The U.S. Department of Health and Human Services this week removed the influenza shot—along with five others—from the list of recommended vaccines for all children, an announcement that surprised some school health leaders as it comes during a particularly brutal flu season.
Vaccines against the measles, polio, whooping cough, and others remain recommended for all children. But the annual flu shot is now included in a separate group of shots—alongside those that protect against meningitis and Hepatitis A and B—that are recommended only after consultation with a health care provider—a designation the federal government is calling “shared clinical decisionmaking.”
The change is likely to lead to confusion and an added burden for schools both in the short and long term as families decipher the guidance and some opt not to receive shots that help prevent outbreaks of common respiratory illnesses including influenza, COVID-19, and RSV, said Lynn Nelson, president of the National Association of School Nurses.
No longer recommending the annual flu shot to all might have the most immediate effect on schools, she said.
“The flu shot has always been optional, but to sow those seeds of doubt with parents just feels so irresponsible, especially in a season like this one where the flu is more contagious and making more people sick,” Nelson said.
Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement that the new vaccine schedule “protects children, respects families, and rebuilds trust in public health.”
The U.S. Centers for Disease Control and Prevention estimates that there have been at least 11 million illnesses, 120,000 hospitalizations, and 5,000 deaths from the flu so far this season, which runs through the fall and winter and typically peaks between December and February. Nine of the deaths have been among children, including one during the week that ended Dec. 27, according to the most recent CDC data.
Forty-eight states are reporting high or very high flu levels, according to the CDC.
Last year’s flu season was also considered severe—by some measures the most intense in 15 years.
Experts have warned the number of cases could continue to rise with the return to school after the holiday break.
Some schools in Kansas, New Hampshire, North Carolina, Ohio, Texas, and Minnesota either temporarily switched to online classes or closed buildings for at least one day in late December as the number of local flu cases among students surged.
One likely factor contributing to the increase in flu cases is that there has been a decline in flu vaccinations in recent years, Nelson said. That’s true even as public health experts have said this year’s vaccine doesn’t appear to match the predominant strain of the flu that is circulating.
Still, vaccines are effective at ensuring those who become infected do not become as severely ill or experience complications such as pneumonia that can land people in the hospital.
And for kids, there is evidence that even mismatched vaccines can protect them from contracting the flu in the first place, Nelson said, citing small research studies.
What schools can do to slow the spread
To help slow the spread of flu and other respiratory illnesses, schools should send reminders to parents via email or newsletters about when it’s necessary to keep kids home from school—if they have a fever, vomit, or have diarrhea, for example—and remind them it’s important to not send their children if they have symptoms of contagious illnesses, Nelson said.
Schools should develop and frequently share clear guidelines with parents, especially during cold and flu season, she said.
And if parents have questions about the updated federal childhood vaccination guidelines, schools could direct them to their child’s pediatrician for guidance, Nelson said.
“Those partnerships and ensuring families feel like they can ask questions and get support will be very important,” she said.
Schools should also remind teachers to take sick time if they need to and have substitutes at the ready to fill in.
Teachers are both uniquely vulnerable to, and can have more resilience to, seasonal bugs than the general population. They face a mountain of stress, which can reduce their immune system’s ability to ward off illnesses, and they’re exposed to all kinds of bugs in the classroom.
Compared with professionals in other fields, teachers are more likely to work through illness—and many teachers also say they don’t feel empowered to take their available sick leave.
Teachers should ensure they’re up to date with routine vaccinations and take a little extra time to clean frequently touched surfaces in their classrooms.
