Few US Child Care Centers Require Flu Vaccine

Children have higher risk for serious complications from influenza, making vaccination key to preventing unnecessary hospitalizations and mortality.

However, a study published in the Journal of Pediatric Infectious Diseases Society reports that child care centers in the United States rarely require children or adult care workers to be vaccinated against influenza. Of 518 child care centers surveyed, 24.5% and 13.1% reported an influenza vaccine requirement for children and adult child care workers, respectively.

A nationwide telephone survey was developed by a group working on infectious disease management in child care centers. The questionnaire was designed for child care center directors and piloted in 2008, prior to the recent study, which was conducted in 2016.

The survey was distributed to 2500 centers derived from simple random sampling of 180,000 total centers.

A total of 518 respondents completed the survey. The survey was conducted by telephone interviewers and took approximately 15 to 20 minutes.

The primary outcomes were reported influenza vaccination requirements for adult caregivers and for children.

Over half of respondents (54.7%) had worked in the same child care center during the 2009 H1N1 pandemic.

Only 24.5% of respondents reported their care center as having an influenza vaccine requirement for children, and only 13.1% had a similar requirement for child care workers.

The US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices has recommended influenza vaccination for children 6-23 months since 2004, children aged 24-59 months since 2006, and everyone 6 months and older since 2008. But at the time of the study, only 4 states had influenza vaccine requirement laws in child care centers.

Notably, 37 respondents from states with a child care influenza vaccination law were more likely (52.8%) to report having a vaccine requirement than those from states that did not require vaccination (22.3%).

Yet even among such states, there was variation, with 85.7% of Connecticut and New Jersey center directors reporting an influenza vaccine requirement versus 6.7% of Ohio care center directors. Study authors pointed to a variety of possible explanations, particularly that Ohio’s requirements were established more recently.

Investigators were also aware of 2 states with influenza vaccine requirement laws for child care workers, but effects were not measurable in the study because there were not respondents from Rhode Island and the California law had only recently been passed.

Investigators encouraged the passage of state legislation around influenza vaccines for children and workers in child care centers. While few states have such legislation from which to draw empirical conclusions, respondents from those states had a statistically significant higher likelihood of reporting child care center vaccine requirements.

Despite the troublingly low number of child care centers with a vaccine requirement, study authors did draw a distinction between vaccination requirements and vaccination rates.

“Decisions to vaccinate, in lieu of requirements, are made by parents and adult caregivers, and vaccination rates are likely to be significantly higher than the director-reported vaccination requirements,” study authors wrote.