State Immunization Laws for Healthcare
Workers and Patients

Immunization Administration Requirements For
Hospital Employees (Influenza)

** Click on each result to read the abridged text of the state immunization law.

States	Hospital Employees	Medical (M), Religious (R), or Philosophical (P) Exemptions
AL	Ensure[21]	No
AK	No	Yes – (M)[27]
AZ	No	No
AR	No	No
CA	Offer[505]	No
CO	Ensure[565]	Yes – (M)[567]
CT	No	No
DC	No[63]	No
DE	No	No
FL	No	No
GA	Offer[569]	No
HI	No	No
ID	No	No
IL	Offer[85]	No
IN	No	No
IA	No	No
KS	No	No
KY	No	No
LA	No	No
ME	Offer[116]	Yes – (M)[119], (R)[120] & (P)[121]
MD	Offer[559]	Yes – (M)[124] & (R)[125]
MA	Offer[555]	No
MI	No	No
MN	No	No
MS	No	No
MO	No	No
MT	No	No
NE	Offer[560]	No
NH	Ensure[146]	Yes – (M)[148] & (R)[149]
NJ	No	No
NM	No	No
NY	No	Yes – (M)[177]
NV	No[190]	No
NC	No	No
ND	No	No
OH	No	No
OK	Offer[558]	No
OR	No[221]	No
PA	No	No
RI	Offer[235]	Yes – (M)[237]
SC	No	No
SD	No[573]	No
TN	Offer[512]	No
TX	No[574]	No
UT	No	No
VT	No	No
VA	No[286]	No
WA	No	No
WV	No	No
WI	No	No
WY	No	No

[21] For Alabama requirements, see Ala. Admin. Code r. 420-5-7-.04, requiring each hospital to establish vaccination requirements for employees that are consistent with current recommendations from the Federal Centers for Disease Control and Prevention and the Federal Occupational Safety and Health Administration (at a minimum to require annual influenza vaccinations). These requirements apply only to those facilities covered by Alabama’s definition of a hospital, defined in Ala. Admin. Code r. 420-5-7-.04 as a health institution planned, organized, and maintained for offering to the public generally facilities and beds for use in the diagnosis and/or treatment of illness, disease, injury, deformity, abnormality or pregnancy, when the institution offers such care or service for not less than 24 consecutive hours in any week to 2 or more individuals not related by blood or marriage to the owner and/or chief executive officer/administrator.
[27] For Alaska requirements, see Alaska Admin. Code tit. 7 § 12.650 for medical exemptions to rubella administration requirements set forth in Alaska Admin. Code tit. 7 § 12.650. Alaska Admin. Code tit. 7 § 12.650 provides that immunization requirements may be waived if a physician signs a certificate that there are medical reasons which dictate that an employee should not be vaccinated against rubella.
[63] For D.C., no regulation or statute specifically refers to vaccination against influenza for hospital employees. However, note 22 DCMR § B2017.10, requiring that immunization against communicable disease shall be required of all employees and all other persons who routinely come into contact with patients or patient areas. This regulation only applies to those institutions meeting the definition of “hospital” set forth in 22 DCMR § 2099.
[85] For Illinois requirements, see Ill. Admin. Code tit. 77, § 956.30 relating to “influenza vaccination”. Ill. Admin. Code tit. 77, § 956.30 provides that beginning with the 2010 to 2011 influenza season, each health care setting shall ensure that all health care employees are offered the opportunity to receive seasonal, novel, and pandemic influenza vaccine during the influenza seasons (between September 1 and March 1 of each year), unless the vaccine is unavailable. Healthcare employees who decline vaccination for any reason shall sign a statement declining vaccination and certifying that he or she received education about the benefits of influenza vaccine. Ill. Admin. Code tit. 77, § 956.10 defines a “health care setting” as including, among others, hospitals as defined in the Hospital Licensing Act.
