SEPTEMBER 2008

New Child Care, Preschool, and School Vaccination Requirements:

Child Care and Preschool: On Friday December 14, the State of New Jersey became the first state to require an annual flu shot for children attending licensed child care centers and preschools beginning in September 2008. There are approximately 1,100-1,500 children enrolled in Cape May County child care centers and preschools who will need a flu shot next year. New Jersey will also require pneumococcal vaccination for children attending child care or preschool.

The Centers for Disease Control and Prevention (CDC) recommends annual flu shots for children 6 months of age to 5 years, as a high priority group. As it has done in recent years, the Cape May County Department of Health will continue to hold free flu clinics for children. Primary care physicians and pediatricians are asked to consider this new child care and preschool regulation when planning for their flu vaccine needs next season.

As you know, CDC recommends pneumococcal vaccination at 2, 4, and 6 months, with a booster at 12-15 months of age. 

Middle School: Children born after January 1, 1997 and enrolled in grade six or transferring into a New Jersey school from another state or country will be required to receive a booster dose of the diphtheria, tetanus and pertussis vaccine as well as one dose of meningococcal vaccine.

The childhood recommended immunization schedule can be found at http://www.cdc.gov/vaccines/recs/schedules/default.htm#child. The Summary of Recommendations for Childhood and Adolescent Immunization can be found at http://www.immunize.org/catg.d/p2010.pdf.

Article on School Age Flu Vaccination and Herd Immunity: For your reference, an article in the New England Journal of Medicine (Reichert TA, Sugaya N, Fedson DS, Glezen WP, Simonsen L, Tashiro M. The Japanese experience with vaccinating schoolchildren against influenza. N Engl J Med. 2001;344:889-96) provides a retrospective analysis of a mass influenza vaccination program for Japanese school children showing evidence of herd immunity. In 1957, the Asian influenza epidemic claimed the largest recorded death toll from influenza in Japan. With widespread school closures and attack rates as high as 60% coinciding with school sessions, school attendance seemed to play an important role in the spread of infection. In 1962, a nationwide program was launched to vaccinate school children against influenza in the attempt to prevent another deadly epidemic. In 1977, legislation made influenza vaccination mandatory, and coverage rates ranged from 50% to 85% until the late 1980s. In 1987, new legislation was passed allowing parents to refuse vaccination for their children and in 1994, the program was discontinued because of increasing doubt about its effectiveness. In Japan, the 5-year moving average of excess death rates declined by 50% between 1962 and 1972, and by 40% between 1972 and 1987, despite a doubling in the number of elderly persons. During this immunization program period, mortality attributable to pneumonia and influenza decreased by 10,000 to 12,000 deaths per year, and all-cause mortality decreased by 37,000 to 49,000 deaths per year; one death was prevented for every 420 schoolchildren vaccinated. After 1987, when influenza vaccination of schoolchildren was made voluntary, the number of excess deaths began to rise and rose steeply after 1994, when the immunization program was abandoned. Together, these trends in excess deaths in Japan support the hypothesis that the lower rate of excess deaths between 1962 and 1987 was due to vaccine-induced herd immunity. Excess deaths attributable to pneumonia and influenza are now similar to the level before the program was begun in 1962.