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Vaccination of Health Care Workers for Influenza – Health Order

Published:  December 5, 2019

 To:Sonoma County Health Care Providers, Hospitals, Skilled Nursing Facilities (SNFs) Residential Care Facilities for the Elderly (RCFEs), Residential Facilities for the Developmentally Disabled, and Dialysis Centers 
 From:Celeste Philip, MD, MPH, Health Officer
 Re:Requirement for Influenza Vaccination of Certain HealthCare Workers in Sonoma County

The 2019-2020 flu season is here. As healthcare leaders in Sonoma County, we need to continue our work to minimize the spread of communicable disease, provide outstanding health care for our citizens and keep our healthcare work force healthy. As Health Officer for Sonoma County, I am reissuing the Health Officer Order mandating certain health care facilities in Sonoma County implement programs that require their health care workers (HCWs) to receive an annual influenza vaccination. If they decline, they will be required to wear a mask during every influenza season while working in patient care areas.

For the purposes of this Order, influenza season is defined as November 1 to April 30. The order applies to hospitals, skilled nursing facilities (SNFs), residential care facilities for the elderly (RCFEs), residential facilities for the developmentally disabled, and dialysis centers. This Order is ongoing and applies to each influenza season unless the Order is rescinded or modified. In addition, I strongly recommend that health care workers in outpatient care and other health settings receive an annual influenza vaccination. 

Background Information

Influenza infection affected approximately 14% of the US population in 2017-2018 and led to an estimated 61,000 associated deaths, 810,000 associated hospitalizations and 21 million medical visits. HCWs are both at risk for influenza and can transmit the virus to their patients and coworkers. Vaccination of HCWs reduces HCW infection and absenteeism, prevents illness and mortality in their patients, and results in financial savings to families and to the health care system. A Healthy People 2020 objective targets a 90% seasonal influenza vaccination rate for all health care personnel. 

State law (CA Health & Safety Code §1288.7 and §5199 Aerosol Transmissible Diseases standard of Cal OSHA) requires that general acute care hospitals and certain employers offer influenza vaccination to employees. If employees decline vaccination, they are only required to sign a declination statement in lieu of vaccination. While compliance rates with these laws are high, actual HCW vaccination rates are not and may be below the level that will reduce the spread of infection in our health care facilities. Mandatory vaccination or masking policies have shown to increase HCW vaccination rates to above 95%.  

My goal is to protect both HCWs and patients from influenza disease, hospitalization and death by increasing rates of influenza vaccination of HCWs and reducing HCW-to-patient transmission of influenza and vice versa. 

Order

As the Health Officer for Sonoma County, I am requiring that each and every health care facility in Sonoma County, as specified below, implement a program requiring its health care workers to receive an annual influenza vaccination, and if they decline, to wear a mask for the duration of the influenza season while working in patient care areas of that health care facility. 

Duration

This order is ongoing and applies to each and every influenza season unless the Order is rescinded or modified. The influenza season is defined as November 1 through April 30 of the following year. In any given year, if surveillance data demonstrates an unusual time course, I may modify the period during which the masking requirement will apply for that season. 

Facilities Subject to the Order

This Order applies to hospitals, skilled nursing facilities, residential care facilities for the elderly, residential facilities for the developmentally disabled, and dialysis centers. 

Definition of a Health Care Worker

For the purpose of this Order, “health care workers” are persons, paid or unpaid, who work in the above specified health care facilities, and have direct patient contact or work in patient care areas. 

I thank you for your assistance in working with the Sonoma County Department of Health Services to make Sonoma County a healthier community.

To assist with your vaccination programs, see our Frequently Asked Questions page.

If you have questions, please call Emely Hernandez, Supervising PHN of Sonoma County Public Health Disease Control at (707) 565-4567

(signed) Celeste Philip, MD, MPH
Health Officer 
Department of Health Services 

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