Order of the Sonoma County Health Officer: Mandatory Influenza Vaccination of Specified Healthcare Staff

Published:  November 10, 2020

En español

To: Sonoma County Hospitals, Clinics, Medical Offices, Skilled Nursing Facilities and Residential Care Facilities for the Elderly, Hospice, Home Health Agencies, and other Health Facilities

RE: Mandatory Influenza Vaccination of Staff at Health Care and Specified Congregate Facilities

As Sonoma County works to reduce transmission of SARS-CoV-2 (also referred to as "COVID-19), influenza season is approaching. The co-occurrence of influenza season and the COVID-19 pandemic increases the risk that our health systems may be overwhelmed with patients with critical respiratory illness. An effective vaccine against COVID-19 is not anticipated until early next year, at the earliest. Influenza is preventable with a vaccine that is currently available. Influenza vaccination has long been accepted as a safe and effective way to prevent millions of illnesses and thousands of related doctor and hospital visits every year.

Since at least 2017, Sonoma County has required that all health care facilities establish an influenza vaccination program requiring that all health care workers providing direct patient care receive an annual influenza vaccine or wear a mask. The Order applied to every influenza season thereafter.

This year, Sonoma County Public Health is expanding the order to require that all health care and specified congregate care facilities establish an influenza vaccination program requiring all staff receive an annual influenza vaccination. We strongly recommend it for EMS Providers and all congregate care facilities.

Legal Authority:

The Health Officer has the authority to "take measures as may be necessary to prevent and control the spread of disease within the territory under their jurisdiction" (Health and Safety Code §120175). State law requires that general acute care hospitals and certain other health care facilities offer influenza vaccination to employees and, for those employees who decline vaccination, maintain a record of the signed declination form (Health and Safety Code §1288.7; CA Code of Regulations §5199 Aerosol Transmissible Diseases).


All health care and specified congregate facilities in Sonoma County must implement an influenza vaccination program requiring all staff to receive an annual influenza vaccination.


This order is ongoing and applies to each future influenza season unless modified, suspended, or rescinded. Influenza season starts November 1, 2020 and ends May 1, 2021. If influenza surveillance shows unusually early and/or late peaks, the order may be extended.

Staff Subject to the Order:

This order applies to all persons, paid or unpaid, who work for the facilities subject to the order.

Facilities Subject to the Order:

This order applies to all health care and specified congregate facilities in Sonoma County, including but not limited to hospitals, skilled nursing and other long-term care facilities, outpatient medical clinics, hospice, and home health agencies.

Exceptions and Accommodations:

Facility mandatory flu vaccination programs may allow for a medical exemption. Medical exemptions must be based upon a written recommendation from the primary health care provider that the person should be medically exempted from receiving an influenza vaccination. Facility mandatory flu vaccination programs may also allow requests for accommodation based on disability or religious belief consistent with the facility's policies and procedures for reasonable accommodation. If a facility grants accommodation due to religious belief or disability, the facility shall provide aggregate data to Sonoma County Public Health every month indicating the number or percentage of accommodations granted.

For any additional questions, please contact Sonoma County Public Health, Disease Control Unit, a PHNurse@sonoma-county.org or (707) 565-4567.

Thank you for your role in flattening the curve and protecting our county’s most vulnerable residents. 


Dr. Sundari Mase, MD MPH
Sonoma County Health Officer

Dated: November 10, 2020



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