OC Health Officer's Declarations, Orders & Recommendations

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VERONICA KELLEY, DSW, LCSW AGENCY DIRECTOR LORRAINE DANIEL, MPA ASSISTANT AGENCY DIRECTOR REGINA CHINSIO-KWONG, DO COUNTY HEALTH OFFICER CHRISTOPHER ZIMMERMAN, MD, MPH INTERIM COMMUNICABLE DISEASE CONTROLLER DEPUTY MEDICAL DIRECTOR CDCD 405 W. 5TH STREET, 7TH FLOOR SANTA ANA, CA  92701 www.ochealthinfo.com

COUNTY OF ORANGE HEALTH OFFICER’S ORDER

Annual Influenza Immunization Requirement
for Health Care Workers During Respiratory Virus Season
Issue Date: September 30, 2025

Summary of the Order:

All health care workers who provide care in Orange County must receive an annual influenza vaccine for the current respiratory virus season.

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.

1. 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.
2. 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.
3. 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.
4. Health Care Workers Subject to this Order: This Order applies to the following health care workers: 
          a. All paid and unpaid employees, contractors, contract workers, students, and volunteers, who have direct patient contact or who work in patient-care areas in health care facilities listed above and the prehospital care setting (e.g., any setting in which medical care is provided prior to the patient’s arrival at a hospital). This includes, but is not limited to, physicians, nurses, aides, emergency medical personnel, ancillary health staff supporting medical and non-medical services for patient care and facility operations, including roles in laboratory, radiology, pharmacy, rehabilitation, and housekeeping. These positions range from specialized professionals like therapists and pharmacists to essential support staff such as cleaning crews, playing a vital role in the overall functioning and quality of health care delivery in hospital, long term care facilities, outpatient settings and field medical settings.
          b. Nothing in this Order shall be construed as an obligation, on the part of employers, public or private, to require employees obtain the annual influenza vaccine as a term or condition of employment.
5. Definitions. For the purpose of this Order, the following terms are defined as follows:
          a. Respiratory Virus Season. The term “Respiratory Virus Season” refers to November 1 - March 31 of each year.
6. Influenza Vaccination Requirement: All health care workers who provide care in Orange County must receive an annual influenza vaccine authorized for use in the United States for the current Respiratory Virus Season prior to or during the current Respiratory Virus Season, unless an exemption, such as for medical or religious reasons, applies.
7. Masking Guidance:
          a. Employers are required to follow California Code of Regulations, Title 8, Section 5199. Aerosol Transmissible Diseases.
          b. Outside of known aerosol transmissible diseases, during the Respiratory Virus Season, when there is evidence of high levels of respiratory viruses such as COVID-19, influenza, or respiratory syncytial virus in the community (trends indicating a rise in percent positivity, wastewater, emergency department visits, or hospitalizations), health care workers regardless of their vaccination status are strongly advised to wear masks in patient care areas as an added layer of protection. Facilities and health care workers caring for high-risk populations (immunocompromised individuals, or those at higher risk because of age or underlying conditions) can consider universal masking as an added layer of protection.
          c. During the Respiratory Virus Season, health care workers at highest risk of severe illness (extremes of age, underlying conditions, or have not received an influenza vaccine due to exemption) are strongly advised to wear a mask in patient care areas.
8. Return to Work Guidance for Health Care Workers Who Become Ill:
   Health care workers who become ill with a respiratory virus are advised to follow the California Department of Public Health’s Interim Guidance for Healthcare Personnel with Acute Respiratory Viral Infections issued January 10, 2025 which recommends that health care personnel (HCP) with suspected or confirmed respiratory viral infection, regardless of whether testing is performed, should:
          ● Not return to work until at least 3 days have passed since symptom onset* and at least 24 hours have passed with no fever (without use of fever-reducing medicines), symptoms are improving, and they feel well enough to return to work.
          ● If testing is performed that renders a positive result, but HCP is asymptomatic throughout their infection, HCP should not return to work until at least 3 days have passed since their first positive test.
          ● Wear a facemask for source control in all patient care and common areas of the facility (e.g., HCP breakrooms) for at least 10 days after symptom onset or positive test (if asymptomatic), if not already wearing a facemask as part of universal source control masking.
          ● Perform frequent hand hygiene, especially before and after each patient encounter or contact with respiratory secretions.
   *Where the first day of symptoms is day 0, making the first possible day of return to work on day 4.
9. General Provisions
          a. This Order shall not supersede any conflicting or more restrictive orders issued by the State of California or federal government. If any portion of this document or the application thereof to any person or circumstance is held to be invalid, the remainder of the document, including the application of such part or provision to other persons or circumstances, shall not be affected and shall continue in full force and effect. To this end, the provisions of this Order are severable.
          b. The Order contained in this document may be enforced by the Orange County Sheriff or Chiefs of Police pursuant to California Health and Safety Code § 101029, and California Government Code § 26602 and § 41601. A violation of a health order is subject to fine, imprisonment, or both (California Health and Safety Code § 120295).
10. Issue Date. This Order issued September 30, 2025, remains in effect until it is revised, rescinded, superseded, or amended in writing by the County Health Officer.

