Massachusetts will require most students who are six months or older to get the flu vaccine this year as the state prepares to handle both Covid-19 and seasonal influenza this fall, the department of health said Wednesday in a statement.

The requirement applies to all students above six months old who are attending state child care, pre-school, kindergarten, grade school, colleges or universities. The state expects students to receive the vaccination by Dec. 31, 2020, the state said, unless the student provides a medical or religious exemption.

Home-schooled students and students at affected colleges and universities who live off campus for the semester are also exempt, the state said. However, college students who attend any activities on campus, "even once," must be vaccinated by Dec. 31, the state said.

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