Having up-to-date immunizations is very important to the overall health of young children and the public at large. Making sure that every child enrolled in an early childhood setting has received all recommended vaccines is an important--and big--task.

Each year, the U.S. Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) publish the Recommended Childhood and Adolescent Immunization Schedule. While there may be some variation in the number of doses required for specific vaccines, states generally follow this schedule when setting immunization requirements for children attending out-of-home childcare programs. All infants and children should be up-to-date with the recommended early childhood immunizations prior to entering any childcare program.

An immunization registry is a confidential, computerized information system, usually maintained by the public health department, that keeps track of immunization data within a geographic area such as a city or state. The CDC has recommended the use of such registries, and one of the recommendations of the U.S. Department of Health and Human Services Healthy People 2010 is to have 95 percent of all children less than six years of age participating in registries.

There are many benefits to tracking early childhood immunization data via state registries. Registries consolidate vaccination records of children from multiple health care providers. This helps public health departments identify areas where children are not getting their recommended vaccines, and when health care providers look up a child’s record they know which shots are needed. These factors help increase and sustain high rates of immunization coverage, which protects everyone.

Health care providers are more likely to give immunizations because the registries make it easier for them: they generate reminder notices to be sent to parents when their children are due for more shots, print official vaccination forms and required parent information sheets, and help avoid duplication of vaccinations. Immunization tracking helps prevent disease outbreaks by identifying under-immunized children who may have “fallen through the cracks” either from losing health care benefits, moving to a different area, or changing health care providers. Once identified, children can be referred to a health care provider who can provide the appropriate immunizations.

Other benefits of tracking immunizations include identifying children from uninsured families who may be eligible for state health insurance benefits or vaccine coverage through CDC’s Vaccines for Children, a program that provides free vaccines to doctors who serve eligible children.

Childcare programs can provide important information to immunization registries as well. Many public health departments achieve this via random childcare program site visits and annual surveys. Some states require childcare programs to report all immunization data on an annual basis. In Pennsylvania, for example, the immunization status of every child aged two months through five years enrolled in a group childcare setting must be reported annually to the state’s health department.

So how can childcare programs ensure that their enrollees are up-to-date with their immunizations and have met their state’s immunization requirements? First, be aware of the requirements of your state. This information is available through each state’s public health or human services departments as well as on the CDC’s National Immunization Program website. Keep a copy of the annual AAP Recommended Childhood and Adolescent Immunization Schedule on hand.

Maintain accurate, up-to-date and confidential written records of all health screenings and immunizations for each child. For smaller daycare and family home providers, a written immunization record on each child is adequate. Many states provide standardized immunization forms to childcare providers free of charge. Send written reminders to parents to inform them that a child is overdue for an immunization, and remind parents to inform you when a child has received a new vaccination.

What if the childcare program is unable to obtain the required immunization records from the parent? That information can be obtained from the local health department if the child is entered in the city or state immunization registry. If the child was in a previous childcare setting, you may obtain the information from that program if state law permits this disclosure. Doctors can release the information if the parent has authorized it.

There are excellent software packages and Internet-based applications designed specifically for managing larger early childhood programs that can ease the burden of immunization record keeping. Many companies offer software that allows each child’s immunizations and other health-related data to be entered along with other important family information. Software often can be purchased as an all-in-one package, while others sell individual modules specifically for tracking immunization and health data.

Pricing varies, but individual modules generally cost between $200-$600 while all-in-one packages can cost more than $1,500. Many include tutorials and customer support. Some applications can be obtained online so that information can be shared with administrators, staff, and parents.

While entering each child’s health and immunization data into a software program or self-created database may be simple enough, childcare providers also need to keep track of when immunizations are overdue so that reminders can be sent to parents whose children are not in compliance with immunization laws. There are some applications that count doses of each immunization to determine if a child is overdue.

Children who are fully immunized have the best chance of protection against serious life-threatening diseases. Making certain that young children have been properly immunized when entering an early childhood setting, as well as throughout the duration of their attendance, are important tasks for childcare providers.

By working closely with parents, health care providers and state immunization programs, childcare providers can ensure that children are fully immunized through careful record keeping, sending reminders to parents, and being familiar with state immunization requirements for early childhood settings.

Elaine Abrams
Certified Health Education Specialist and Public Health Professional

American Academy of Pediatrics; 847-434-4000; www.aap.org/healthtopics/immunizations.cfm

Centers for Disease Control & Prevention (CDC) National Immunization Hotline; 800-232-2522

CDC National Immunization Program Childhood and Adolescent Immunization Schedule: www.cdc.gov/nip/recs/childschedule.htm

CDC Vaccines for Children Program (no-cost vaccines): www.cdc.gov/nip/vfc/

CDC State Immunization Registry Contact List:
www.cdc.gov/nip/registry/contact-prog-tech.htm#view

Immunization Action Coalition State Mandates on Immunization and Vaccine-Preventable Diseases www.immunize.org/laws

Kinderstreet™ www.kinderstreet.com

WellCareTracker™ www.wellcaretracker.org