1. C RITICAL O PPORTUNITIES FOR P UBLIC H EALTH L AW : FEDERAL MANDATE FOR SEASONAL INFLUENZA VACCINE FOR CHILDREN 6 MONTHS – 17 YEARS OLD Amy Hardenbergh, RN, BSN and Karen Garcia, RN, BSN University of Pennsylvania

2. A P ROBLEM Only 45.3% of children 6 months – 17 years old have received an influenza vaccination in the past 12 months. According to the CDC, those at high risk for developing flu-related complications, such as acute ear infections, include children younger than 2 years old. Each year, an average of 20,000 children under the age of 5 are hospitalized because of the flu. In the 2012-2013 flu season, there have been 154 pediatric deaths from influenza. 90% of child deaths reported in the 2012-2013 season were NOT vaccinated. The flu results in unnecessary days lost from work and school, doctor visits, hospitalizations and even deaths. According to the Philadelphia Board of Health, the seasonal influenza vaccine is NOT a requirement for children attending ANY K-12 school in the city.

3. W HERE D OES L AW F IT I N ? Federal Mandating of Flu Vaccines in Children is impeded by: Schools not regulating the influenza vaccination Parents’ beliefs about vaccines and the risk for autism The lack of attention brought to light concerning the amount of children hospitalized for the flu Making flu vaccines federally mandated for school children could fix these impediments.

4. E VIDENCE S UPPORTING THE R EFORM Magnitude of Effect Strength of Evidence - According to a new study reported in the journal, Vaccine, offering flu vaccine clinics at elementary schools could increase vaccination rates and reduce costs. -Direct and Indirect Costs of One Day Flu Clinics: $3.90 per dose -Direct and Indirect Costs of Pediatrician Offices: $19.26 per dose - Vaccination rates increased by 13.2% in children with access to school flu clinics. -Offering flu vaccine clinics at public schools allows for greater access. - If this proposed mandate is not passed, primary care practices may not have the capacity to keep up with the demand. An estimated 42 million additional patient visits would ensue during the flu season.

5. A W AY F ORWARD The main barriers to making flu vaccines for children a federal mandate are: - Parents’ beliefs about vaccines and their effects on children, such as autism. - Those who will use religious exceptions or illness as their excuse to opt out of the flu vaccine. Not everyone will always adhere to the rules if it’s made a mandate!