By Julie Steenhuysen

(Reuters Health) – Only a quarter of childcare centers in the United States require children in their care to get a flu shot, and even fewer require childcare workers to be vaccinated, U.S. researchers reported on Thursday.

Young children are at increased risk of serious complications such as hospitalization and even death from seasonal influenza, but few centers charged with caring for young children require them to be immunized, Dr. Timothy Shope of UPMC Children’s Hospital of Pittsburgh and colleagues report in the Journal of the Pediatric Infectious Diseases Society.

In the United States, nearly 1 in 4 children under age 5 attend large group childcare or preschool programs.

According to Shope, flu spreads quickly among these children, and methods that can protect older children, such as frequent handwashing, isolating sick children or urging them to cough or sneeze into their elbow or shoulder, don’t work for young children.

Dr. Deborah Lehman, a professor of clinical pediatrics at the David Geffen School of Medicine at the University of California, Los Angeles, and an infectious disease expert who was not involved in the study, agreed.

“Young children are the shedders and the spreaders,” Lehman said in a telephone interview. “They don’t always have the best personal hygiene. Flu is spread through secretions and touches of hands. As you can imagine, in a daycare setting, it allows the virus to spread.”

That’s why vaccination is important, Shope said in a telephone interview.

Shope and colleagues based their findings on a 2016 telephone survey of 518 childcare center directors in 48 states that were randomly chosen from a national database of licensed U.S. childcare centers.

Only 24.5% of center directors said they required children to have a flu shot, and even fewer, 13.1%, said they required caregivers on their staff to be vaccinated.

To better understand why, the team looked at a number of factors such as the director’s years of experience, prior experience with flu outbreaks and state laws requiring immunization. State laws were the only factor that appeared to influence immunization requirements, the researchers report. For staff, centers that had mandatory vaccination requirements for children were more likely to also require that caregivers be vaccinated.

“The reported requirements for flu vaccine by childcare directors for both children and adults are really low. The only factor that influenced that was the very low number of states that had laws requiring flu vaccines,” Shope said.

In the study, only four states required flu shots for children attending childcare centers, and only two states required adult caregivers to be vaccinated. As a result, many of these decisions are left up to the center director.

Parents “shouldn’t rely on the childcare center’s entry requirements for what is the best, safest thing for their child. They should take matters into their own hands prior to entry,” he said.

The U.S. Centers for Disease Control and Prevention (CDC), which funded the research, recommends flu shots for everyone age 6 months or older, but many go unvaccinated.

“A lot of families I’ve spoken to don’t see the need to get a flu vaccine because they’ve heard it doesn’t work that well,” Lehman said.

Unlike many childhood vaccinations, which can provide lifelong immunity, the influenza vaccine needs to be given each year. That’s because the virus mutates quickly, and flu shots must be adapted to protect against the strains circulating each season.

Nevertheless, Lehman said, the vaccine is “very safe” and has been shown to prevent the most severe complications of influenza, which can include pneumonia, viral infections of the heart and death.

“We really do not put enough emphasis on how important influenza vaccine is,” Shope said. “Every year, 100 children on average die of influenza in the United States.”

Although the 2019-2020 flu season in the United States is just getting underway, already six children have died, according to the CDC.

SOURCE: Journal of the Pediatric Infectious Diseases Society, online December 12, 2019.