title: Do laws bring children in child care centers up to date for immunizations?
abstract: BACKGROUND
  Pennsylvania state law requires licensed child care centers (CCCs) to document that each enrolled child is up to date (UTD) for routine immunizations within 60 days of enrollment. This study evaluates the law's impact on immunization coverage among children aged <or=59 months who attend CCCs in Philadelphia.
  
  
  METHODS
  Out of Philadelphia's 440 commercial CCCs, 75 were randomly selected. Of these, 9 had closed, 3 did not accept children aged <or=59 months, and 3 refused assessment. For the remaining 60 CCCs, vaccination dates were abstracted from CCC records for all enrolled children <or=59 months. For children not UTD for all vaccines according to CCC records, additional data were sought from Philadelphia's immunization registry, health care providers, and parents.
  
  
  RESULTS
  Records of 2847 children were assessed. According to CCC records, information from the immunization registry, vaccination providers, and parents, 71% of children aged 0-18 months, 77% of children 19-35 months, and 84% of children 36-59 months were UTD for their age for diphtheria, tetanus toxoids, and pertussis vaccine; polio; Haemophilus influenzae type b; and measles, mumps, and rubella vaccines. No significant increase in immunization coverage levels was found between the date children enrolled in a CCC and 60 days later.
  
  
  CONCLUSIONS
  Up to one quarter of children <5 years of age enrolled in Philadelphia's CCCs are not UTD for immunizations, with children 0-18 months of age being most behind in their immunizations. Furthermore, many children do not receive vaccines within 60 days of enrollment. These low coverage levels combined with the potential exposures inherent in group care settings indicate that children in CCCs are at risk for contracting vaccine-preventable diseases.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. mxk2@cdc.gov
authors.forename: Maureen S
authors.initials: MS
authors.lastname: Kolasa
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Chilkatowsky
authors.forename: John M
authors.initials: JM
authors.lastname: Stevenson
authors.forename: James P
authors.initials: JP
authors.lastname: Lutz
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Watson
authors.forename: Robert
authors.initials: R
authors.lastname: Levenson
authors.forename: Jorge
authors.initials: J
authors.lastname: Rosenthal
mesh_terms: D002656:Child Day Care Centers / Q000331:legislation & jurisprudence* / Q000592:standards; D002675:Child, Preschool; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D005568:Forms and Records Control; D018073:Haemophilus Vaccines / Q000008:administration & dosage; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008004:Licensure / Q000331:legislation & jurisprudence*; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage; D010414:Pennsylvania; D015143:Philadelphia; D023321:Poliovirus Vaccines / Q000008:administration & dosage; D014611:Vaccination / Q000592:standards / Q000706:statistics & numerical data*
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D022542:Measles-Mumps-Rubella Vaccine; D023321:Poliovirus Vaccines