Influenza Vaccination Honor Roll

Mandatory Influenza Vaccination for Healthcare Personnel

About the Honor Roll

The best way to prevent the transmission of influenza to patients is to require the vaccination of healthcare personnel. The Influenza Vaccination Honor Roll recognizes the champions who have taken the lead in requiring influenza vaccination within their organization or institution.

Criteria for Inclusion

To be included in’s Influenza Vaccination Honor Roll:

  • You must require influenza vaccination for employees.
  • You must include serious measures to prevent the transmission of influenza from unvaccinated workers to patients.

Such measures might include a mask requirement, reassignment to nonpatient-care duties, or dismissal of the employee.

Apply for the Influenza Vaccination Honor Roll

See current honorees

Position Statements

Leaders in medicine and infectious diseases have spoken: Requiring influenza vaccination for all healthcare personnel is imperative!

Use these position statements from leading medical organizations to help guide you in developing and implementing a required influenza vaccination policy at your healthcare institution or medical setting.

Influenza Immunization for All Health Care Personnel: Keep It Mandatory

Released: October 2015

The purpose of this statement is to reaffirm the American Academy of Pediatrics’ support for a mandatory influenza immunization policy for all healthcare personnel. With an increasing number of organizations requiring influenza vaccination, coverage among healthcare personnel rose to 75% in the 2013–2014 influenza season but still remains below the Healthy People 2020 objective of 90%. Mandatory influenza immunization for all healthcare personnel is ethical, just, and necessary to improve patient safety. It is a crucial step in efforts to reduce healthcare–associated influenza infections.

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Policy on Patient Safety and Healthcare Provider Immunization

For the safety of the individual healthcare provider, fellow healthcare providers, and the patients we serve, all healthcare providers should be immune to, or have received appropriate immunizations at the intervals recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, against the following transmissible infectious diseases, unless a medical contraindication exists or a religious objection to immunization exists:

  • Diphtheria
  • Influenza
  • Hepatitis B
  • Measles/Mumps/Rubella
  • Pertussis
  • Varicella

In 2010, the Board of Regents endorsed the following patient safety and quality-of-care initiative: An annual influenza vaccine should be required for every healthcare provider with direct patient care activities, unless a medical contraindication to influenza immunization exists or a religious objection to immunization exists.

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Released: December 2013

Policy Statement on Influenza Vaccination of Healthcare Personnel

AMDA supports a mandatory annual influenza vaccination for every long-term healthcare worker who has direct patient contact unless a medical contraindication or religious objection exists.

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Effective Date: August 9, 2018

Position Statement on Immunizations

All healthcare personnel, including registered nurses, should be vaccinated according to current recommendations for immunization of healthcare personnel by CDC and the Association for Professionals in Infection Control and Epidemiology.

ANA supports exemptions from immunization only for the following reasons:

  1. Medical contraindications
  2. Religious beliefs

All requests for exemption from vaccination should be accompanied by documentation from the appropriate authority to support the request. Individuals who are exempted from vaccination may be required to adopt measures or practices in the workplace to reduce the chance of disease transmission. Employers should ensure that reasonable accommodations are made in all such circumstances.

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Released: July 21, 2015

Policy Statement: Annual Influenza Vaccination Requirements for Health Workers

Key Points:

  • Urges providers, employers, and other organizations to implement comprehensive infection control programs that include vaccination requirements along with vaccination training and education, respiratory protection, standard respiratory precautions, and housekeeping routines in keeping with infection control standards
  • Emphasizes that vaccination of health workers is important not only for patient safety but also for their own protection and calls for strengthening both the health sector’s commitment to safe working environments and its capacity to achieve national goals for protecting the health workforce from influenza through education and convenient access to employer-provided vaccination
  • Strongly recommends that institutions that train health professionals, deliver health care, or provide laboratory or other medical support services require immunizations for personnel at risk for contracting or transmitting vaccine-preventable illnesses
  • Encourages institutional, employer, and public health policy to require influenza vaccination of all health workers as a precondition of employment and thereafter on an annual basis, unless a medical contraindication recognized in national guidelines is documented in the worker’s health record. An educational component should be created for health workers to learn about vaccine safety science.

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Policy date: November 9, 2010

The APIC Advocacy Agenda: Mandatory Healthcare Personnel Influenza Vaccination

APIC supports efforts by legislators to encourage acute care hospitals, long‐term care, and other facilities that employ healthcare personnel to require an annual influenza immunization as a condition of employment unless there are evidence‐based medical contraindications.

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Released: November 2016

IDSA, SHEA, and PIDS Joint Policy Statement on Mandatory Immunization of Health Care Personnel According to the ACIP-Recommended Vaccine Schedule

IDSA, SHEA, and PIDS support universal immunization of healthcare personnel by healthcare employers as recommended by the Advisory Committee on Immunization Practices of CDC for healthcare personnel.

