Immunizations for Child Care Workers

Keeping kids healthy is a priority for parents, child care providers and communities alike, but sometimes it can be challenging. Schools and child care centres are settings where infectious diseases can be spread because children eat, play and learn close together and can easily spread germs to one another. Child care workers are also at risk for several diseases because of the close contact they have with children. Child care workers who are ill can also spread infectious diseases to young children. While not all diseases can be prevented, many can be through vaccination. Keeping vaccinations up-to-date is important for everyone.

In Ontario, the Child Care and Early Years Act (CCEYA) protects children from vaccine-preventable diseases that can be spread in child care centres. As per the Act, children in Ontario require certain vaccines to attend licensed child care centres, or they require a valid exemption for religious, conscientious or medical reasons. Likewise, prior to commencing employment, child care workers who will be working in licensed child care centres are required to be up to date with immunizations as recommended by the local medical officer of health or have a valid exemption.

Recommended immunizations for child care workers

Vaccine Required documentation*

Tetanus, Diphtheria, Pertussis (Tdap)

Tetanus is naturally occurring in the soil.

Pertussis, also called the “100-day cough” is very dangerous to young infants.

Documented one dose of Tdap as an adult, then Td vaccine booster every 10 years

Measles, Mumps, Rubella (MMR)

Measles is very contagious and can spread through the air even after the infectious person has left the room.

Documented 2 doses

OR

Proof of immunity (if born in 1969 or earlier or a blood test)

Varicella (chickenpox)

Chickenpox can spread through the air days before the rash is present. It can lead to severe complications.

Documented 2 doses given at least 6 weeks apart

OR

Proof of immunity (self-reported history of chickenpox or a blood test)

Hepatitis B

People with hepatitis B may not show symptoms but can spread the virus through body fluids.

For personal protection, all staff should be vaccinated.

Documented 2-4 dose series (as a child or adult)

OR

Proof of immunity

Some may have received this vaccine in infancy, or as a combination hepatitis A/B vaccine for travel (e.g., Twinrix)

*or a valid exemption (see below)

Vaccines and immunity testing strongly encouraged by the medical officer of health

Vaccine Required documentation

Seasonal influenza

  • Annual influenza (flu) vaccination is recommended for everyone.
  • Children less than 5 years of age are at high risk of influenza-related complications.
  • Influenza vaccine is also imprtant for staff who have chronic health conditions.
Annual vaccination, no documentation required

Hepatitis A

  • Hepatitis A is a virus that is shed in the stool. It is spread person-to-person by the fecal-oral route.
  • Children who have hepatitis A often don’t show symptoms. Changing diapers means hepatitis A could spread to staff.
  • Food handlers with hepatitis A infection who do not wash their hands after having a bowel movement can spread the virus to others through food preparation.

Two or three** dose series, no documentation required.

**Three-dose series if given as a combined hepatitis A/B vaccine

Additional recommendations for women of childbearing age

Immunity testing for:

  • Cytomegalovirus (CMV)
  • Rubella (German measles)
  • Parvovirus B19 (Fifth disease)
  • Varicella (chickenpox)

Exemptions from immunization

Child care workers seeking exemptions from vaccination for religious, conscientious or medical reasons must submit to their employer one of the Ministry of Education exemption forms. The operator must collect and maintain the infomation on file at the child care centre for review by a Ministry of Education licensing officer. These forms are not collected by Public Health.

Name of Form Requirements
Statement of Conscience or Religious Belief Must be signed by a Commissioner for Taking Affidavits
Statement of Medical Exemption Must be signed by a healthcare provider and include their license or registration number

Exclusion of unvaccinated staff

If there is an outbreak of a vaccine-preventable disease, Public Health may require that an employee who is not adequately immunized (including those with exemptions) be excluded from working at the child care program until the outbreak is over. It is recommended that staff who are not vaccinated (including those with exemptions) sign a document that clearly outlines the actions that your program will take in regards to employment (e.g., unpaid leave, paid time off, reassignment) in the event of an outbreak of a vaccine-preventable disease at the child care facility.

Tuberculosis screening

Tuberculosis screening is no longer required for staff working in licensed child care settings.