The capacity of children's services in New South Wales to meet their responsibilities under the Public Health (Amendment) Act 1992.
From 1 January 1994 the New South Wales government has required directors of licensed children's services to ask parents for proof of their children's immunisation status, to record and update this information and notify public health units of outbreaks of vaccine-preventable disease. Before introduction of the legislation, we studied the health and safety policies and practices of a random sample of 77 long-day-care centres caring for children under two years of age. All but one recorded immunisation in some way; however, of the 73 centres for which adequate information was available, only 22 per cent (95 per cent confidence interval (CI) 14 to 33) recorded immunisation according to the National Health and Medical Research Council schedule. A review of the records of one in four children enrolled in the centres showed that triple antigen (TA) was recorded in some way on 94 per cent (CI 92 to 95) of records, and measles-mumps-rubella (MMR) on 80 per cent (CI 78 to 83) of records. These entries were independently verified for only 31 per cent of TA and 26 per cent of MMR records, and 38 per cent of TA and 41 per cent of MMR records had not been updated when necessary. Only 53 per cent of directors thought that the school-entry legislation would affect children's services. Directors were generally unaware of the role of the public health units and would have had difficulty in managing an outbreak of a vaccine-preventable disease. Without technical and administrative support, the directors will not be able to meet their responsibilities under the legislation.