Although some voluntary healthcare personnel vaccination programs have been effective when combined with strong institutional leadership and robust educational campaigns, mandatory immunization programs are the most effective way to increase healthcare personnel vaccination rates. As such, when voluntary programs fail to achieve immunization of at least 90 percent of personnel, we support healthcare employer policies that require healthcare personnel documentation of immunity or receipt of ACIP-recommended vaccinations as a condition of employment, unpaid service, or receipt of professional privileges.

For healthcare personnel who cannot be vaccinated due to medical contraindications or because of vaccine supply shortages, healthcare employers should consider, on a case-by-case basis, the need for administrative and/or infection control measures to minimize risk of disease transmission (e.g., wearing masks during influenza season or reassignment away from direct patient care).

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Revised: December 2013

Influenza Vaccinations for Healthcare Personnel Policy

NACCHO urges healthcare employers and local health departments to require influenza vaccination for all staff as a condition of employment. This mandate is necessary to achieve the Healthy People 2020 annual goal of 90% influenza vaccine coverage for healthcare personnel.

NACCHO stresses the importance of implementing prevention strategies that will reduce the spread of influenza infection among healthcare personnel and their clients to decrease the burden on the overall healthcare system.

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Implementation date: November 2012, updated January 2017

Mandatory Flu Vaccinations for Healthcare Workers

The NPSF recognizes vaccine-preventable diseases as a matter of patient safety and supports mandatory influenza vaccination of healthcare workers to protect the health of patients, healthcare workers, and the community. NPSF appreciates that where vaccination is not possible for any reason, due to unavailability or medical contraindications of potential vaccine recipients, hospitals and healthcare professionals must use all available alternatives to avoid transmission to patients and coworkers, including use of masks and adjustment of job responsibilities.

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Released: November 18, 2009; reissued November 12, 2015

Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel

SHEA views influenza vaccination of healthcare personnel as a core patient and healthcare personnel safety practice with which noncompliance should not be tolerated. We believe that it is the professional and ethical responsibility of healthcare personnel and the institutions within which they work to prevent the spread of infectious pathogens to their patients by following evidence‐based infection prevention practices.

Just as healthcare personnel would not be allowed to participate in a surgical procedure without first performing an appropriate surgical hand scrub or wearing appropriate sterile attire, failure to perform a basic patient safety intervention, such as influenza vaccination, is unacceptable. Therefore, for the safety of patients and healthcare personnel, SHEA endorses a policy in which influenza vaccination is an ongoing condition of healthcare personnel employment, unpaid service, or receipt of professional privileges.

The implementation of this policy should be part of a multifaceted, comprehensive influenza infection control program; it must have full, visible leadership support with the expectation for influenza vaccination fully and clearly communicated to all existing and applicant healthcare personnel, and it must have ample resources and support to implement and to sustain the program.

This recommendation applies to all healthcare personnel working in all healthcare settings, regardless of whether they have direct patient contact or whether they are directly employed by the facility. It also applies to all students, volunteers, and contract workers. SHEA recommends that only exemptions due to recognized medical contraindications to influenza vaccination be considered.

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Released: August 31, 2010; revised October 2010

Seasonal Influenza Prevention Program for VHA Healthcare Personnel

To prevent and control seasonal influenza and its associated complications, the Veterans Health Administration requires a policy and implementation guidance that will ensure VHA achieves the Department of Health and Human Services Healthy People 2020 goal and The Joint Commission standard of annual seasonal influenza vaccination of 90 percent of healthcare personnel.

This directive articulates the VHA policy requiring all healthcare personnel to participate in the seasonal influenza prevention program and outlines the key implementation steps. Healthcare personnel covered by the policy are expected to receive annual influenza vaccination. Those who are unable or unwilling to be vaccinated are required to wear a face mask throughout the influenza season.

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Released: September 26, 2017