[116] For Maine requirements, see Code Me. R. § 10-144-264(2), relating to “Designated Healthcare Facilities.” Code Me. R. § 10-144-264(2) provides that Designated Healthcare Facilities shall adopt a policy that recommends and offers annual immunizations against influenza to all personnel who provide direct care for residents of the facility. No chief administrative officer may permit any employee to be in attendance at work without a certificate of immunization for each disease or other acceptable evidence of immunity to each disease, or documentation of exemption or declination. “Designated Healthcare Facilities” are defined in Code Me. R. § 10-144-264(1) as a licensed nursing facility, residential care facility, intermediate care facility for the mentally retarded, multi-level health care facility, hospital, or home health agency.	Top of Page
[119] For Maine, for medical exemptions to the immunization requirements of Code Me. R. § 10-144-264(2), see Code Me. R. § 10-144-264(3), providing that an employee who does not meet the immunization/immunity requirement may be permitted to attend work where the employee presents to the Designated Healthcare Facility a physician’s written statement that immunization against one or more of these diseases is medically inadvisable. If the statement does not include all the diseases, the employee must meet the immunization/immunity requirements for any diseases not covered by the statement
[120] For Maine, for religious exemptions to the immunization requirements of Code Me. R. § 10-144-264(2), see Code Me. R § 10-144-264(3), providing that an employee who does not meet the immunization/immunity requirement may be permitted to attend work where the employee states in writing an opposition to immunization because of a sincere religious belief or for philosophical reasons.
[121] For Maine, for philosophical exemptions to the immunization requirements of Code Me. R. § 10-144-264(2), see Code Me. R. § 10-144-264(3), providing that an employee who does not meet the immunization/immunity requirement may be permitted to attend work where the employee states in writing an opposition to immunization because of a sincere religious belief or for philosophical reasons.
[124] For Maryland, for medical exemptions to the immunization requirements of MD. Regs. Code tit. 10, § 06.01.12 (regarding rubeola) and MD. Regs. Code tit. 10, § 06.01.15 (regarding rubella), see MD. Regs. Code tit. 10, § 06.01.12 and MD. Regs. Code tit. 10, § 06.01.15. MD. Regs. Code tit. 10, § 06.01.12 and MD. Regs. Code tit. 10, § 06.01.15 provide that a hospital shall grant a medical exemption for any worker who presents a written statement from a licensed physician or a health officer indicating that immunization is medically contraindicated or detrimental to the worker’s health. The statement shall indicate whether the exemption should be permanent or temporary. If the exemption is temporary, the statement shall indicate the date on which the worker is to receive the immunization. A hospital shall withdraw a temporary medical exemption on the day following that date.	Top of Page
[125] For Maryland, for religious exemptions to the immunization requirements of MD. Regs. Code tit. 10, § 06.01.12 (regarding rubeola) and MD. Regs. Code tit. 10, § 06.01.15 (regarding rubella), see MD. Regs. Code tit. 10, § 06.01.12 and MD. Regs. Code tit. 10, § 06.01.15. MD. Regs. Code tit. 10, § 06.01.12 and MD. Regs. Code tit. 10, § 06.01.15 provide that if a worker objects to the immunization on the grounds that it conflicts with the worker’s bona fide religious beliefs and practices, the hospital shall grant a religious exemption.
[146] For New Hampshire requirements, see N.H. Rev. Stat. Ann. § 151:9-b, relating to “hospitals.” N.H. Rev. Stat. Ann. § 151:9-b requires that before November 30th of each year, each hospital and residential care facility licensed under Title XI, chapter 151 of the New Hampshire Revised Statutes shall provide to its consenting employees annual immunizations against influenza, in accordance with the Advisory Committee on Immunization Practices of the Centers for Disease Control, and subject to the availability of an adequate supply of the necessary vaccine and subject to exemptions for medical contraindications and religious beliefs. N.H. Rev. Stat. Ann. § 151:C-2 defines a “hospital” as an institution which is engaged in providing to patients, under supervision of physicians, diagnostic and therapeutic services for medical diagnosis, treatment and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of such persons. The term “hospital” includes psychiatric and substance abuse treatment hospitals. N.H. Rev. Stat. Ann. § 151:9-b only applies to those facilities covered by the definition of “hospital” found at N.H. Rev. Stat. Ann. § 151:C-2.
