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Although 97%-98% of children in the United States are vaccinated before or shortly after starting school, the proportion of preschool children who have completed a full series for all recommended vaccines is considerably lower. Although low immunization coverage among preschoolers has been attributed to difficulties in reaching certain groups, such as the urban poor and racial and ethnic minorities, more recent evaluations suggest that the health-care delivery system itself bears much of the responsibility. To eliminate barriers and obstacles (e.g., appointment-only systems and unnecessary prevaccination physical examinations) that impede efficient vaccine delivery and to encourage providers to take advantage of all health-care visits as opportunities to provide vaccinations, the National Vaccine Advisory Committee (NVAC) called for the development of standards for immunization policies and practices. Eighteen standards were developed in collaboration with a 35-member working group representing 22 public and private agencies. These 18 standards have since been recommended by the NVAC, approved by the U.