Parents will be required to get flu vaccinations for children attending day care or preschool in New Jersey beginning next September.

The new rule, approved yesterday by state Health Commissioner Fred M. Jacobs, confirmed a state Public Health Council vote Monday that amended immunization regulations to include four more childhood vaccinations.

Immunization against several other communicable diseases is already required for day care and preschool. Those children now must also get pneumococcal vaccine beginning at two months of age, and annual flu shots beginning at six months. "This is a public-health policy that is aimed at protecting children and the community at large," said Eddy Bresnitz, state epidemiologist and a deputy health commissioner.

Young children's immune systems are weak, making them vulnerable to communicable illnesses, experts said. Day-care centers and similar settings give such infections an opportunity to spread.

Nevertheless, dozens of people testified or wrote to the Public Health Council in opposition to the change, mainly over safety concerns.

Some said they believed that thimerosal - a mercury-containing preservative once used in vaccines - can trigger autism. Trace amounts can still be found in some. "Thimerosol-free preparations are available, and the trace amounts in some preparations are truly tiny, tiny, tiny, tiny, tiny, tiny, tiny amounts," said Craig Newschaffer, chair of the department of epidemiology and biostatistics at the Drexel University School of Public Health.

While recognizing that some parents are worried the shots trigger autism, he said, no scientific studies have found such a link. Not everyone trusts the research. "It is our feeling that parents have the right to make medical decisions for their families," said Sue Collins, a parent and leader of the New Jersey Alliance for Informed Choice in Vaccination.

"I don't want trace amounts of mercury in my body or my children's bodies under any circumstances," she said. "We know it is a dangerous toxin and yet we keep injecting it into our kids."

The new rules follow recommendations of the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention.

Pennsylvania uses the same guidelines, requiring day-care centers and preschools to show that children were immunized.

Both states allow exemptions based on medical and religious grounds, but not for "philosophical" reasons.

Widespread immunization dramatically lowered communicable diseases nationwide.

But some children still don't get the benefit, said Sarah S. Long, chief of infectious disease at St. Christopher's Hospital for Children. "We just had a baby die from pneumococcal meningitis," Long said. That child's death could have been avoided by immunization.

Health officials in New Jersey said the new rules are intended to prevent illnesses and deaths from avoidable diseases, including the flu.

"Flu is turning out to be a stealth killer," said Robert I. Field, chair of the department of health policy and public health at the University of the Sciences in Philadelphia.

"Seasonal flu, which most people can shrug off as an inconvenience for a week or two, is truly a threat to people at high risk, particularly the very old, the very young, and those with compromised immune systems."

Federal vaccine guidelines and New Jersey's mandate: http://go.philly.com/healthEndText