[148] For New Hampshire, for medical exemptions to the immunization requirements set forth in N.H. Rev. Stat. Ann. § 151:9-b, see N.H. Rev. Stat. Ann. § 151:9-b, providing for exemptions for medical contraindications.
[149] For New Hampshire, for religious exemptions to the immunization requirements set forth in N.H. Rev. Stat. Ann. § 151:9-b, see N.H. Rev. Stat. Ann. § 151:9-b, providing for exemptions for religious beliefs.	Top of Page
[177] For New York, for medical exemptions to the immunization administration requirements set forth in N.Y. Comp. Codes R. & Regs. tit. 10, § 405.3, see N.Y. Comp. Codes R. & Regs. tit. 10, § 405.3, providing that immunization requirements are inapplicable if one of the practitioners designated at 405.3(10)(iii) certifies that the vaccine is contraindicated. The immunization requirements will be inapplicable until they are no longer found to be detrimental to the employee’s health. Certain additional procedural requirements must be met to obtain this exemption. In addition, N.Y. Comp. Codes R. & Regs. tit. 10, § 66-3.6 states that no personnel shall be required to receive an influenza vaccine if the vaccine is medically contraindicated for that individual.
[190] For Nevada, no statute or regulation requires any hospital to ensure that any employees are vaccinated with influenza vaccine. However, note Nev. Admin. Code ch. 441A, § 550, relating to “medical facilities.” Nev. Admin. Code ch. 441A, § 550 provides that if a case having a disease caused by invasive Haemophilus influenzae type b is in a medical facility where there is a contact less than 2 years of age, each employee of the medical facility shall complete a course of antimicrobial prophylaxis. If a case having a disease caused by invasive Haemophilus influenzae type b is in a medical facility where there is a contact who is less than 2 years of age, and where 2 persons have been diagnosed as having a disease caused by invasive Haemophilus influenzae type b within 60 days, each member of the staff in the medical facility shall complete a course of antimicrobial prophylaxis, unless medically contraindicated, regardless of whether the staff member has received an immunization against Haemophilus influenzae type b.
[221] For Oregon, while no statute or regulation requires any hospital to ensure that any employee is vaccinated with influenza vaccine, note Or. Rev. Stat. § 433.416, providing that an employer of a health care worker at risk of contracting an infectious disease in the course of employment shall provide to the worker preventative immunization for infectious disease if such preventative immunization is available and medically appropriate. Such preventative immunization shall be provided by the employer at no cost to the employee. A worker shall not be required as a condition of employment to be immunized under this section, unless such immunization is otherwise required under state or federal law, rule or regulation.
[235] For Rhode Island requirements, see R23-17-HCW, “Rules and Regulations Pertaining to Immunization, Testing, and Health Screening for Health Care Workers”, promulgated pursuant to the authority conferred under Chapters 23-17 and 23-17.7.1 of the General Laws of Rhode Island and revised in October 2012. R23-17-HCW § 3.5.4 states that annual influenza vaccination is required for all health care workers as defined in R23-17-HCW § 1.6, subject to vaccine supply, and requires each health care facility to develop a specific plan to require annual influenza vaccination of all healthcare workers at no cost to the health care worker. R23-17-HCW § 5.4 further states that any health care worker may refuse the annual seasonal influenza vaccination requirements described in the Regulations provided that he or she provides proper annual written notice of refusal prior to December 15 each year and wears a surgical face mask during each direct patient contact in the performance of his or her duties during any declared period in which influenza is widespread. R23-17-HCW § 1.6 defines “health care worker” as any person who is temporarily or permanently employed by or at, or who serves as a volunteer in, or has an employment contract with, a health care facility as defined in § 2.1 of the Regulations, and has or may have direct contact with a patient in that health care facility. R23-17-HCW § 2.1 defines “health care facilities” as including but not limited to hospitals, nursing facilities, rehabilitation centers, kidney disease treatment centers, freestanding emergency care facilities, facilities providing surgical treatment to patients not requiring hospitalization, physician ambulatory surgery centers and podiatry ambulatory surgery centers, among others.	Top of Page
