Caring for Our Children (CFOC)

Chapter 7: Infectious Diseases

7.2 Immunizations

7.2.0 Immunization of Staff

Content in the STANDARD was modified on 02/25/2022.

To protect children and staff from vaccine-preventable diseases, early care and education staff should be up to date on all recommended immunizations, including annual immunizations (i.e., influenza). Programs should encourage staff members to work with their primary health care providers to ensure that they receive all program-required vaccines and other recommended vaccines based on their health status. Exclusion may be required for the duration of possible exposure or until they complete appropriate immunizations. Programs should require and maintain documentation of staff immunization records. Programs should require staff members who are not appropriately immunized for medical, religious, or philosophical reasons to provide written documentation of the reason.

  • All early care and education adult staff members should receive all vaccines routinely recommended for adults, in consultation with their primary health care provider, including:1
    • Annual influenza
    • Tdap/Td (tetanus, diphtheria, pertussis)
    • Varicella (chickenpox)
    • MMR (measles, mumps, and rubella)
    • Human papillomaviruses (HPV)
    • Zoster recombinant (shingles)
    • COVID-19
  • Other vaccines recommended, in consultation with their primary health care provider, if a specific risk factor is present:
    • Pneumococcal
    • Hepatitis A
    • Hepatitis B
    • Meningococcal
    • Haemophilus influenzae type B
  • Other vaccines as determined by the Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and state and local public health authorities as new vaccines are developed or in response to unexpected emergence of other diseases (e.g., the 2020 COVID-19 pandemic).1,2
  • Programs should seek health department guidance on temporary exclusion of unimmunized adults who are susceptible to a vaccine-preventable disease outbreak in a program.
Routine immunization is the best means of preventing vaccine-preventable diseases in children and adults. Vaccines, which are safe and effective in preventing these diseases, need to be used in adults to minimize disease and to eliminate potential sources of transmission.1–3 Because vaccine preventable diseases can be transmitted to children, staff members who do not receive recommended immunizations put at risk themselves, other staff, and children in their care. Immunization with Tdap that protects against pertussis (whooping cough) is especially important because adults often spread pertussis to vulnerable infants and young children. Staff members who receive an annual influenza (flu) vaccine help protect infants who are too young to receive the vaccine. Staff previously vaccinated for, or infected with, some infectious diseases (e.g., COVID-19, influenza, pertussis) can become reinfected and spread the illness to staff and children and may require additional vaccines. Although immunization for hepatitis A is not a routine recommendation, the disease may spread to staff in early care and education programs. Unless requested, vaccines for hepatitis A and B, pneumococcal, and meningococcal are recommended only for adults with high-risk conditions or who work in high-risk settings. 

For more information and up-to-date adult vaccine recommendations, visit the CDC website on immunizations and vaccines at and Vaccine Information for Adults: What Vaccines are Recommended for You, at,4 The CDC also has useful educational resources including fact sheets on adult immunization that may be shared with staff, at

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Pre-service Training Training on Occupational Risk Related to Handling Body Fluids Pre-Employment and Ongoing Adult Health Appraisals, Including Immunization Infectious Disease Outbreak Control Influenza Immunizations for Children and Staff Influenza Control Influenza Prevention Education
  1. Centers for Disease Control and Prevention. Recommended adult immunization schedule for ages 19 year and older: United States 2021. Web site. Last reviewed February 11, 2021. Accessed November 3, 2021. 
  2. Kroger A, Bahta L, Hunter P. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP) Web site. Updated May 4, 2021. Accessed November 3, 2021.

  3. Centers for Disease Control and Prevention. Vaccines & immunizations. Web site. Updated February 16, 2021. Accessed November 3, 2021.
  4. Centers for Disease Control and Prevention. What vaccines are recommended for you. Web site. Updated November 21, 2019. Accessed November 3, 2021.

  5. Centers for Disease Control and Prevention. Educating adult patients: Vaccination resources. Web site. Updated April 21, 2020. Accessed November 3, 2021.


Content in the STANDARD was modified on 02/25/2022.