Immunization Index  |  Data and Statistics

Daycare and Head Start
Immunization Validation Survey

Results of the 2002 - 2003 Daycare and Head Start Validation

Indiana State Department of Health

Gregory A. Wilson, M.D., State Health Commissioner

M. Elizabeth Carroll, J.D., Deputy State Health Commissioner

Community and Family Health Services Commission

Wendy Gettelfinger, R.N., D.N.S., J.D., Assistant Commissioner

Immunization Program

Michael Runau, M.S., Program Director

Charlene Graves, M.D., Medical Director

Primary Author

Megan Steiger, M.P.H., Epidemiologist

Immunization Program

Indiana State Department of Health

2 North Meridian

Indianapolis, IN 46204

Published: 08/2003

Preface

Each year, according to Indiana Code 12-17.5-2-5, Indiana childcare centers must submit an annual report to the Indiana State Department of Health (ISDH) demonstrating compliance with immunization requirements for their enrolled children. To verify the accuracy of the reports sent to ISDH by these childcare centers, the Immunization program biennially conducts a validation survey on a random sample of Daycare and Head Start centers throughout Indiana. The results of the Daycare and Head Start validation survey for the 2002 - 2003 school year are found in this report.

Methods

A random sample of childcare centers was selected from the 571 Daycare and 102 Head Start sites listed in the Immunization Program’s Daycare and Head Start database. This sampling was conducted according to procedures developed by the Assessment Branch of the National Immunization Program at CDC. Factors involved in this sampling include: total number of enrolled children, approximate immunization coverage levels, and acceptable level of error in sampling. Using this methodology, 34 Daycare centers and 35 Head Start sites were selected for a validation of the coverage levels found in their 2002 - 2003 immunization report.

ISDH immunization field representatives reviewed records for the up-to-date status of attendees at each of the 34 Daycare centers and 35 Head Start sites selected for validation. Complete immunization levels for each site were then calculated and compared with the site’s reported immunization coverage level for the 2002 - 2003 reporting year. These comparisons were made for overall coverage levels at each center, as well as coverage levels for children in each of the age categories required in the reports; Daycare centers compared children 15 – 23 months of age, 2 – 4 years of age, 5 – 6 years of age, and 7 years and above, while Head Start centers compared children 2 years of age to kindergarten, since they only enroll children in this age category.

Summary Tables and Graphs

The 2002-2003 Daycare and Head Start validation survey found a majority of childcare centers accurately report immunization coverage levels of children enrolled at their sites (i.e. ± 10.0 percent difference between reported rate and validated rate).  The median change in coverage between the validation survey and a center’s self-reported coverage was 1.3 percent for Daycare centers and 3.0 percent for Head Start centers statewide.

Figure 1. Percent change between validation surveys and Daycare and Head Start annual reports, 2002-2003 Indiana immunization validation survey.

*Daycare sites missing immunization report data (n=8) could not be included in statistical analysis

**Head Start sites missing immunization report data (n=7) could not be included in statistical analysis

Table 1. Results of Daycare immunization report validation survey, Indiana, 2002 - 2003.

* Standardized sampling techniques were followed for reviewing records at centers with > 100 enrolled students.

Table 2. Results of Head Start immunization report validation survey, Indiana, 2002-2003.

* Head Start centers only enroll children between two years of age and pre-kindergarten.

** Standardized sampling techniques were followed for reviewing records at centers with > 100 enrolled students.

Recommendations and Conclusions

• Validation of self-reported immunization coverage levels in Daycare and Head Start facilities is an important role of the ISDH Immunization Program.

• All childcare centers must implement and strictly enforce immunization policies to prevent the outbreak of vaccine-preventable diseases among their enrollees.  Failure to comply is a violation of state law and it places susceptible children at risk for contracting an otherwise preventable disease.

• Underreporting of Daycare and Head Start Center immunization rates may be linked to: the highly variable nature of childcare center enrollment, lag time between reporting and validation which allows children to get caught up with their immunizations, and incorrect reporting by childcare centers.

• Overreporting of Daycare and Head Start Center immunization rates may be linked to: children receiving invalid doses which were counted by childcare center in rates, but not included as valid in immunization field representative report.

Data in this report was collected from validation surveys conducted by ISDH immunization field representatives at a sample of 34 Daycare centers and 35 Head Start sites throughout Indiana