Vaccination rule lax at day care sites

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http://www.ajc.com/metro/content/printedition/2008/11/23/spotlight.html

Vaccination rule lax at day care sites

Many children let in without the required proof

By Alison Young

The Atlanta Journal-Constitution

Sunday, November 23, 2008

Day care centers across metro Atlanta —- just like schools —- are routinely

violating state law by taking care of children who lack proof of required

vaccinations, records show.

Despite the public health risk of unvaccinated children in close quarters,

local health departments rarely notify state child care regulators about

violations.

Instead, they have adopted a practice of declaring centers to be in

compliance with state law even if as many as 10 percent of the children in

their care are unvaccinated or undervaccinated. Centers that are even more

lax about compliance are often given months to work on the problem without

consequences.

Responsibility for enforcing the law is spread over multiple agencies: the

state health department, local health districts and a state day care

licensing agency. Meanwhile there is confusion among them about what the law

says and how it is to be enforced.

In 2007, health officials who perform annual audits of day care centers’

vaccination records didn’t report any violations to the day care licensing

officials, according to regulators at the Georgia Department of Early Care

and Learning.

Many centers were 100 percent in compliance last year. But at least 400

centers kept children in their care without proper vaccination documentation

temporary waivers or legal exemptions on file, according to a review of 755

centers’ vaccination compliance audits in Cobb, DeKalb, , Fulton and

Gwinnett counties by The Atlanta Journal-Constitution.

More than 200 metro Atlanta centers had five or more children out of

compliance at the time of their audits; about half of those centers had 10

or more such children.

Centers can legally let children attend for about 30 days under a temporary

waiver that allows parents time to get shots or paperwork. But even with

this grace period, parents often still don’t get it done because they can’t

get time off from work, center officials said.

When the waiver period ends, the law says day care operators are supposed to

kick out the children until they have proof of vaccination —- but at many

centers that rarely happens. Doing so creates hardship for parents who could

lose their jobs if they miss work, they said. Centers also don’t get paid if

they refuse to admit children.

“You don’t want to kick the kids out,” said Yvette Elliott, assistant

director of Due West Academy near Marietta, where records show 61 of the 158

children had no vaccination certificates at the time of its March 2007 audit

Elliott said she kept “hounding” parents and by September 2007 the center

was 98 percent compliant.

Haynes said she’s never kicked a child out of her Haynes Learning

Center in Atlanta. Last year only four of the 27 children had valid

immunization certificates. “Maybe I’ve been lax sometimes,” she said, adding

that the center’s children are currently up to date on shots.

Officials at the Centers for Disease Control and Prevention, as a result of

some U.S. Measles outbreaks, have expressed concern about the risk posed by

clusters of unvaccinated and under-vaccinated children.

Although Georgia hasn’t had an outbreak, federal officials have noted it

takes only one person to import disease from another state or abroad.

Last month the AJC reported that thousands of metro Atlanta schoolchildren

were allowed to enroll and remain in classes in 2007 without proof of shots

because principals ignore the law and health officials fail to enforce it.

Results of 2008 vaccination audits are due to the state by Nov. 30.

The AJC’s investigation of day care centers found many of the same problems.

Georgia child care regulators said they have no way of knowing about lax

compliance if the local health departments —- which conduct the annual

audits —- don’t tell them.

“We do take it seriously when we’re notified, but that’s all we can speak to

” said Haynesworth, the licensing agency’s regional director for

child care services.

While her department received no reports about noncompliant day care centers

last year, it has received five so far in 2008.

Haynesworth said she doesn’t know what standard local health officials use

to decide when to report a facility. She said she has no way of knowing

whether the law is being effectively enforced.

It’s against Georgia law for schools and day care centers to admit a single

child who lacks proof of required shots or paperwork establishing an

exemption because of a medical condition or for religious beliefs or a

waiver. The law says it’s a misdemeanor.

State health officials said they strive for 100 percent compliance and many

centers achieve that. But they concede that 90 percent is used as a

regulatory benchmark, since that’s what the CDC set as a national health

goal for immunization. CDC officials said that goal wasn’t intended to be

used as a regulatory standard.