[237] For Rhode Island, for exemptions to the immunization requirements of R23-17-HCW, “Rules and Regulations Pertaining to Immunization, Testing, and Health Screening for Health Care Workers”, promulgated pursuant to the authority conferred under Chapters 23-17 and 23-17.7.1 of the General Laws of Rhode Island and revised in October 2012, see R23-17-HCW § 5.1. R23-17-HCW § 5.1 states that a health care worker shall be exempt from the immunization requirements described in the Regulations provided that a physician, physician assistant, or certified registered nurse practitioner signs a medical exemption stating that the health care worker is exempt from a specific vaccine because of medical reasons, in accordance with the Advisory Committee on Immunization Practices (ACIP) guidelines, and determined as acceptable by the facility. R23-17-HCW § 1.6 defines “health care worker” as any person who is temporarily or permanently employed by or at, or who serves as a volunteer in, or has an employment contract with, a health care facility as defined in § 2.1 of the Regulations, and has or may have direct contact with a patient in that health care facility. R23-17-HCW § 2.1 defines “health care facilities” as including but not limited to hospitals, nursing facilities, rehabilitation centers, kidney disease treatment centers, freestanding emergency care facilities, facilities providing surgical treatment to patients not requiring hospitalization, physician ambulatory surgery centers and podiatry ambulatory surgery centers, among others.
[286] For Virginia, no statute or regulation requires any hospital to ensure that any employees are vaccinated with influenza vaccine. Note, however, 12 Va. Admin. Code § 5-410-490, providing that hospitals shall have an infection control committee to periodically evaluate, and revise as needed, infection control policies, procedures, and techniques for all appropriate phases of hospital operation and service in order to protect patients, employees, and visitors. These policies shall include, but are not limited to, appropriate employee health screening and immunization, among other things.
[505] For California requirements, see Cal. Health & Safety Code § 1288.7 (2007), providing that by July 1, 2007, the department shall require that each general acute care hospital, in accordance with the Centers for Disease Control guidelines, take all of the following actions: (a) Annually offer onsite influenza vaccinations, if available, to all hospital employees at no cost to the employee. Each general acute care hospital shall require its employees to be vaccinated, or if the employee elects not to be vaccinated, to declare in writing that he or she has declined the vaccination. See also Cal. Code Regs. tit. 8, § 5199, relating to “aerosol transmissible diseases”. Cal. Code Regs. tit. 8, § 5199(h)(10) requires employers to make seasonal influenza vaccine available to all employees with occupational exposure, and to ensure that each employee who declines to accept the seasonal influenza vaccine signs an influenza vaccine declination statement. Cal. Code Regs. tit. 8, § 5199 applies to hospitals, skilled nursing facilities, clinics, medical offices and other outpatient medical facilities, among others. Outpatient medical facilities whose policy is not to diagnose or treat aerosol transmissible diseases are not required to comply with this standard if they meet certain other conditions.
[512] For Tennessee requirements, see Tenn. Comp. R. and Regs. 1200-8-1-.06 (2007), relating to standards for hospitals. Tenn. Comp. R. and Regs. 1200-8-1-.06(3)(f) provides that the facility shall have an annual influenza vaccination program which shall include at least the offer of influenza vaccination to all staff and independent practitioners or accept documented evidence of vaccination from another vaccine source or facility.The program shall also include a signed declination statement on record from all who refuse vaccination for other than medical contraindications, education of direct care personnel about influenza transmission and control, and an annual evaluation of the program including reasons for non-participation.	Top of Page
[555] For Massachusetts requirements, see Mass. Regs. Code tit. 105, § 130.325, relating to requirements that hospital personnel be vaccinated against influenza. Mass. Regs. Code tit. 105, § 130.325(B) provides that each hospital shall ensure that all personnel are vaccinated with seasonal influenza vaccine unless an individual declines vaccination in accordance with Mass. Regs. Code tit. 105, § 130.325(F). Mass. Regs. Code tit. 105, § 130.325(A) defines personnel as individuals employed by or affiliated with the hospital, whether directly, by contract with another entity, or as an independent contractor, paid or unpaid, including but not limited to employees, members of the medical staff, contract employees or staff, students, and volunteers who either work at or come to the licensed hospital site, whether or not such individual(s) provide direct patient care.
