“About 85 percent of the nation’s children get all or at least some of their inoculations from private physicians’ offices, which operate as businesses. The federal and state governments pay for vaccines for about 55 percent of children, mainly poor ones. But even those government-subsidized vaccines are mainly administered by private doctors.

Private physicians have been taking on a greater role in immunization since a 1989 measles outbreak spurred efforts to increase vaccination rates. Now, however, ‘we’re worried about seeing a reverse trend,’ back to public health departments, said Dr. Howard D. Backer, chairman of the Association of Immunization Managers, a group of state vaccine officials.

To be sure, most pediatricians continue to offer most or all vaccines. And immunization rates for the older vaccines remain higher than ever. More than 90 percent of children get shots for polio, mumps and hepatitis B, for instance.

…Getting a vaccination was not always so difficult. In 1980, it cost only about $23, or $59 adjusted for inflation, for the seven shots and four oral doses needed to immunize a child, according to data provided by Dr. Thomas Saari, who is emeritus professor of pediatrics at the University of Wisconsin.

Today, though, a child who receives all the recommended vaccines would receive as many as 37 shots and 3 oral doses by the 18th birthday — at a cost exceeding $1,600.

… Some states that once provided free vaccines to all children, like North Dakota, have had to abandon that practice. The Washington State Department of Health, which is still trying to provide vaccines for all, is requesting an additional $13 million a year from the state Legislature to pay for the new vaccines, which would nearly double the $16 million current appropriation.

Spending by the federal Vaccines for Children program, which pays for immunizations for Medicaid children and some others, has grown to $2.5 billion, up from $500 million in 2000.”

“The nation’s pediatricians, the foot soldiers in the campaign to vaccinate America’s children, are starting to revolt.

The soaring cost and rising number of new vaccines, doctors say, make it increasingly difficult for them to buy the shots they give their patients. They also complain that insurers often do not reimburse them enough, so they can lose money on every dose they deliver.

As a result, some pediatricians are not offering the newest and most costly vaccines. And some public health experts say that if the situation worsens, it could lead to a breakdown in the nation’s immunization program, with a rise in otherwise preventable diseases.

‘We cannot pay for the vaccination of the American public any longer,’ said Dr. Dorothy A. Levine, a pediatrician in Stamford and New Canaan, Conn. ‘We’re not giving them with as much vigor as we should, and the main reason is financial.”

Putting young children in day care means exposing them to health risks not faced by children cared for at home by their mothers. Placement in day care especially elevates the health risks for infants. The health hazards of day care come into mathematically precise focus in a study recently published by researchers from Johns Hopkins University, South Carolina University, and Western Kentucky University. 

The authors of the new study assess the health care risks of day care by analyzing data collected for 1188 children — some in day care, some cared for at home — enrolled for medical care either through a Health Maintenance Organization (HMO) or a consortium of Medicaid providers in Columbia, South Carolina. These data show that “in general, risks of diarrheal illness and U[pper]R[espiratory]I[nfection] in day-care children are greater than in home-care children.” Indeed, when comparing day-care children to peers cared for at home, the researchers calculate statistically elevated risks for day-care children in contracting Mild Diarrhea (Odds Ratio of 1.83), Severe Diarrhea (Odds Ratio of 1.79), Mild Upper Respiratory Illness (Odds Ratio of 1.96), and Severe Upper Respiratory Illness (Odds Ratio of 1.64). 

The authors of the new study are not surprised by their findings, since they are “consistent with previous studies [showing] that day-care children are at a higher risk of contracting both diarrheal illness and U[pper]R[espiratory]I[llness] compared to home-care children.”   The researchers do, however, note that the health risks associated with placement in day-care depend in part on the age of the children.  “Among day-care children,” write the scholars, “the youngest group was at the highest risk of contracting both diarrhea and U[pper] R[espiratory]I[llness].”  The particular vulnerability of very young day-care children appears most pronounced for Upper Respiratory Illness.  Thus, when looking specifically at children less than eighteen months old, the researchers calculate that day-care children are nearly four times as likely to contract Mild Upper Respiratory Illness than home-care peers (Odds Ratio of 3.61) and are almost three times as likely to contract Severe Upper Respiratory Illness (Odds Ratio of 2.94).

In concluding their study, the research team comments on what might strike some as a decidedly unhealthy social pattern: “Despite persuasive evidence of higher risk of acquiring common infectious diseases in day care settings, the demand for child day care services is increasing.”

(Source: N. Lu et al., “Child day care risks of common infectious diseases revisited,” Child: Care, Health & Development 30 (2004): 361-368.)