Healthcare workers in the United States are recommended to receive vaccines against hepatitis B, influenza, measles, mumps, rubella, varicella, tetanus, diphtheria, pertussis, COVID-19, and polio. Only one of these, hepatitis B, carries a federal workplace mandate backed by OSHA. The rest are strong CDC recommendations that most hospitals and health systems enforce through their own hiring and employment policies. What you actually need depends on your employer, your state, and sometimes your specific role.
The Core Vaccines for All Healthcare Workers
The CDC’s immunization schedule for healthcare personnel includes the following vaccines, regardless of clinical specialty:
- Hepatitis B: A 2, 3, or 4-dose series depending on the specific vaccine product used. This is the only vaccine with a federal OSHA mandate for workers with occupational exposure to blood or bodily fluids.
- Influenza: One dose annually of the inactivated or recombinant flu vaccine.
- MMR (measles, mumps, rubella): One or two doses for anyone born in 1957 or later, depending on the specific indication.
- Varicella (chickenpox): Two doses for anyone born in 1980 or later who lacks evidence of immunity.
- Tdap/Td (tetanus, diphtheria, pertussis): At least one dose of Tdap, with additional doses for wound management or pregnancy.
- COVID-19: One or more doses of the current season’s updated vaccine.
- Polio (IPV): A completed 3-dose series for anyone who was incompletely vaccinated. Self-reported previous doses are acceptable.
These recommendations come from the CDC’s Advisory Committee on Immunization Practices (ACIP). While they aren’t all legally required at the federal level, most healthcare employers treat them as conditions of employment.
Hepatitis B: The One Federal Mandate
Hepatitis B stands apart because OSHA requires employers to offer the vaccine series to every worker with occupational exposure to blood or other potentially infectious materials. Your employer must offer the vaccine at no cost to you, at a reasonable time and place, within 10 days of your initial assignment to a role involving exposure. You cannot be required to get a blood test first to check whether you’re already immune, though you can choose to.
If you decline, your employer must have you sign a declination form. But if you change your mind later, the employer is still obligated to provide the vaccine free of charge as long as you remain in an exposed role. After you complete the series, a healthcare professional provides a written opinion confirming whether vaccination was indicated and whether you received it.
Proving Immunity to MMR and Varicella
For measles, mumps, rubella, and varicella, most employers don’t just want proof of vaccination. They want proof of immunity, which can be established in a few ways: documented vaccination records, a blood test (called a titer) showing protective antibody levels, or in some cases, documented history of the disease itself confirmed by a healthcare provider.
The stakes here are practical. Healthcare workers without evidence of varicella immunity who are exposed to chickenpox or shingles at work must be excluded from duty from day 8 through day 21 after the exposure. That’s potentially two weeks off work. Workers with confirmed immunity face no work restrictions after the same exposure. Getting vaccinated or confirming your immunity before you start working avoids this entirely.
Influenza: Annual Requirement With a Catch
Nearly all healthcare employers require annual flu vaccination, but enforcement varies. Several states have laws that allow workers to decline but impose consequences. The most common policy: if you refuse or are exempt from the flu vaccine, you must wear a surgical or procedure mask throughout flu season whenever you’re in areas where patients are present.
New York, Colorado, and other states have codified this mask-or-vaccinate approach into law. Tennessee requires facilities to keep signed declination statements from every worker who refuses. Rhode Island goes further, requiring flu vaccination for all healthcare workers and mandating that facilities track the number of employees who decline. Illinois allows religious exemptions for employees of ambulatory surgical centers and certain other facilities.
In practice, even where no state law applies, most hospitals and clinics have adopted their own vaccinate-or-mask policies. If you’re starting a new healthcare job, expect to either get a flu shot each fall or wear a mask for several months.
COVID-19 Vaccine: No Longer Federally Mandated
The CMS mandate that required COVID-19 vaccination for staff at Medicare and Medicaid certified facilities has expired. It is no longer in effect as of 2025. However, the CDC continues to recommend that healthcare workers receive the current season’s updated COVID-19 vaccine. Individual employers may still require it as a condition of employment, so check with your facility’s occupational health department.
TB Screening: Not a Vaccine, But Always Required
Tuberculosis screening is a standard part of the onboarding process for every healthcare job in the United States, even though it’s not a vaccination. All healthcare personnel should be screened upon hire through a combination of an individual risk assessment, a symptom evaluation, and a TB test (either a blood test or a skin test).
After that baseline screening, routine repeat testing is no longer recommended unless there’s a known exposure at your facility or evidence of ongoing transmission. If you’ve been diagnosed with latent TB infection and don’t receive treatment, you’ll need annual symptom screening and a yearly reassessment of whether treatment makes sense for you.
Specialized Vaccines for High-Risk Roles
Certain healthcare roles carry additional vaccine requirements beyond the standard list. These apply mainly to laboratory workers handling specific dangerous pathogens.
- Meningococcal vaccine: Recommended for microbiology staff who work with cultures of the bacteria that cause meningitis. A single dose is given, then repeated every five years.
- Typhoid vaccine: Recommended for lab workers handling the bacteria that cause typhoid fever.
- Anthrax vaccine: Offered to personnel working with clinical specimens from the bacteria that cause anthrax, or those involved in processing environmental samples during a bioterrorism response.
- Rabies vaccine: Required for all employees in public health or veterinary diagnostic labs where rabies virus testing occurs.
- Smallpox vaccine: Required for lab personnel who perform smallpox-specific testing or who might process specimens referred for possible smallpox evaluation.
- Ebola vaccine: Recommended for workers at designated Ebola treatment centers and laboratorians working in the highest-level biosafety labs (BSL-4).
If you work in a clinical role rather than a lab, these specialized vaccines almost certainly don’t apply to you.
Medical and Religious Exemptions
Two types of exemptions exist under federal law. Medical exemptions fall under the Americans with Disabilities Act. If a disability prevents you from safely receiving a vaccine, your employer must evaluate whether a reasonable accommodation is possible, such as reassignment or additional protective equipment, before taking adverse action. Your employer may request supporting medical documentation as part of this process.
Religious exemptions fall under Title VII of the Civil Rights Act. You need to explain the conflict between the vaccine requirement and your sincerely held religious beliefs. Employers should generally take these requests at face value, but they can ask for additional information if they have an objective reason to question whether the belief is genuinely religious in nature or sincerely held. In both cases, the employer is not required to grant an exemption if doing so would pose a significant safety risk that can’t be reduced through accommodation.
What to Expect During Onboround
When you start a new healthcare job, occupational health will typically ask for vaccination records, run blood titers for measles, mumps, rubella, varicella, and hepatitis B, administer any vaccines you’re missing, perform a TB screening, and document everything. Bring whatever immunization records you have from childhood and previous employers. Missing records usually mean repeat vaccinations or titer testing, which can delay your start date. Completing everything before your first day, or as quickly as possible afterward, keeps the process smooth.