“We do take the law seriously,” said Ben Sloat, immunization coordinator at

the Georgia Division of Public Health. “But there may be reasons we at the

state level aren’t aware of for why they aren’t in compliance with the

immunization law.”

In interviews, some county health officials and several day care operators

said they believe the Georgia vaccination law specifies that it’s OK for 10

percent of children to be out of compliance.

But the law requires 100 percent compliance. Neither state nor local health

officials responded to requests for copies of regulations that say otherwise

Confusion has been fueled by a state health department immunization pamphlet

for school and child care operators, some center directors said. The

pamphlet, which remained on the department’s Web site last week, said that

“at least 90% of children attending the facility must have current

immunization certificates for the facilities/schools to meet the

requirements of the law.”

The East Metro Health District, which covers Gwinnett County, has forms that

say: “Georgia Law Requires 90% Compliance Rate,” center directors said.

State officials told the AJC the pamphlet is wrong. In the wake of the AJC’s

investigation, the department said it is reviewing the processes for

assessing compliance and following up with facilities. The pamphlet, they

said, will be revised.

East Metro health officials did not respond to repeated requests for

interviews.

Studies have found that a school vaccination law is not enough to stop

disease outbreaks if the law is not enforced. In other studies, CDC

epidemiologist Maureen Kolasa and her colleagues found that, despite state

vaccination laws, children who attend day care —- and are at greater risk of

disease exposure—- tend to be no better immunized than those who don’t. Lack

of enforcement is one possible reason, they’ve written.

Still, Georgia health officials defend their 90 percent standard.

“I think with all the ins and outs of children in day care it’s going to be

tough to hit 100 percent,” said Crossman, a Cobb- health

official. “So I’m not sure if it’s a huge public health risk to have a few

kids in your day care center not fully immunized at any point in time.”

WHAT THE LAW SAYS

Local health officials often tell day care operators their centers are

complying with the law as long as 90 percent of their children have proof of

vaccinations, a temporary waiver or medical or religious exemption.

But the law says:

“No child shall be admitted to or attend any school or facility in this

state unless the child shall first have submitted a certificate of

immunization to the responsible official of the school or facility. …”

“Any responsible official permitting any child to remain in a school or

facility in violation of this Code section, and any parent or guardian who

intentionally does not comply with this Code section, shall be guilty of a

misdemeanor and, upon conviction thereof, shall be punished by a fine of not

more than $100.00 or by imprisonment for not more than 12 months.”

To read the full text of the law, O.C.G.A. 20-2-771, go to http://health

state.ga.us/programs/immunization/schools.asp.

HELP WITH SHOTS

To attend day care, depending on the child’s age, Georgia law may require

vaccination against measles, mumps, rubella, polio, whooping cough,

chickenpox, diphtheria, tetanus, hepatitis A and B, pneumococcal disease,

and Haemophilus influenzae type B (Hib). Exemptions are allowed for medical

and religious reasons.

For more information or help with vaccines:

Cobb and Public Health: 770-514-2300

DeKalb County Board of Health: 404-294-3700

East Metro Health District: 770-339-4260

Fulton County Department of Health and Wellness:

404-730-1211

SPOTLIGHT GETS RESULTS

Last month the AJC reported that many schools in Fulton County were allowing

large numbers of students to attend class without proof of vaccinations —-

and that local health officials hadn’t examined individual schools’

compliance.

Now, the Fulton County Department of Health and Wellness is taking several

actions, said t , the department’s nursing director:

> Beginning as early as January, health officials plan to send mobile units

to provide shots —- with parents’ permission —- at schools where audits this

fall show low vaccination compliance. “That’s going to be a lot of schools,

but it’s worth it,” she said.

> The county will launch programs to educate principals, superintendents,

day care operators and parents about the importance of vaccinations.

> Fulton is working on a proposal to audit vaccination compliance among

ninth-graders as they enter high school. Currently, kindergarten and

sixth-grade compliance is audited statewide.

> Health officials will use the Georgia Immunization Registry’s database,

where doctors and clinics record all shots given in the state, to identify

Fulton County children who may be missing shots, send their parents letters

and provide resources for getting up to date.

“Our ultimate goal is to make sure, to the best of our ability, that 100

percent of the children attending school in Fulton County are adequately

immunized,” said.

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