Journal Articles and Editorials

Declines in Influenza Vaccination Coverage Among Health Care Personnel in Acute Care Hospitals During the COVID-19 Pandemic — US, 2017-2023
MMWR (November 10, 2023)
Population Mortality and Laws Encouraging Influenza Vaccination for Hospital Workers
Annals of Internal Medicine (Jan. 2021)
Influenza Vaccination in Health Care Workers
Infectious Disease Special Edition (Fall 2019)
Association of State Laws with Influenza Vaccination of Hospital Personnel American
Journal of Preventive Medicine (June 2019)
Changes in Influenza Vaccination Requirements for Health Care Personnel in U.S. Hospitals
JAMA Network Open (June 2018)
Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism during Multiple Respiratory Virus Seasons
Infection Control and Hospital Epidemiology (April 2018)
Influenza Immunization for All Health Care Personnel: Keep It Mandatory
Pediatrics (October 2015)
Qualitative Evaluation of Rhode Island’s Healthcare Worker Influenza Vaccination Regulations
Vaccine (Oct. 14, 2014)
A Systematic Review of Mandatory Influenza Vaccination in Healthcare Personnel
American Journal of Preventative Medicine (September 2014)
Managing the Human Toll Caused by Seasonal Influenza: New York State’s Mandate to Vaccinate or Mask
Commentary by Arthur Caplan, PhD, et al., JAMA (October 2013)
Morality of Influenza Vaccine Mandates
Commentary by Arthur Caplan, PhD, Clinical Therapeutics (February 2013)
Video Commentary by Arthur L. Caplan, PhD: Why Hospital Workers Should Be Forced to Get Flu Shots
Medscape (Sept. 13, 2012)
Voluntary to Mandatory: Evolution of Strategies and Attitudes towards Influenza Vaccination of Healthcare Personnel
Infection Control and Hospital Epidemiology (Jan. 2012)
Institutional Requirements for Influenza Vaccination of Healthcare Personnel: Results from a Nationally Representative Survey of Acute Care Hospitals – United States, 2011
Clinical Infectious Diseases
Increases in Vaccination Coverage of Healthcare Personnel following Institutional Requirements for Influenza Vaccination: A National Survey of U.S. Hospitals
Time to Mandate Influenza Vaccination in Health-Care Workers
Perspective by Arthur Caplan, PhD, The Lancet
Vaccinating Health Care Workers against Influenza: The Ethical and Legal Rationale for a Mandate
American Journal of Public Health (February 2011)
Mandatory Influenza Vaccination of Health Care Workers: Translating Policy to Practice
Clinical Infectious Diseases
Mandatory Influenza Vaccination of Healthcare Workers: A 5-Year Study
Infection Control and Hospital Epidemiology
On Being First: Virginia Mason Medical Center and Mandatory Influenza Vaccination of Healthcare Workers
Editorial by Thomas R. Talbot, MD, MPH, et al., Infection Control and Hospital Epidemiology
Mandating Influenza Vaccination for Health Care Workers: Putting Patients and Professional Ethics over Personal Preference
Editorial by Gregory A. Poland, MD, MACP, FIDSA, Vaccine
Mandate to Protect Patients from Health Care-Associated Influenza
Commentary by Andrew T. Pavia, MD, FIDSA, Clinical Infectious Diseases
Mandatory Influenza Vaccination of Health Care Workers: Translating Policy to Practice
Clinical Infectious Diseases
Requiring Influenza Vaccination for Healthcare Workers: Seven Truths We Must Accept

Websites and Toolkits

National Adult and Influenza Immunization Summit logo.
National Adult and Influenza Immunization Summit (NAIIS)

Recommendations and requirements for vaccination of healthcare personnel and links to useful toolkits and related resources to get the job done!

CDC, Centers for Disease Control and Prevention logo.

This toolkit outlines how important vaccination is for healthcare personnel. It also provides tools needed to increase coverage and outlines additional tools you may want to add to monitor vaccination in your facility.

Immunity Community logo.
Immunity Community

This toolkit is designed to help healthcare organizations promote influenza and Tdap (tetanus, diphtheria, pertussis) immunization for their employees.

Colorado Hospital Association logo.
Colorado Hospital Association (CHA)

Guidance and an overview on developing mandatory influenza vaccination programs at your facility.

Government Mandates

Department of Veteran Affairs, Veterans Health Administration (VHA)

This directive articulates the VHA policy that all healthcare personnel are expected to receive annual influenza vaccination. Those unable or unwilling to be vaccinated are required to wear a face mask throughout the influenza season.

Implementation Date: September 26, 2017


Indian Health Service Policy for Mandatory Seasonal Influenza Immunizations for Civilian Health Personnel

Indian Health Service, an agency within the Department of Health and Human Services that provides healthcare to American Indians and Alaska Natives, requires mandatory seasonal influenza immunizations for civilian health personnel.

Implementation Date: July 28, 2016


U.S. Department of Defense: Policy for Mandatory Influenza Vaccination

Requirements for civilian healthcare personnel who provide direct patient care in Department of Defense military treatment facilities.

Implementation Date: April 4, 2008

North Bay Parry Sound District Health Unit, North Bay, Ontario, Canada

All healthcare workers, as well as clerical and janitorial staff, must receive influenza vaccine or face dismissal. Exemption to immunization is only allowed for valid medical contraindications. After 2005, it is a condition of employment to have the influenza vaccine. Failure to do so without a National Advisory Committee on Immunization–approved medical contraindication or precaution will result in dismissal (there is no option for antiviral medication). Those hired before 2005 can opt for antivirals. If they refuse, they are suspended without pay.

Implementation date: October 2005


Peterborough County – City Health Unit, Ontario, Canada

Since 2002, mandatory immunization for influenza is included in the terms of employment, which a new employee signs. For new hires, exemption to immunization is only allowed for valid medical contraindications. In addition, we do allow for conscientious objection, but that is only for the staff who were hired before 2002. For staff hired before 2002, those who are not vaccinated must take antivirals to keep working in their assigned jobs, or they are reassigned to non-patient care duties and/or take holidays. For staff hired after 2002, they will be suspended without pay until they comply with the policy. Noncompliance could be grounds for dismissal.

Implementation date: 2002

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