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Rural/Metro paramedic John Dowd has a flu shot administered by clinical coordinator and nurse Barbara McDonald at their office in San Jose, Calif. on Thursday, Sept. 13, 2012. (Nhat V. Meyer/Staff)

A controversial new mandate will force thousands of health care workers in Contra Costa and Santa Clara counties to get flu shots this fall -- or wear a mask at work the entire influenza season.

San Francisco and Sacramento counties already have similar mask mandates aimed at curbing the spread of the deadly disease and convincing health care workers to practice what they preach. Alameda County is considering a similar rule.

While patient advocates applaud the new requirement, a nurses union said forcing employees to wear a mask on the job for five months of the year is ineffective and would stigmatize them with a scarlet letter.

The mandate comes after an analysis by this newspaper in December revealed that nearly one-third of employees at many Bay Area hospitals failed to get a flu shot during the 2010-11 season, and at some institutions, half of workers were unprotected.

"This is really to protect the most frail, and persons at highest risk in these facilities," said Dr. Marty Fenstersheib, health officer for Santa Clara County.

"The vaccine compliance rates in health care workers are just too low."

The new rule applies to all employees who have contact with patients in hospitals, clinics, ambulance companies, adult day health centers, nursing homes and other health facilities.

The national Centers for Disease Control and Prevention recommends that nearly everyone age six months and older receive a flu vaccination annually.

Each year in the United States, five to 15 percent of people become ill with the flu, and nearly 36,000 die. Seniors, infants, pregnant women and those with chronic health conditions are at greatest risk.

Fenstersheib issued an order in July imposing the vaccination mandate for the upcoming flu season in Santa Clara County, from Nov. 1 to March 31.

Dr. Bill Walker, health officer for Contra Costa County, followed with a similar order at the end of August.

Walker noted that people can be contagious for a full day before symptoms appear, so having employees stay home once they become ill does not do enough to halt the disease's spread.

"We need to do what we can to protect vulnerable folks where they get their health care," he said.

The health officers say they have the power to impose such mandates under their authority to take needed steps for controlling contagious diseases.

County health departments don't have enough staff to check if health care workers are complying, so it will be up to individual employers to enforce the rules, the health officers said.

Alameda County will have a similar mandate this flu season but is working out details in discussions with health care providers, said spokeswoman Sherri Willis.

San Mateo County health leaders share the same goals but will not be imposing a mandate, health officer Scott Morrow said.

"I just don't feel that's the best mechanism at this point in time," he said.

So why do so many health care workers ignore the recommendations and forgo shots?

Fenstersheib and Walker say they hear a variety of reasons, including that people believe they have a strong immune system and don't need to worry, are concerned about side effects or don't think the vaccine is effective.

The mandate is opposed by the California Nurses Association, which supports vaccination of its members but objects to the mask requirement.

CNA President DeAnn McEwen said workers should have the right to opt out of getting immunized without having to wear a mask for months even though they are healthy. She argued that wearing a mask has not been proven effective in preventing people from becoming infected.

Such a requirement is "really demeaning and insulting to people's intelligence," McEwen said.

Instead, she argued that immunization rates could be improved with educational campaigns to deal with misinformation, help employees better understand the need and have their questions answered. A bigger concern, she added, is some employers' punitive absence policies that pressure workers to come to work ill.

Fenstersheib said health leaders have tried for years to improve health care worker immunization rates through education and other means without much success. A mask requirement has proved to be one of the most effective methods, leading to compliance rates exceeding 95 percent in some instances, he said.

Charles Cristobal, an EMT with Rural/Metro ambulance company in San Jose, got a flu shot last week and said it helps prevent illness for everyone involved.

"Why not get that extra protection for you and your family?" he asked.

A patient advocacy group praised the mandate.

"What makes our health care workers, who know firsthand how deadly influenza can be, exempt from receiving a vaccination to eliminate the spread of deadly infection?" said Carmella Gutierrez, president of Californians for Patient Care.

Sandy Kleffman covers health. Contact her at 510-293-2478. Follow her at Twitter.com/skleffman.

Vaccination mandates
Who it covers: Paid and unpaid health care workers who have contact with patients in Contra Costa and Santa Clara counties.
What it requires: Workers to receive a flu vaccination or wear a mask from Nov. 1 to March 31.
Where it applies: Hospitals, clinics, nursing homes, adult day health centers, ambulance companies, dialysis clinics and other health facilities.
How it's enforced: Employers are responsible for enforcing.