[558] For Oklahoma requirements, see Okla. Admin. Code § 310:667-5-4, relating to “employee and/or worker health examinations.” Okla. Admin. Code § 310:667-5-4 provides that each hospital shall have an annual influenza vaccination program that shall include (1) the offer of influenza vaccination onsite, at no charge to all employees and/or workers in the hospital or acceptance of documented evidence of current season vaccination from another vaccine source or hospital and (2) documentation of vaccination for each employee and/or worker or a signed declination statement on record from each individual who refuses the influenza vaccination for other than medical contraindications.
[559] For Maryland requirements, see MD. Regs. Code tit. 10, § 07.01.34 relating to “infection prevention and control program”. MD. Regs. Code tit. 10, § 07.01.34 provides that hospitals shall establish processes and programs to prevent the spread of communicable diseases and infections. Immunizations for influenza shall be offered to staff and licensed independent practitioners, and reasons for refusal of the influenza vaccine by an employee shall be documented by the infection control or employee health program.
[560] For Nebraska requirements, see Neb. Rev. Stat. §71-467, pertaining to “general acute hospital; employees; influenza vaccinations; tetanus-diphtheria-pertussis vaccine; duties; record”. Neb. Rev. Stat. §71-467 states that each general acute hospital shall annually offer onsite influenza vaccination to all hospital employees and shall offer to all employees a single dose of tetanus-diphtheria-pertussis vaccine if they have not previously received such vaccine and regardless of the time since their most recent vaccination with such vaccine. Neb. Rev. Stat. §71-467 further states that each general acute care hospital shall require all hospital employees to be vaccinated against influenza, tetanus, diphtheria, and pertussis, except that an employee may elect not to be vaccinated, and that this section shall not apply in individual cases when contraindicated or if a national shortage of the vaccine exists.	Top of Page
[565] For Colorado requirements, see 6 CCR 1011-1, Chapter 2, Part 10, pertaining to influenza immunization of healthcare workers. 6 CCR 1011-1 Chapter 2, §10.8 provides that each licensed hospital, hospital unit, ambulatory surgical center and long-term care facility shall have a written policy regarding the annual influenza immunization of its healthcare workers that, at a minimum, ensures that each of its healthcare workers has either proof of immunization or a medical exemption signed by a physician, physician’s assistant, advanced practice nurse or nurse midwife licensed in the State of Colorado stating that influenza vaccination for that individual is medically contraindicated as described in the product labeling approved by the United States Food and Drug Administration. 6 CCR 1011-1 Chapter 2, §10.8 additionally provides that such written policy must ensure that each healthcare worker who does not have proof of immunization wears a surgical or procedure mask during influenza season when in direct contact with patients and in common areas as specified by the licensee’s policy. 6 CCR 1011-1 Chapter 2, §10.6 provides for exemptions to the requirements of Sections 10.7 through 10.12 if a licensed healthcare entity demonstrates that it has vaccinated a targeted percentage of its employees in a given year, using its own methodology, and continues to use the same or more stringent methodology. The minimum targets required for the exemption are 60 percent of employees vaccinated by December 31, 2012; 75 percent of employees vaccinated by December 31, 2013, and 90 percent of employees vaccinated by December 31, 2014 and December 31 of each year thereafter. 6 CCR 1011-1 Chapter 2, §10.5 defines a hospital as a facility licensed and regulated pursuant to 6 CCR 1011-1, Chapter IV, General Hospitals and defines a healthcare worker as any person working in a healthcare entity who has the potential for exposure to patients, residents, or consumers of the healthcare entity and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. The definition of healthcare worker does not include volunteers.
