DEL.ICIO.USVaccination rule lax at day care sites
Many children let in without the required proof
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.
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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, Douglas, 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.
Mary 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 Brenda 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 Lisa Crossman, a Cobb-Douglas 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.”
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