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

This order has been rescinded and is no longer in effect in Marin County. Please visit the current Health Orders page to review current active orders in Marin.


Original Issue Date: September 2, 2020

TO:     Marin County Hospitals, Clinics, Medical Offices, Skilled Nursing Facilities and Residential Care Facilities for the Elderly, Correctional Facilities, Hospice, Home Health Agencies, Emergency Medical Services (EMS), and other Health Facilities

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

As Marin County works to reduce transmission of SARS-CoV-2, flu season is approaching. The co-occurrence of flu 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.  Flu 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.

Marin County Public Health is issuing an order for mandatory influenza vaccination for all staff in health care settings and congregate living facilities in order to protect staff, patients, and the wider community.

In 2013, Marin County implemented mandatory flu vaccination for all health care facilities.  In 2015, we included Emergency Medical Service providers; and in 2017, we extended to all “health care personnel.”  In 2019, we encouraged residential care, senior housing, and health care facilities to promote influenza vaccination among caregivers, home health workers, and volunteers.

This year, Marin County Public Health is expanding the Order to require mandatory influenza vaccination for all staff at health care, skilled nursing facilities, and residential care facilities for the elderly.  We strongly recommend it for all staff and residents of all congregate facilities in Marin County.


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, skilled nursing facilities, residential care facilities for the elderly, correctional facilities and EMS providers in Marin County, must implement a 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 October 25, 2020 and ends May 1, 2021. If influenza surveillance shows unusually early and/or late peaks, the order may be extended.


Facilities Subject to the Order:

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

For any additional questions, please contact Laurel Johnson RN, Marin County Immunization Coordinator, at (415) 473 4163.

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



Matt Willis MD, MPH                           Lisa M. Santora MD, MPH

Public Health Officer                           Deputy Public Health Officer