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Many daycare centers have no requirements for children to get vaccinated for the flu. Getty Images
  • Young children are at increased risk for getting the flu and having severe symptoms.
  • But a study finds many daycare centers don’t require flu vaccinations for eligible children or adults.
  • Experts point to lax state regulations as one reason that few centers require vaccinations.

Each year, children under the age of 5 face the greatest health risks when it comes to influenza.

New research has pinned down one potential reason why so many young children are getting sick: The vast majority of childcare centers don’t require children and adult caregivers to get vaccinated.

As a result, infectious diseases like the flu spread rapidly among children and staff who aren’t vaccinated in these settings, according to the study, which published in the Journal of the Pediatric Infectious Diseases Society on Thursday.

This year, health officials reported multiple pediatric deaths, and children under 5 have the second highest rate of hospitalization for the flu.

The main reason childcare centers don’t have flu shot requirements is because they don’t need to.

Most states’ immunization laws don’t include the flu vaccine, so childcare centers can operate without ordering children and staff to get vaccinated.

“When there is no state law for flu vaccine, the childcare regulations won’t contain a requirement and the state won’t monitor or enforce influenza vaccination,” the study’s lead author Dr. Timothy Shope, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, told Healthline.

This has many health experts concerned because the flu can cause severe complications and be life threatening in young children.

“With today’s immunization rates in the U.S., influenza is the most serious vaccine-preventable disease. Approximately 100 children die each year of influenza which far exceeds annual deaths from all of the other vaccine-preventable diseases combined,” Dr. Shope said.

Researchers conducted a telephone-based survey in 2016 in which they contacted 518 directors of childcare centers across 48 states.

The directors, who were randomly selected, were asked about their organization’s influenza requirements.

Of the 518 directors called, only 24 percent required children to be vaccinated against the flu and just 13 percent required staff to be vaccinated.

Childcare centers in states that have flu vaccine requirements in childcare settings — which, at the time of the survey, were Connecticut, New Jersey, Ohio, and Rhode Island — were more likely to require children to get vaccinated.

For example, about 85 percent of directors in Connecticut and New Jersey reported having influenza vaccine requirements.

Although in Ohio, just 6 percent of directors reported flu shot requirements.

Since 2004, the Advisory Committee on Immunization Practices (ACIP) — a federal committee that recommends routine immunizations — has recommended that children between 6 and 23 months get the influenza vaccine.

Children ages 24 to 59 months have been advised to get vaccinated since 2006, and everyone 6 months and older since 2008.

But many states lag behind and haven’t started enforcing these recommendations.

According to Shope, most states enact legislation a year or two after the ACIP makes a recommendation, making the 15-year lag with flu shot requirements surprising.

“It may be that legislators can’t stomach the intense anti-vaccine lobbies and protests that seem to be gaining momentum. In addition, more than other vaccine-preventable diseases, people have inaccurate beliefs about the disease severity of influenza and the efficacy and side effects of the influenza vaccine,” Shope said.

Unfortunately, when there’s no state law in place, directors are much less likely to require children and staff to get the flu vaccine.

On top of that, many directors may have lenient flu vaccine requirements due to the many religious and philosophical exemptions available, the researchers suspect.

The American Academy of Pediatrics (AAP) has previously stated they support state laws requiring immunization in childcare settings and find non-medical exemptions for required immunizations such as the flu vaccine to be inappropriate for public health.

Although influenza vaccination rates among children 6 months to 4 years have been increasing in recent years — from 63 percent in 2010/2011 to about 68 percent in 2017/2018 — immunization rates are still much lower than what health experts would like to see.

Dr. Richard Martinello, a Yale Medicine infectious disease expert, says communicating the importance of vaccines has been a challenge over the past decade, but he hopes people are starting to change their minds about them.

“I think parents and families are beginning to better understand that vaccines are highly effective, they’re safe, and that parents who are physicians vaccinate their own children,” Dr. Martinello said.

What makes this issue even more concerning is that the flu typically has a more severe course in young children.

And in a childcare center where children are coughing, sneezing, and playing with each other, it’s incredibly easy for the virus to spread.

Unlike adults, children haven’t been exposed to as many flu shots or viruses, making them more likely to contract an infection.

“This immaturity of their immune system may both lead to them being more susceptible to infection, and having a less controlled response to their infection,” Martinello said.

On top of that, kids spread the virus for a longer period of time compared to adults.

Whereas adults spread the flu virus heavily for two days — with the amount of the virus they spread decreasing until their fifth day of infection — kids spread it heavily for about five days and can then continue to spread it for over a week, according to Martinello.

Vaccination is the best way to protect kids against the flu and its complications, such as ear infections, pneumonia, dehydration, and even death.

Even if a child does get the flu, the flu shot will lessen the severity of their symptoms.

“In our busy flu months, we consistently see that children who are vaccinated recover more quickly and are much less miserable from the flu’s high fever, body aches, and cough,” said Dr. Geoffrey Hart-Cooper, a Stanford Children’s Health primary care pediatrician and medical director of Stanford’s Virtual PrEP Program.

Dr. Hart-Cooper said every year he sees children come in with the flu, causing the whole family to miss a week of school and work — but that’s not the worst of it.

“What really breaks my heart is that every year about 50 to 150 kids die from the flu,” he said.

When kids get sick, that typically means they bring the flu home and spread it to their family members, including grandparents and those with a compromised immune system who have a heightened risk.

Experts suggest that everyone should be getting the flu shot to not only protect themselves and their children, but others from the flu as well.

New research has found that the vast majority of childcare centers don’t require children and adult caregivers to get vaccinated.

As a result, infectious diseases like the flu spread rapidly among children and staff who aren’t vaccinated in these settings.

Because children have a heightened risk and are more likely to experience complications from the flu, health experts hope to see more kids age 5 and under vaccinated, especially if they spend time in a childcare center.