Study looks at flu vaccine requirement for children, caregivers in U.S. child care centers

Influenza can be especially dangerous for children, who are at greater risk for serious complications from the illness, including hospitalization and even death. Yet child care centers in the U.S. rarely require children or the adults who care for them to be vaccinated against flu, according to a new study published in the Journal of the Pediatric Infectious Diseases Society.

When kids are in close proximity to each other in child care centers they spread infectious diseases very efficiently. The interventions that we use for older children and adults to prevent influenza, such as maintaining a distance of 3 feet between individuals, and coughing or sneezing into a shoulder or an elbow, don't work very well for a 2-year-old. So the best way we can protect them is through immunization."

Timothy R. Shope, MD, MPH, lead study author, UPMC Children's Hospital of Pittsburgh

The Centers for Disease Control and Prevention recommends influenza vaccination for everyone 6 months of age and older every flu season. In the new study, only 24.5 percent of child care center directors reported having a flu vaccine requirement for children. Even fewer directors, 13.1 percent, said they had such a requirement for adult caregivers. The findings are drawn from a telephone-based survey, conducted in 2016, that included 518 directors across 48 states, randomly selected from a national database of licensed U.S. child care centers.

Researchers also looked at various factors to see if they predicted whether flu vaccination was required, including quality indicators for child care centers, directors' years of experience, their previous experience with flu outbreaks, and the relevant laws in their state. Only state law was associated with directors having a flu vaccine requirement for children. Directors located in one of the four states that currently have laws mandating flu vaccination for children in day care (Connecticut, New Jersey, Ohio, and Rhode Island) were more likely to report having flu vaccination requirements at their own child care centers, compared to directors in states without such laws. Child care center directors who reported having a flu vaccine requirement for children were, in turn, more likely to have a requirement for adult caregivers.

"We can't depend on child care directors' experience or knowledge for implementing their own influenza vaccine requirements," Dr. Shope said. "If we're concerned with the public health of children and preventing influenza morbidity and mortality, we have to legislate the issue."

Legislation that limits non-medical exemptions from childhood vaccination laws has advanced in several states in response to outbreaks of vaccine-preventable diseases, including measles, which suggests that there may be progress on this issue. In the meantime, parents should take the initiative themselves. "For parents, they don't need to wait until there is an influenza vaccination requirement for children in child care," Dr. Shope said. "They should do what is best for their child's health and get them immunized."

Fast facts

• Children are at a greater risk for serious complications from influenza, including hospitalization and even death. The Centers for Disease Control and Prevention recommends flu vaccination for everyone 6 months of age and older every season.
• Only 24.5 percent of child care center directors reported having a flu vaccine requirement for children, and only 13.1 percent said they required adult caregivers to be immunized against flu, according to a new study based on a nationwide survey of 518 center directors.
• Four states (Connecticut, New Jersey, Ohio, and Rhode Island) currently have laws mandating flu vaccination for children in day care. Child care center directors in these states were more likely to have flu vaccination requirements for children, the study found.