The impact of mandatory influenza vaccination in child care centers in New Jersey

Introduction: Preschool-aged children are at increased risk for severe influenza-related illness and complications. Congregate child care settings facilitate influenza transmission among susceptible children. To protect against influenza transmission in these settings, New Jersey (NJ) became, in 2008, the first state to implement regulations requiring that all children aged 6–59 months receive at least 1 dose of influenza vaccine each year to attend a licensed child care program. To date, no studies have been performed to evaluate the impact of the New Jersey mandate on influenza vaccination coverage. The purpose of this study was to assess influenza vaccination coverage before and after the mandates’ implementation using New Jersey Immunization Information System (NJIIS) and the National Immunization Survey (NIS); to assess demographic and socioeconomic factors which alter vaccination coverage; and to assess changes in hospitalization and mortality rates after the mandates’ implementation. Methods: Coverage rates for influenza, measles mumps and rubella (MMR) and pneumococcal conjugate (PCV) vaccine were calculated from the NJIIS and NIS systems. Coverage was evaluated over time, at different geographic regions (i.e., New Jersey vs. United States) and by select demographic factors. Changes in population-based morbidity and mortality rates were also evaluated for New Jersey (NJ), the Northeast and the United States (US). Results: The findings demonstrated that after the mandates’ implementation an increase in influenza vaccine coverage in NJ was observed in both data systems analyzed. Substantial gains in vaccination coverage were not observed in the US for other childhood vaccinations evaluated. Similarly, NJ did not see gains in MMR vaccine but some gains in coverage for PCV vaccine were observed. Overwhelming difference in rates of influenza- associated hospitalizations and influenza-associated deaths were not observed after the mandates’ implementation. Conclusion: The findings of this dissertation provide evidence that the mandate likely contributed to the increases in influenza vaccine coverage in New Jersey. While increases in vaccine coverage were noted, changes in rates of morbidity and mortality were not observed.Ph.D.Includes bibliographical referencesby Lisa McHug