Not all kids equal when it comes to shots

Immunization audits show childcare centers, schools rarely 100 percent compliant

Vanessa Miller
Published: December 10 2012 | 5:30 am - Updated: 1 April 2014 | 3:10 am in

Every time a new child enrolls at the Corridor Christian Early Learning Center in North Liberty, one of director Melissa Schilling’s first questions for parents is whether their child is immunized.

“Before I can let a child in for drop-in care or permanent care, they have to give us a well-child check up and an immunization report,” Schilling said.

Children can be exempt from immunizations for medical or religious reasons. They also can be allowed in on a provisional basis if they are on a delayed immunization schedule.

“But, for them to come here, we have to have a schedule of shots to make sure they have a plan for it,” Schilling said.

With all the effort she puts toward collecting records from parents and keeping each child’s immunization file updated, Schilling said it still is a challenge to keep up. And she’s not alone.

Immunization audits for 60 licensed child care facilities in Johnson County in 2012 showed that only nine had every child’s records accounted for when a public health inspector visited.

Twenty-five of the child care providers could not account for more than 10 percent of their enrolled children’s immunization records. Six could not account for more than 20 percent of their students’ records, according to a Gazette review of the audit reports.

K-12 schools in Johnson County fared a little better. Only nine of the 57 audited schools could not account for more than 10 percent of their students’ immunization records. Six schools could not account for more than 20 percent of the required documents, five of which were either private or Amish schools.

Iowa law requires licensed child care centers and schools to have signed and dated immunization certificates on file for every enrolled child. The state requires immunization for six diseases — measles, mumps, rubella, diphtheria, tetanus and polio — unless a child has been exempted for religious or medical reasons.

County health departments are mandated by law to audit all of its jurisdiction’s K-12 schools, but they’re not required to do the same for child care centers. Many do, like Johnson County. But some do not, like Linn County.

Still, all licensed child care centers are inspected annually — including their immunization records — as part of the state’s licensing process. The Iowa Department of Human Services has 11 consultants who make unannounced visits to the 1,400-some licensed child-care centers in Iowa.

Their reports, beginning last month, now are available on the state department of human services’ website.

Correcting the problem

When consultants discover incomplete immunization records at a center, they work with directors to solve the problem, said Roger Munns, spokesman for the state’s Department of Human Services. The goal is not to punish them, he said.

“There isn’t a fining system,” he said. “Instead, the operator of the child care center is notified that this is deficient, and they are required to come up with some sort of plan to make amends.”

And, he said, most do.

“The licensing rules are designed to be helpful as opposed to being punitive,” Munns said. “Seldom is there a revocation of a license.”

County public health officials who inspect child care and K-12 schools operate much the same way because they have no power to affect a center’s license or to penalize a school.

“We do the audits for education and encouragement,” said Johnson County Public Health Director Doug Beardsley.

And the county sends its audit reports for child care centers and schools to the state’s Department of Public Health, Beardsley said.

Johnson County’s audit reports show that most schools in the Iowa City Community School District had 90 percent or more of their immunization records accounted for in the last school year. Poulton said the records that are missing often are quickly recovered and updated.

“Usually it’s an oversight on someone’s part,” Poulton said. “Like those records were there but not in the right file.”

State law requires that schools allow students to attend who have not been immunized for religious or medical reasons. But, Poulton said, on occasion they have sent home students who simply weren’t immunized or didn’t have records.

“It’s usually just a few days until records are found,” Poulton said.

Exemptions rise

Statewide, the number of religious exemptions from immunizations is rising. It increased slightly in the category of K-12 schools from 4,206 in the 2010-11 school year to 4,958 in the 2011-12 school year. But it’s more than two times higher than a decade ago, when there were about 1,778 religious immunization exemptions in Iowa.

Jean Kim, a clinical assistant professor in pediatric infectious diseases with the University of Iowa Children’s Hospital, said the increase in exemptions is concerning.

“This is a nationwide issue,” she said. “There are certain populations that will, as a community, not vaccinate their children. It’s concerning to that population and to the people who interact with them. Not only are those people susceptible to getting disease, they can transmit it to other children.”

Kim said childhood vaccinations are important because the required ones are “not for diseases that are minor.”

“We don’t typically worry about the minor cold,” she said. “We worry about things that can kill you.”

Kim said that day care centers and schools with lower immunization rates might see all kinds of illnesses and infectious diseases pass through their population at a higher rate. And, she said, many of the exemption forms don’t require detailed explanations of why the person wants to be exempt.

“You can just say, ‘I don’t believe in vaccines,’?” she said. “There aren’t strict rules about what constitutes an exemption. And it’s concerning that any population would, in general, just stand against vaccinations.”

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