Frequently Asked Questions about Influenza Vaccination

Why is the influenza vaccination and masking order needed?

Influenza vaccination protects health care workers (HCWs) and patients. Influenza is a serious disease that can cause severe illness, hospitalization, and death in people of all ages. The most effective method of preventing influenza infection is through vaccination. HCWs are at increased risk of exposure to influenza from ill patients. Infected HCWs can transmit influenza to patients and coworkers before they are symptomatic.

Does it make a difference?

After our first year of mandating these policies in Sonoma County, overall HCW flu vaccination rates in skilled nursing facilities (SNFs) increased from 59% to 85%. Mandatory influenza vaccination or masking policies have been found to significantly increase HCW vaccination rates in hospitals and large multi-hospital systems.

Which takes precedence, Sonoma County Health Officer Order or state laws regarding influenza and HCWs?

This Health Officer order is <u>in addition to</u>State laws regarding influenza and HCWs. California Health & Safety code §120175 authorizes Health Officers to control contagious, infectious, or communicable disease and may “take measures as may be necessary” to prevent and control the spread of disease within their jurisdiction. Facilities must comply with the Health Officer order as well as the applicable State laws regarding influenza vaccine and HCWs.

Can facilities impose additional requirements?

Yes. Facilities can develop their own policies specifying more rigorous requirements for their employees, but they must at a minimum, comply with the health officer order and state law.

How is this order different from an influenza vaccination declination policy?

State law currently requires that certain health care facilities offer influenza vaccination to employees. Employees that decline vaccination are only required to sign a declination statement. This Health Officer order strengthens this by requiring HCWs that decline influenza vaccination to wear a mask during influenza season.


Which facilities are affected by the mandatory influenza vaccination and masking order?

This Health Officer order applies to all Sonoma County hospitals, skilled nursing facilities, residential care facilities for the elderly, residential facilities for the developmentally disabled, and dialysis centers.

Who is considered a health care worker?

For the purposes 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. Health care organizations may wish to develop policies covering additional facilities or employees, such as ambulatory or other clinic staff.

When is influenza season?

For the purposes of this order, the influenza season is defined as the period of November 1 to April 30 of the following year. The Health Officer may extend the mandatory masking period if surveillance data demonstrate an unusually early or late peak of influenza activity and widespread disease.

What kind of mask should be used? When should masks be changed, replaced, or discarded?

The term “mask” in this order refers to a surgical mask. Please check with your facility about details of the implementation of this order including specifications of type of mask and how often to change masks.

What is considered a patient care area?

Please check with your facility about details of the implementation of this order including facility specific patient care areas.

Flu Vaccine

What kind of flu vaccine can HCWs receive?

There are multiple flu vaccines available with varying indications and ways to give them. There are inactivated vaccines, recombinant vaccines, and live attenuated vaccines, and two ways to give them: intramuscular (in the muscle– inactivated and recombinant vaccines only) or intranasal (nasal spray- live attenuated vaccine only). Most HCWs should be vaccinated in accordance with the normal guidelines for vaccine selection. Special considerations apply for HCW caring for immunosuppressed patients (see below).

What about HCWs taking care of immunosuppressed patients?

Health care workers who care for severely immunosuppressed patients (e.g. bone marrow transplant patients) who require a protective environment (e.g., a specialized patient-care area with a positive airflow relative to the corridor, high-efficiency particulate air filtration, and frequent air changes) should receive inactivated or recombinant vaccine. Nasal spray vaccine is an alternative option only if CDC lifts its’ recommendation against using the live attenuated vaccine and if the HCW will not work in the protective environment for a week after receiving the vaccine.

Should a HCW who is immune-compromised or has a chronic health condition (asthma, diabetes, etc.) receive influenza vaccine?

Yes, HCWs in these groups are considered a priority group that should get yearly influenza vaccinations as they are at greater risk of severe influenza illness and complications. HCWs in these groups should check with their primary care providers to determine which kind of flu vaccine they should get.

Should a HCW who is pregnant receive influenza vaccine?

Yes, the influenza shot is safe and should be given to pregnant women during any trimester. Pregnant women are another group that should be prioritized if vaccine supply is limited. Pregnant women and their newborn can benefit from influenza vaccination as both are at greater risk of severe influenza illness and complications. By California law (Health and Safety Code 124172), pregnant women should receive preservative-free influenza vaccine available as prefilled syringes and single dose vials.


Summary Recommendations – Prevention and Control of Influenza: https://www.cdc.gov/flu/professionals/acip/2018-2019/2018-19summary.htm

Full Report of Prevention and Control of Seasonal Influenza with Vaccines – Recommendations of the ACIP: https://www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm

Sample Influenza vaccine declination form: http://www.immunize.org/catg.d/p4068.pdf

Influenza vaccine information for HCW’s: http://www.cdc.gov/flu/healthcareworkers.htm

Educational posters for HCW’s:

Sonoma County Department of Health Services Resources Influenza page: http://sonomacounty.ca.gov/Health/Disease-Control/Influenza/ which contains:

  • Influenza Health Advisory
  • Health Officer Order - Vaccination of Health Care Workers for Influenza
  • FAQs on Mandatory Influenza Vaccination or Masking of HCW in Sonoma County

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Santa Rosa, CA 95404
38.441691, -122.713746

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