Dear Colleague Letter: Importance of Influenza Vaccination for All Health Care Personnel (HCP)

December 2013

Dear Colleague:

The 2013 influenza season is here and influenza vaccine distribution has begun. I am writing to reiterate the critical importance of influenza vaccination for all health care personnel (HCP) as the single most important tool available to prevent transmission of influenza in health care settings. During the 2012-2013 influenza season, the average influenza vaccination rate for HCP in hospitals in New York State was only 60 percent, and the rate for long term care facilities was only 48 percent. We can and must do better.

Beginning this influenza season, in accordance with the requirements of New York Codes, Rules and Regulations, title 10, Section 2.59 (10 NYCRR Section 2.59), any healthcare facility, residential facility or agency licensed under Article 28 or Article 36 of the Public Health Law and any hospice established pursuant to Article 40 of the Public Health Law, must require that HCP who are not vaccinated against influenza wear a surgical or procedure mask during influenza season while working in areas where patients may be present1. These regulations were enacted to help prevent transmission of influenza disease in health care settings.

Systematic strategies to optimize the HCP influenza vaccination rate for your facility or agency and minimize the number of HCP in your facility or agency that will be required to wear face masks during the influenza season in compliance with 10 NYCRR Section 2.59 include:

  • Improving access to vaccination (e.g., offering vaccination at work and during work hours on all three shifts and utilizing a mobile cart to deliver vaccine to staff);
  • Offering influenza vaccine free of charge for all HCP employed by or affiliated with your facility or agency;
  • Providing incentives for vaccination or prizes for units or floors with highest rates of vaccination;
  • Requiring personnel not wishing to be vaccinated to sign declination forms to acknowledge they have been educated about the benefits and risks of vaccination2;
  • Mandating that all HCP at your facility or agency receive the influenza vaccine as a condition of employment unless they have a medical contraindication to vaccination3,4,5,6.

To assist you in your efforts, a tool kit for influenza vaccination programs in health care facilities is available on the New York State Department of Health (Department) website at:

Achieving high influenza vaccination rates among HCP is a critical step in preventing health care transmission of influenza and protecting patients. In addition to the immunization of HCP, the following actions to prevent transmission within health care facilities are recommended7:

  • reinforcement of respiratory hygiene and cough etiquette;
  • appropriate exclusion of ill HCP;
  • adherence to infection control precautions for all patient care activities and aerosol-generating procedures;
  • implementation of environmental and engineering infection control measures; and
  • implementation of restrictions on visitors during the peak of influenza illness in the community.

The successful implementation of these strategies is dependent on clear administrative policies and organizational leadership that promotes and facilitates adherence to these recommendations and requirements among patients, visitors, and HCP.

In closing, I want to reiterate the importance of annual vaccination as the single most important action to prevent seasonal influenza infection. The Department strongly urges all facilities to actively promote influenza immunization for all HCP to assure patient health and safety and a healthy and robust health care workforce during the current influenza season. Please see the Department website at and the CDC website at for additional information and resources.

Questions about 10 NYCRR Section 2.59 should be directed to Questions about the Healthcare Personnel Influenza Vaccination Report should be directed to the Department's Bureau of Immunization at either (518) 473-4437 or

Thank you for working with us to promote the health and safety of all New Yorkers.


Nirav R. Shah, M.D., M.P.H
Commissioner of Health

1Prevention of Influenza Transmission by Healthcare and Residential Facility and Agency Personnel.

2The Joint Commission on Accreditation of Healthcare Organizations: Providing a Safer Environment for HealthCare Personnel and Patients Through Influenza Vaccination;
(accessed July 20, 2011).

3Mandatory Influenza Vaccination of Health Care Workers: Translating Policy to Practice by Hilary M. Babcock, et al; Clinical Infectious Diseases 2010; 50:459–64;

4Rakita RM, Hagar BA, Crome P, Lammert JK. Mandatory Influenza Vaccination of Healthcare Workers: A 5- Year Study. Infect Control Hosp Epidemiol. July 23, 2010.

5Morbidity and Mortality Weekly Report (MMWR) Interim Results: State-Specific Seasonal Influenza Vaccination Coverage --- United States, August 2009—January 2010. April 30, 2010/ 59(16); 477–484;

6Morbidity and Mortality Weekly Report (MMWR) Interim Results: State-Specific Seasonal Influenza Vaccination Coverage --- United States, August 2011—February 2011. June 10, 2011 / 60(22); 737–743;

7Centers for Disease Control and Prevention: Strategies for Seasonal Influenza in Healthcare Settings 2010.