Background:
Respiratory viruses circulate year-round in California and Orange County, but with more significant circulation of several viruses during late fall to early spring. These viruses pose significant risks to vulnerable individuals and can significantly impact local clinical ability to meet the medical needs of residents and visitors in health care settings. Additionally, vulnerable individuals commonly need medical care services during this period and require improved efforts to reduce exposure from health care workers involved in their care as well as the clinical settings they visit.
Nationally, the 2024-25 influenza season was severe, resulting in the highest hospitalization rate in the United States since the 2010-11 influenza season, and the highest number of pediatric deaths related to influenza since the condition became reportable in 2004.1,2 Multiple factors are believed to have contributed to heightened severity, including circulation of more virulent influenza strains, reduced community immunity, low vaccine coverage, and the simultaneous spread of other respiratory viruses.
Among health care workers, influenza vaccination coverage dropped from 80.6% in the 2021– 2022 season to 75.9% in 2022–2023, reflecting a concerning downward trend.3 This decline coincided with a notable surge in influenza-related illness during the 2024–2025 season.
Emergency department visits for influenza surpassed those for both COVID-19 and respiratory syncytial virus (RSV) at national and local levels. Nationally, preliminary estimates indicate between 27,000 and 130,000 influenza-related deaths and 610,000 to 1.3 million hospitalizations.4 Locally, at the peak of the season, influenza accounted for 6.3% of all hospitalizations—more than double the rate of the previous two seasons—and 11.8% of all emergency room visits.
Health care workers remain vulnerable - as they can be exposed to influenza both in the community and in clinical settings while caring for symptomatic and asymptomatic patients.
During the initial 24 hours of an infection, a health care worker may be asymptomatic yet still shed the virus particle, increasing the risk of transmission to others. Influenza vaccination remains a critical preventive measure that has been shown to reduce risk of severe illness and employee absenteeism of health care workers during the influenza season.
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices as well as the California Department of Public Health, continue to support increased immunity through vaccination against influenza to reduce influenza severity.5,6 Furthermore, California law requires that general acute care hospitals and certain employers offer vaccination to employees (Cal. Health & Safety Code § 1288.7 subd. (a); 8 Cal. Code Regs., § 5199, subd. (c)(6)(D) and (h)(10)).
This Order enhances patient protection by requiring health care workers to receive an annual influenza vaccine for the current influenza season. While this Order is focused on requiring an annual influenza vaccine to help protect both health care workers and the patients they serve, it also strongly recommends that all in the health care community adopt measures to enhance respiratory immunity and reduction of transmission by following vaccination guidance provided by the California Department of Public Health as well as improving ventilation in the clinical setting and following mask use guidance to reduce transmission during periods of high viral transmission in the community.
ORDER:
Pursuant to the Health Officer authority under California Health & Safety Code §120175, the County of Orange Health Officer hereby orders that all health care workers who provide care in Orange County must receive an annual influenza vaccine for the current respiratory virus season.
- Purpose: Influenza and other respiratory viruses continue to pose significant risks. High vaccination rates amongst health care workers reduce the risk of spreading influenza to patients, coworkers and the community they serve. This Order continues the annual requirement that all health care workers who provide care in Orange County receive an annual influenza vaccine authorized for use in the United States for the current Respiratory Virus Season.
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- Intent: The primary intent of this Order is to lower the risk of influenza transmission to health care workers and patients by requiring health care workers in the inpatient, outpatient, and field settings to receive an annual influenza vaccine as a protective measure. The optimal period for health care workers to receive a vaccine is in October ahead of the Respiratory Virus Season, allowing at least 2 weeks to build up immunity from the vaccine.
- Health Care Facilities Subject to this Order: This Order applies to general hospitals, skilled nursing facilities, intermediate and long term care facilities, emergency medical services provider agencies, congregate living health facilities, chemical dependency recovery hospitals, acute psychiatric hospitals, dialysis centers, home health agencies, primary care clinics, ambulatory surgery centers, hospice facilities, chemical dependency recovery hospitals, ambulatory and community clinical settings, and any other licensed health care facility and emergency medical services provider organizations.
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ORDER:
Pursuant to the Health Officer authority under California Health & Safety Code §120175, the County of Orange Health Officer hereby orders that all health care workers who provide care in Orange County must receive an annual influenza vaccine for the current respiratory virus season.
- Purpose: Influenza and other respiratory viruses continue to pose significant risks. High vaccination rates amongst health care workers reduce the risk of spreading influenza to patients, coworkers and the community they serve. This Order continues the annual requirement that all health care workers who provide care in Orange County receive an annual influenza vaccine authorized for use in the United States for the current Respiratory Virus Season.
- Intent: The primary intent of this Order is to lower the risk of influenza transmission to health care workers and patients by requiring health care workers in the inpatient, outpatient, and field settings to receive an annual influenza vaccine as a protective measure. The optimal period for health care workers to receive a vaccine is in October ahead of the Respiratory Virus Season, allowing at least 2 weeks to build up immunity from the vaccine.
- Health Care Facilities Subject to this Order: This Order applies to general hospitals, skilled nursing facilities, intermediate and long term care facilities, emergency medical services provider agencies, congregate living health facilities, chemical dependency recovery hospitals, acute psychiatric hospitals, dialysis centers, home health agencies, primary care clinics, ambulatory surgery centers, hospice facilities, chemical dependency recovery hospitals, ambulatory and community clinical settings, and any other licensed health care facility and emergency medical services provider organizations.
