Mandatory Influenza Vaccination or Masking of Healthcare Personnel During Flu Season

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Page last updated 10/30/2025

All healthcare personnel (HCP) are at risk for both contracting influenza (flu) and transmitting the virus to their patients. The County of San Diego Public Health Officer has issued an Order requiring:

  • HCP and emergency medical responders to receive an annual flu vaccination, or
  • Wear a mask for the duration of the flu season while in contact with patients or working in patient care areas if they decline. 

This order was issued on November 4, 2014, and updated (November 1, 2017, and October 29, 2024) to include additional sectors (including emergency medical service responders and other healthcare professionals).

  • This order is enforceable, and noncompliance may carry financial penalties on facilities that do not achieve a 90% vaccination rate.

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Flu Season

In the United States, flu season occurs in the fall and winter. While influenza viruses circulate throughout the entire year, most of the time flu activity peaks between December and February, but activity can last as late as May. See Respiratory Viruses Data and Reports for local surveillance information on respiratory viruses, including COVID-19, flu, and respiratory syncytial virus (RSV).

  • Persons with chronic medical conditions, infants and children, seniors, and pregnant women are at greater risk for severe influenza-related illnesses and deaths. 
  • All HCP are both at risk for contracting influenza and transmitting to patients, including those in high-risk areas such as intensive care units, oncology wards, and emergency departments.

Influenza in healthcare settings leads to increased staff absences, reduced productivity, and higher healthcare costs.

  • Up to 25% of HCP are infected with influenza each season.
  • Many HCP may work while ill, increasing the risk of spreading flu in healthcare settings.
  • Around 50% of infected individuals may be asymptomatic yet still shed and transmit the virus for 5-10 days.
  • Influenza acquired during hospitalization (nosocomial flu) increases patient mortality and length of stay.

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HCP’s Role in Preventing the Spread of Flu in Healthcare Settings

Vaccinations of HCP protect patients and can lead to decreased illness among personnel and staff absenteeism.  

 

  • Exemptions: Healthcare workers maybe exempt from vaccination if they provide their employer or facility with documentation from their medical provider of an Advisory Committee on Immunization Practices (ACIP) recognized medical contraindication to both inactivated and live attenuated vaccines. 
    • These individuals must still wear a mask during flu season.
  • Definitions
    • Healthcare Personnel (HCP) includes as all persons, including paid and unpaid employees, contractors, students, and volunteers, who work in areas where patient care is provided in a licensed or unlicensed facility, or who, otherwise, have direct contact with patients at such a facility
      • This includes, but is not limited to, physicians (e.g., in private practice or healthcare systems), nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, laundry, security, maintenance, administrative, billing, and volunteers) not directly involved in patient care, but potentially exposed to infectious agents that can be transmitted to and from healthcare workers and patients.
      • Physicians who are licensed independent practitioners are also considered healthcare personnel, as are employees of nursing homes and chronic care facilities, students in those professions, volunteers, and ancillary personnel who provide services within six feet of a patient.
    • Emergency medical service (EMS) personnel include paramedics, emergency medical technicians (EMTs), and advanced EMTs. 
    • Healthcare Facility includes licensed and unlicensed acute care hospitals, long-term care and skilled nursing facilities, ambulatory and community clinics, EMS agencies and other facilities in San Diego.

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Call the Immunization Unit at (866) 358-2966, or send an email, for more information.