We found that over half (63%) of childcare centres in the Hunter New England area kept records of staff vaccination, and a large proportion of staff were not vaccinated against pertussis. Preschools were shown to be statistically less likely to keep records of staff vaccination. While those at greatest risk are infants less than one year of age, older children still experience morbidity and are a known source of infection for younger siblings [17
Recent research conducted in Australia has shown that pertussis immunity following vaccination decreases by three years of age [19
]. With 50% of three year olds in child care [7
] and siblings being a key source of infection for children under one year of age [17
], it is vital that they are protected from infection.
Excluding sick children and staff is an important way of limiting the spread of infection in a child care centre. Having a written policy that clearly states the centre’s exclusion criteria is also important. In this study less than half the centres had policies for respiratory illness in staff. Only 6% of centres mentioned the “Staying Healthy in Child Care” manual. A previous study is Australia in 2006 also identified low awareness of guidelines for staff immunisation [20
]. In the four years since this study, the implementation of these guidelines has not changed and remains low.
Child care centres are required to keep up-to-date records of children’s vaccination status and to exclude those that are not vaccinated; however this has not been extended to include child care centre workers. Of particular concern was that 19% of centres knew that none of their staff were vaccinated against pertussis.
Two thirds of the directors did not know why staff had not had a pertussis vaccination, suggesting this had not been discussed with staff. A barrier to staff immunisation in some centres is likely to be that 16% of directors reported not knowing that their staff should be vaccinated against pertussis. Empowering directors with useful information about staff vaccination may result in more complete follow-up of vaccination status in staff, as is done for the children who attend centres. This could be done through requirement in accreditation or licensing processes.
A strategy to minimise transmission in these settings would be to enforce the guidelines in the “Staying Healthy in Child Care” manual for staff vaccination during accreditation or licensing processes. Guidelines include:
· develop a staff immunisation policy; which outlines the immunization requirements for childcare staff at the centre which are inline with NHMRC requirements;
· develop a staff immunisation record; this should document previous infection or immunisation for the relevant diseases;
· require all new and current staff to complete the staff immunisation record;
· regularly update staff immunisation records as staff become vaccinated;
· provide staff with information about diseases that are preventable by immunisation, for example through in-service training and written material such as fact sheets; and
· take all reasonable steps to encourage non-immune staff [12
The “Staying Healthy in Child Care” manual is currently being reviewed by the NHMRC, with a new version scheduled for release in 2012.
This study highlighted the influence of the presence of a respiratory illness policy and vaccination coverage between long day care centres and preschools. Due to the age of the children (under 1
year of age) long day care centers are required to have a higher carer to child ratio then preschools. However both are required to have qualified staff depending on the number of children. Both types of day care are required to be licensed however not all preschools are accredited. Therefore the difference in policies and vaccination coverage may be due to different accreditation practices.
Even though this study had a very high participation rate there are a number of limitations. Child care centres in the regional area studied may not be representative of all child care centres in the state. The survey relied on information provided by the centre director not the individual child care workers and this could have been influenced by recall bias and time constraints in answering the questions. In addition, the questions relating to vaccination coverage were not open ended, directors were provided with options to choose from, therefore the categories of response could have been biased by the survey design. However the options were previously pilot tested with two child care centre directors in an attempt to reduce bias.