No abstract

Recent advances in the development of new and improved vaccines have resulted in both the prospect of additions to the list of vaccine-preventable childhood diseases and opportunities to more effectively prevent diseases that are already vaccine-preventable.1 The recently revised schedule of routine vaccinations for all children as recommended by the Advisory Committee on Immunization Practices (ACIP) of the US Public Health Service is shown in the Table. The challenges of applying these new or improved vaccines, in light of our current understanding of the epidemiology of the diseases and a more efficient monitoring system for ensuring age-appropriate vaccination, is to more effectively control vaccine-preventable diseases in child day-care settings. BACKGROUND The nation experienced a marked increase in measles cases during 1989 and 1990. From 1980 to 1988, a median of 3124 measles cases was reported annually. During 1989 to 1991, a major resurgence of measles occurred, with a total of 55 622 cases reported during this period. The resurgence of measles was associated with a change in the epidemiology of reported cases. From 1980 to 1988, a median of 29% of cases occurred among children under 5 years of age.2 However, during 1989-1991, preschool-age children accounted for 37% to 49% of all reported cases.2,3 Many of these cases were reported from areas with large outbreaks of measles among predominantly unvaccinated black and Hispanic children living in large urban areas such as Los Angeles, New York City, Chicago, and Dallas. These cases among preschool-age children were associated with a large number of complications of measles.