Child Influenza Vaccination and Adult Work Loss: Reduced Sick Leave Use Only in Adults With Paid Sick Leave

Am J Prev Med. 2019 Feb;56(2):251-261. doi: 10.1016/j.amepre.2018.09.013. Epub 2018 Dec 17.


Introduction: Children are a population of interest for influenza. They are at increased risk for severe influenza, comprise a substantial portion of influenza morbidity, and significantly contribute to its transmission in the household and subsequent parental work loss. The association between influenza vaccination and work loss prevention, however, has rarely been studied, and the sparse existing literature has very limited generalizability to U.S. adults, thus requiring better characterization.

Methods: Using pooled National Health Interview Survey data (2013-2015, analyses conducted in 2018) nationally representative of working U.S. adults with household children (n=23,014), zero-inflated negative binomial regression examined the association of child influenza vaccination (exposure) with sick days (outcome) stratified by paid sick leave (no: n=10,741, yes: n=12,273).

Results: Child influenza vaccination was associated with significantly lower sick day usage, but only among adults with paid sick leave (prevalence rate ratio=0.79, 95% CI=0.67, 0.93), equating to average annual sick days of 4.07 vs 3.29 in adults with unvaccinated versus vaccinated household children (difference=0.78 fewer days annually).

Conclusions: Influenza vaccination of children is associated with reduced sick leave in household adults, helping to keep the workforce healthy and reduce influenza's costly annual economic burden. This only occurred among adults with paid sick leave, however, which is distributed inequitably by income, education, gender, occupation, and race/ethnicity. Health in All Policies considers downstream health effects of social and economic policy; the failure of federal policy to ensure paid sick leave likely contributes to propagating influenza and health inequities.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child, Preschool
  • Cross-Sectional Studies
  • Family Characteristics
  • Family Leave / economics
  • Family Leave / statistics & numerical data*
  • Family Leave / trends
  • Female
  • Humans
  • Influenza Vaccines / administration & dosage*
  • Influenza, Human / economics
  • Influenza, Human / prevention & control*
  • Male
  • Mass Vaccination / statistics & numerical data*
  • Middle Aged
  • Nutrition Surveys / statistics & numerical data
  • Parents
  • Sick Leave / economics
  • Sick Leave / statistics & numerical data*
  • Sick Leave / trends
  • Unemployment / statistics & numerical data
  • Young Adult


  • Influenza Vaccines