 

IT IS SO ORDERED:

Date: September 30, 2025

Regina Chinsio-Kwong, DO
County Health Officer
County of Orange

 

¹ (O'Halloran, Habeck, Gilmer, & et al., 2025)

² (Reinhart, Huang, Kniss, Reed, & Budd, 2025)

³ (Mehreen, et al., 2025)

⁴ (US Centers for Disease Control and Prevention, 2025)

⁵ (Grohskopf, et al., 2025)

⁶ (California Department of Public Health , 2025)

 

References

California Department of Public Health . (2025, September). Public Health for All. Retrieved from California Department of Public Health: https://www.cdph.ca.gov/Pages/public-health-for-all/publichealthforall.aspx

Grohskopf, L., Blanton, L., Ferdinands, J., Reed, C., Dugan, V., & Daskalakis, D. (2025). Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices- United States, 2025-26 Influenza Season. MMWR Morb Mortal Wkly Rep(74), 500-507. doi: https://www.cdc.gov/mmwr/volumes/74/wr/mm7434a1.htm

Mehreen, M., Garacci, Z., Razzaghi, H., de Perio, M., Laney, A., & Black, C. (2025, February 4). CDC FluVaxView- Influenza Vaccination Coverage Among Health Care Personnel- United States, 2022-23 Influenza Season. Retrieved from CDC FluVaxView: https://www.cdc.gov/fluvaxview/coverage-by-season/health-care-personnel-2022-2023.html

O'Halloran, A., Habeck, J., Gilmer, M., & et al. (2025). Influenza-Associated Hospitalization During a High Severity Season. MMWR Morb MOrtal Wkly Rep(74), 529-537. doi: https://www.cdc.gov/mmwr/volumes/74/wr/mm7434a1.htm

Reinhart, K., Huang, S., Kniss, K., Reed, C., & Budd, A. (2025). Influenza-Associated Pediatric Deaths- United States, 2024-25 Influenza Season. CDC Morbidity and Mortality Weekly Report, 74(36), 565-569. doi: http://dx.doi.org/10.15585/mmwr.mm7436a2

US Centers for Disease Control and Prevention. (2025, May 9). Preliminary Estimated Flu Disease Burden 2024- 2025 Flu Season. Retrieved from CDC Flu Burden: https://www.cdc.gov/flu-burden/php/data-vis/2024- 2025.html

 

 

 

 

 

 

 

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VERONICA KELLEY, DSW, LCSW AGENCY DIRECTOR JASON AUSTIN, MA, MFT ASSISTANT AGENCY DIRECTOR REGINA CHINSIO-KWONG, DO COUNTY HEALTH OFFICER 405 W. 5TH STREET, 7TH FLOOR SANTA ANA, CA  92701 www.ochealthinfo.com

COUNTY HEALTH OFFICER

DECLARATION OF LOCAL HEALTH EMERGENCY FOR AREAS IN
THE COUNTY OF ORANGE IMPACTED BY THE AIRPORT FIRE

WHEREAS, Health and Safety Code Section 101080 authorizes a local health officer to declare a local health emergency in the health officer’s jurisdiction affected by a threat to the public health because of an imminent and proximate threat of the introduction of any contagious, infectious, or communicable disease, chemical agent, noncommunicable biologic agent, toxin, or radioactive agent;