[567] For Colorado, for exemptions to the immunization requirements of 6 CCR 1011-1, Chapter 2, Part 10, see 6 CCR 1011-1, Chapter 2 §10.8(A)(2). 6 CCR 1011-1, Chapter 2 §10.8(A)(2) provides that in lieu of proof of immunization, a healthcare worker may have a medical exemption signed by a physician, physician’s assistant, advanced practice nurse or nurse midwife licensed in the State of Colorado stating that influenza vaccination for that individual is medically contraindicated as described in the product labeling approved by the United States Food and Drug Administration. Note also that 6 CCR 1011-1 Chapter 2, §10.6 provides for exemptions to the requirements of Sections 10.7 through 10.12 if a licensed healthcare entity demonstrates that it has vaccinated a targeted percentage of its employees in a given year, using its own methodology, and continues to use the same or more stringent methodology. The minimum targets required for the exemption are 60 percent of employees vaccinated by December 31, 2012; 75 percent of employees vaccinated by December 31, 2013, and 90 percent of employees vaccinated by December 31, 2014 and December 31 of each year thereafter. 6 CCR 1011-1 Chapter 2, §10.5 defines a hospital as a facility licensed and regulated pursuant to 6 CCR 1011-1, Chapter IV, General Hospitals and defines a healthcare worker as any person working in a healthcare entity who has the potential for exposure to patients, residents, or consumers of the healthcare entity and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. The definition of healthcare worker does not include volunteers.
[569] For Georgia requirements, see Ga. Code Ann. § 31-7-18, relating to influenza vaccinations for discharged patients aged 65 and older, vaccinations or other measures for health care workers and other employees in hospitals, immunity from liability, and standing orders. Ga. Code Ann. § 31-7-18(b) provides that a hospital shall annually offer to its health care workers and other employees who have direct contact with patients, at no cost, vaccinations for the influenza virus in accordance with the recommendations of the Centers for Disease Control and Prevention, subject to availability of the vaccine.
[573] For South Dakota, no regulation or statute specifically refers to vaccination against influenza for hospital employees. However, note South Dakota Executive Order 2014-11, which requires all state-employed personnel providing direct health care services in a clinic, office, home, or other setting, or any state-employed personnel whose routine work duties brings them into direct contact with a client or patient in a patient or client care area, and all state-employed personnel entering a licensed healthcare facility on a routine basis as part of their job responsibilities to be vaccinated against influenza by December 1 of each year. Exceptions to the requirement are provided to any person who has a documented medical contraindication to the influenza vaccination or who is adherent to a religious doctrine whose teachings are opposed to immunizations. South Dakota Executive Order 2014-11 applies to state employees working in healthcare facilities rather than all hospital employees and therefore does not constitute a requirement for purposes of this database.	Top of Page
[574] For Texas, no regulation or statute specifically refers to vaccination against influenza for hospital employees. However, note 25 Tex. Admin. Code §1.702, which requires each health care facility to develop, implement, and enforce a policy and procedures to protect its patients from vaccine preventable diseases. The policy must, among other things, require covered individuals to receive vaccines for the vaccine preventable disease specified by the facility based on the level of risk the individual presents to patients by the individuals routine and direct exposure to patients, specify the vaccines a covered individual is required to receive based on the level of risk the individual presents to patients by the individuals routine and direct exposure to patients, and include procedures for verifying whether a covered individual has complied with the policy. The policy must include procedures for covered individuals to be exempt from the required vaccines for medical conditions identified as contraindications or precautions by the federal Centers for Disease Control and Prevention, and may include procedures for exemptions based on reasons of conscience, including a religious belief. 25 Tex. Admin. Code §1.701 defines “health care facility” to include hospitals licensed under Chapter 241 of the Texas Health and Safety Code and hospitals maintained or operated by the state.

 

Disclaimer: The purpose of this database is to provide researchers, policymakers, and state and local public health practitioners with descriptive information concerning state immunization-related law. No part of this legal analysis involves providing legal advice or answering specific questions of law on behalf of any person or organization.