Influenza Vaccine Requirements in United States Child Care Centers

National trends in patterns of under-vaccination in early childhood: National Immunization Survey-Child, United States, 2011-2021

BACKGROUND

The study's objective was to examine national trends in patterns of under-vaccination in the United States.

RESEARCH DESIGN AND METHODS

The National Immunization Survey-Child (NIS-Child) is an annual cross-sectional survey that collects provider-verified vaccination records from a large national probability sample of children. Records from the 2011-2021 NIS-Child were used to assess receipt of the combined 7-vaccine series by age 24 months. Based on prior work, patterns indicative of hesitancy included zero vaccines, not starting ≥1 series, and consistent vaccine-limiting. Patterns indicative of practical issues included starting all series but missing doses. Up-to-date (UTD) was defined as receiving all doses in the combined 7-vaccine series.

RESULTS

The study population comprised 127,257 children. Over the observation period, patterns indicative of hesitancy significantly decreased (p-trend < 0.0001), patterns indicative of practical issues significantly decreased (p-trend < 0.0001), and UTD significantly increased (p-trend < 0.0001). In 2021, the weighted percentage in each category was as follows: probable hesitancy 6.3% (95% confidence interval [CI] 5.4%, 7.2%), probable practical issues 26.0% (95% CI 24.4%, 27.6%), and UTD 67.7% (95% CI 66.0%, 69.4%).

CONCLUSION

Over an 11-year period, vaccination coverage in the United States for the combined 7-vaccine series has improved, with patterns suggestive of practical issues or hesitancy declining.

A Comprehensive Assessment Of Child Care Vaccination Laws Across The US

All fifty US states and Washington, D.C., require children from birth through age five to be vaccinated against certain communicable diseases as a condition of attending child care settings such as day care, Head Start, preschools, pre-kindergarten, and other early childhood programs. However, the nuances and implementation of these laws vary greatly across jurisdictions. To date, a comprehensive analysis of all child care vaccination laws in the US has not been performed. We have developed the first compilation of child care vaccination laws across the US. This compilation is the culmination of an exhaustive examination of multiple components of the laws, such as which vaccines are required, provisions that enable unvaccinated children to temporarily attend child care until they are fully vaccinated, attendance provisions for unvaccinated students during an outbreak, methods of enforcement of vaccination policy, and child care personnel vaccination requirements. This comprehensive analysis provides a critical and foundational framework to inform policy makers and public health professionals involved in policy planning and implementation and policy research. It provides a benchmark for further evaluation of existing and future vaccination laws and their impact on vaccine coverage rates.

An Examination of Employee Immunization Policies Among Colorado Child Care Providers

BACKGROUND

Child care employee vaccination policies can protect children and adults from vaccine-preventable diseases (VPDs) in child care programs. We aimed to understand the prevalence and characteristics of employee immunization policies at child care facilities and support among child care administrators for statewide employee vaccination regulations.

METHODS

A postal mail survey was distributed to a cross-sectional sample of 300 center-based and 300 home-based child care programs in Colorado. Programs were asked to report whether they had any type of policy requiring employee immunizations and if they would support statewide regulations mandating employee immunizations for influenza, pertussis, and measles.

RESULTS

The response rate was 48% (288/600). About 55% of child care programs reported having an employee immunization policy. Child care centers (73%) were more likely than home-based child care programs (30%, P < .001) to report having a policy. Overall, 62% of respondents reported that they would support one or more statewide regulations requiring child care employees to be vaccinated. Home-based programs (71%) were more likely than center-based programs (53%, P = .001) to support one or more statewide child care employee immunization regulations.

CONCLUSIONS

Our findings demonstrate the variability of employee immunization policies at child care programs across Colorado. These results may be used to inform strategies to increase employee immunization uptake and reduce the incidence of VPDs, including developing comprehensive employee immunization policies at the facility and state level. Future research is needed to understand vaccination knowledge, attitudes, and behaviors among child care employees including their perspectives on employee vaccination policies and regulations.