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Vaccine Requirements for Healthcare Workers

Hospitals and nursing homes usually ask staffing agencies to prove that each nurse, CNA, or allied worker is protected against certain diseases. CDC and its vaccine advisory committee (ACIP) recommend which vaccines health care personnel should have and what counts as proof. But the actual requirements come from each state and each facility. This guide explains the CDC recommendations and what a credentialing file should show.

Updated October 3, 2026 · Checked against official CDC and OSHA sources

Who sets the rules

CDC makes recommendations. States and facilities decide what is required. CDC's 2011 report on immunizing health care personnel says several states and facilities have set their own requirements for checking vaccination status or giving vaccines.

CDC's definition of health care personnel is broad. It covers paid and unpaid people in health care settings who could be exposed to patients or infectious materials. It names nurses, nursing assistants, therapists, and technicians. It also names "contractual staff not employed by the health-care facility." That includes agency staff.

CDC also suggests that facilities review each worker's vaccination and immunity status at hire and at least once a year.

Read each facility contract for its exact vaccine list and proof rules.
Check your state's rules. CDC keeps a database of state immunization laws for healthcare workers, but it reflects laws collected at a point in time, so confirm with the state.
Keep proof for every worker before the first shift.

The vaccines CDC recommends for health care personnel

CDC's 2011 report on health care personnel covers hepatitis B, flu, measles, mumps, rubella, pertussis (Tdap), and chickenpox (varicella). CDC's adult vaccine page for healthcare workers also lists COVID-19 and meningococcal vaccines.

COVID-19 guidance has changed often. As of CDC's page updated September 23, 2026, a 2026-2027 COVID-19 vaccine is recommended for all adults ages 18 and older. That page also says healthcare workers may be at increased risk for infection. Check CDC's current page before you update your policy.

Hepatitis B: a complete vaccine series for workers whose jobs involve a reasonably expected risk of contact with blood or other infectious body fluids.
Flu: one dose every flu season. CDC says the July 2025 schedule's flu recommendations remain in effect for the 2026-2027 season.
MMR (measles, mumps, rubella): proof of immunity to all three (see below).
Chickenpox (varicella): proof of immunity, or 2 doses given 4 to 8 weeks apart.
Tdap: one dose as soon as possible for any worker, of any age, who has never had Tdap.
COVID-19: see CDC's current guidance, which is updated each season.

Proof of immunity: measles, mumps, and rubella

For measles and for mumps, CDC accepts any one of four kinds of proof. For rubella, the list is similar but only 1 dose is needed.

CDC says not to accept a verbal report of vaccination without written records. A worker's memory that they had the shots is not proof.

Birth before 1957 is accepted in routine times. But CDC says facilities should consider giving 2 doses of MMR to unvaccinated workers born before 1957 who have no lab proof of immunity or disease. During a measles or mumps outbreak, CDC says facilities should recommend 2 doses for those workers. Birth before 1957 does not count as rubella proof for women who could become pregnant.

Measles or mumps: written record of 2 doses of live measles/mumps or MMR vaccine at least 28 days apart.
Rubella: written record of 1 dose of live rubella or MMR vaccine.
Lab evidence of immunity (a positive titer). CDC says equivocal results should be treated as negative.
Lab confirmation of the disease.
Birth before 1957 (with the limits described above).

Proof of immunity: chickenpox (varicella)

CDC says healthcare facilities should make sure all health care personnel have evidence of varicella immunity, and that the proof should be on file and easy to find at the work location.

Workers with no proof should get 2 doses of varicella vaccine, 4 to 8 weeks apart.

Written record of 2 doses of varicella vaccine.
Lab evidence of immunity, or lab confirmation of disease.
Diagnosis or verification of a history of chickenpox by a health care provider.
Diagnosis or verification of a history of shingles (herpes zoster) by a health care provider.

Proof of immunity: hepatitis B

A worker with an incomplete series is not considered protected. CDC says the series should be finished.

CDC also recommends a blood test after vaccination for workers who have contact with patients' blood and body fluids or who are at ongoing risk of needlesticks. The test checks for hepatitis B surface antibody (anti-HBs). It should be done 1 to 2 months after the last dose.

A result of 10 mIU/mL or higher means the person is immune. A worker below that level after the first series should be vaccinated again and retested 1 to 2 months after the last dose of the second series. CDC's Pink Book notes there are 3-dose vaccines and a 2-dose vaccine (Heplisav-B).

Dates of each dose in the complete series.
Post-vaccination anti-HBs result and date, if the worker had one.
Second-series dates and results for anyone who did not respond the first time.
Hepatitis B also falls under an OSHA rule for workers exposed to blood. That rule has its own offer, declination, and recordkeeping duties.

Declinations and exemptions

Some workers will decline a vaccine. How that is handled depends on the vaccine, the state, and the facility.

For flu, CDC's 2011 report notes that some institutions ask staff who refuse the vaccine to sign a declination. CDC says institutions that require one should educate and counsel those workers about the benefits of the vaccine.

CDC's summaries of state laws note that states with healthcare worker vaccine requirements may allow exemptions in some cases. Examples include when a vaccine is medically contraindicated or conflicts with a person's religious or philosophical beliefs. Whether an exemption is allowed, and what the facility requires instead, is set by state law and facility policy.

Hepatitis B is different. For workers with exposure to blood, OSHA requires a signed declination using the exact statement in the regulation.

Use the facility's declination form when it has one.
Keep the signed form with the date in the worker's file.
Ask the facility in writing what it requires from workers who decline.

What a good vaccine record looks like

CDC recommends secure systems for vaccination records so they can be found fast, for example during an outbreak. Each record should show immunity status for each disease: documented disease, vaccination history, or blood test results.

For each vaccine given, CDC says the record should include the date, the maker and lot number, the Vaccine Information Statement edition given, and who gave the shot. CDC also says workers should get a copy of their records to share with future employers.

One line per disease: hepatitis B, flu (current season), measles, mumps, rubella, varicella, Tdap, and COVID-19 if the facility asks.
The type of proof for each: dates of doses, titer result, lab-confirmed disease, or birth year.
Copies of the source documents, not just a checkbox.
Any signed declination or exemption paperwork.
A review date so you can recheck at least once a year.

Common questions

Is being born before 1957 enough proof of measles immunity for a healthcare worker?

CDC accepts it in routine times. But CDC says facilities should consider giving 2 doses of MMR to unvaccinated workers born before 1957 who lack lab proof, and should recommend 2 doses for them during a measles outbreak. Some facilities may not accept birth year alone.

A nurse has 2 documented MMR doses but a negative titer. Is another shot needed?

No, according to CDC. If a worker has 2 documented doses and a negative or equivocal measles titer, CDC does not recommend another dose. The worker should be considered to have presumptive evidence of measles immunity.

Does a history of chickenpox count as proof of immunity?

Only if a health care provider diagnosed it or verified the history. CDC also accepts a provider's diagnosis or verification of a history of shingles.

Is a COVID-19 vaccine required for healthcare workers?

CDC makes recommendations, not facility requirements. As of September 2026, CDC's guidance recommends a 2026-2027 COVID-19 vaccine for all adults 18 and older. Whether it is required for a shift depends on the facility and state.

How often should we review a worker's vaccine records?

CDC suggests facilities review vaccination and immunity status at hire and at least once a year. Flu is the one that changes every season.

Where can I find my state's healthcare worker vaccine laws?

CDC's Public Health Law Program keeps a database of state immunization laws for healthcare workers and patients. Confirm with your state health department, because laws change after the data is collected.

Sources

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