Few US Child Care Centers Require Flu Vaccinations for Children, Adult Caregivers


A study examined influenza vaccination requirements for children who attend child care centers.


Few child care centers in the United States have an influenza vaccination requirement for children who attend and the adults who take care of them, according to a study published in the Journal of thePediatric Infectious Diseases Society.1

With flu season in full swing, vaccinations are especially important for children, who are at greater risk for serious complications from the illness. Because children attending large-group early education and child care settings are in close proximity to one another, the chances of spreading infectious diseases is even greater. The CDC recommends flu vaccination for everyone 6 months of age and older ever season.1

“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,” lead study author Timothy R. Shope, MD, MPH, of the UPMC Children’s Hospital of Pittsburgh, said in a statement.2

For the study, researchers looked at how many child care center directors reported flu vaccination requirements for attending children and examined factors that may have predicted whether flu vaccination was required.

Related: US Adults Forgoing Flu Shot

Child care directors were asked to complete a telephone-based survey, resulting in a 59% cooperation rate, and all states except Montana and Rhode Island were represented. A total of 518 directors who were randomly selected from a national database responded to the survey.1

Overall, only 24% of directors reported having an influenza vaccination requirement for children, whereas 13.1% reported a vaccination requirement  for adult caregivers. The 37 respondent states with a child care influenza vaccination law were more likely to report having a vaccination requirement for children; 85.7% of Connecticut and New Jersey center directors reported having a requirement compared with only 6.7% of Ohio directors, according to the results.1

The findings indicated that state influenza vaccine laws significantly increased director-reported influenza vaccine requirements for children, and that having a child vaccine requirement was also associated with a requirement for adult caregivers.1

In terms of predictive factors, the study found that directors’ years of experience and their previous experience with flu outbreaks were not associated with flu vaccination requirements.  

The researchers concluded that implementation of state laws to require seasonal influenza vaccination for children in child care centers and their adult caregivers is important, especially given the large percentage of children being cared for in these settings and the risk of influenza-related morbidity and mortality in young children.


1. Shope TR, Walker BH, Aird L, et al. Influenza vaccine requirements in United States child care centers. Journal of the Pediatric Infectious Diseases Society. 2019. Doi: https://doi.org/10.1093/jpids/piz078
2. Child Care Centers Rarely Require Flu Vaccination for Children or Their Caregivers [news release]. Pediatric Infectious Diseases Society’s website. http://www.pids.org/news/726-child-care-centers-rarely-require-flu-vaccination-for-children-or-their-caregivers.html. Accessed December 16, 2019.

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