WHEREAS, on September 9, 2024, the wildfire labeled Trabuco Canyon Airport Fire (Airport Fire) started in Orange County near the Radio Controlled (RC) Flying Field off Trabuco Creek Road and has continued to significantly impact the public health of Orange County residents;

WHEREAS, multiple structures have been damaged by the Airport Fire, including cabins in the Holy Jim Canyon;

WHEREAS, when structures are involved in a wildfire, the combustion of building materials results in ash and debris that contain hazardous substances that must be properly handled, transported, and disposed in such a way as to minimize risk to human health;

WHEREAS, if the ash and debris generated by the Airport Fire are not properly managed, they can pose present and potential health threats through dust particles in runoff that can contaminate drinking water supplies including underground water wells in the affected area by the Airport Fire;

WHEREAS, two seasonal underground wells in the Holy Jim Canyon area have the potential of being contaminated if ash generated by the Airport Fire infiltrates the wells with rain activity;

WHEREAS, the ash and debris generated by the Airport Fire have introduced chemical agent, noncommunicable biologic agent or toxin and pose a threat to the health of Orange County residents through dust particles, runoff and impact on the drinking water supplies including water wells;

NOW, THEREFORE, the County Health Officer hereby declares a local health emergency in the areas of the County of Orange impacted by the Airport Fire.
 

 

Regina Chinsio-Kwong, DO County Health Officer

September 20, 2024 Date

 

 

 

 

 

 

 

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For the PDF English version, click here.
For translation, please click on the black "Translate" button on the top right to translate the same order displayed below.

VERONICA KELLEY, DSW, LCSW AGENCY DIRECTOR JASON AUSTIN, MA, MFT ASSISTANT AGENCY DIRECTOR REGINA CHINSIO-KWONG, DO COUNTY HEALTH OFFICER 405 W. 5TH STREET, 7TH FLOOR SANTA ANA, CA  92701 www.ochealthinfo.com

COUNTY HEALTH OFFICER

DECLARATION OF LOCAL HEALTH EMERGENCY FOR AREAS IN
THE COUNTY OF ORANGE IMPACTED BY THE AIRPORT FIRE

WHEREAS, Health and Safety Code Section 101040 authorizes the local health officer to take any preventive measure that may be necessary to protect and preserve public health from any public hazard during an emergency;

WHEREAS, Health and Safety Code, Division 101, Part 3, Chapter 2, commencing with Section 101075, authorizes the local health officer to declare a local health emergency as necessary to protect public health;

WHEREAS, Health and Safety Code Section 101080 authorizes a local health officer to declare a local health emergency in the health officer's jurisdiction, or any part thereof, affected by hazardous waste which is an imminent threat to the public health;

WHEREAS, State and local emergencies have been declared as a result of the fire known as the "Airport Fire";

WHEREAS, the potential for hazardous exposures and threats to the public and the environment exist in a major wildfire disaster, and ash and debris from destruction of structures may contain hazardous substances that pose adverse health impacts to the public;

WHEREAS, the combustion of building materials results in dangerous ash and debris that contain hazardous substances, and household hazardous substances and the improper handling, transportation, and disposal of such debris can spread hazardous substances and can lead to acute and chronic health effects and may cause long-term public health and environmental impacts; and

WHEREAS, the uncontrolled or unmanaged ash and debris can pose present and potential threats to public health through dust particles, runoff and impact the drinking water supplies including water wells.

The County Health Officer of the County of Orange hereby finds:

1. The Airport Fire that started on September 9, 2024 has created an imminent threat to public health in the County of Orange in the form of contaminated debris from household hazardous waste and materials and structural debris from the destruction of structures;
    
2. This hazardous waste debris poses a substantial present or potential hazard to human health and the environment unless its removal and disposal is performed in a manner that will protect the public health and safety; and
    
3. That the aforesaid threat to public health necessitates the declaration of the existence of a local health emergency in areas impacted by the Airport Fire in the County of Orange.

NOW, THEREFORE, the County Health Officer hereby declares a local health emergency in the areas of the County of Orange impacted by the Airport Fire.
 

 

Regina Chinsio-Kwong, DO County Health Officer

September 13, 2024 Date