attending, Bocchini added. "Children require multiple doses of vaccine over the first 15 to 18 months of life," he said. "It's possible they are up to date, then fall behind."

It's obvious, the authors stated, that these figures need to be improved.

Better enforcement of immunizations for children in child care would help, Bocchini said, and this could be accomplished by using states with good enforcement records as models for other states.

Still, only about 50 percent of children even attend day care. What about the other 50 percent?

"We have to do a better job in having parents understand the necessity of immunization and finding ways to give those parents access to immunizations in a timely fashion," said Bocchini, who wasn't involved in the study. Barriers to immunization -- such as not having a primary-care physician, not having health insurance, or not having off-hours in public health clinics -- need to be dealt with.

"Removing barriers to access and education of parents are two important methods that we could use to improve immunization rates," Bocchini concluded.

More information

The National Immunization Program has more on childhood vaccinations.

SOURCES: Joseph Bocchini, M.D., chief, pediatric infectious diseases, Louisiana State University Health Sciences Center, Shreveport, and member, committee on infectious diseases, American Academy of Pediatrics; August 2004 American Journal of Preventive Medicine
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