October 7, 2020
DEPARTMENT OF HEALTH
PO BOX 360
TRENTON, N.J. 08625-0360
www.nj.gov/health
TO: Administrators of general hospitals, special hospitals, nursing homes, and
home health care agencies
FROM: Judith M. Persichilli, R.N., B.S.N., M.A.
Commissioner
RE: Compliance with N.J.S.A. 26:2H-18.79 - Influenza vaccination in health
care facilities
On January 13, 2020, Governor Murphy signed P.L. 2019 c. 330 (codified at
N.J.S.A. 26:2H-18.79 and referred to hereafter as “the Statute”). The Statute requires
certain healthcare facilities to establish and implement an annual influenza vaccination
program. The New Jersey Department of Health (Department) is required by the
Statute to promulgate rules and designate a medical exemption form to be distributed to
the covered healthcare facilities. This memo and the attached form are intended to
assist general or special hospitals, nursing homes (long-term care facilities licensed
pursuant to N.J.A.C. 8:39), and home health care agencies, collectively referred to as
"facility" or "facilities," in understanding and meeting their obligations under the Statute,
until the rules and the medical exemption form can be adopted through rulemaking.
While the Department is in the process of developing the rules and the final
medical exemption form, the attached form, entitled "Medical Exemption Statement for
Health Care Personnel," must be placed on facility letterhead and used as the medical
exemption form required under the Statute.
Providing Influenza Vaccination
Each facility shall provide an on-site or off-site influenza vaccination to each of its
employees. The vaccine must be administered to all employees before December 31,
2020. Employees who wish to receive the influenza vaccine outside the facility must
receive the vaccination and provide an attestation to the facility which includes the lot
number of the vaccine before December 31, 2020. The employee attestation shall be
submitted in a form and manner designated by the facility.
P
HILIP
D.
M
URPHY
Governor
SHEILA Y. OLIVER
Lt. Governor
J
UDITH
M.
P
ERSICHILLI
,
RN,
BSN,
MA
Commissioner
2
Covered Employees
All facility employees are required to be vaccinated, including employees who are
not responsible for direct patient care. Per diem and contract employees are to be
considered facility employees and are required to be vaccinated.
Medical Exemption Form
The attached form is to be placed on your facility’s letterhead and used as the
medical exemption form.
Medical Exemption Review
Facilities are required to review and confirm each medical exemption to ensure
the exemption is consistent with standards enumerated by the Advisory Committee on
Immunization Practices, which can be found at: https://www.cdc.gov/vaccines/hcp/acip-
recs/vacc-specific/flu.html.
Record Keeping
Facilities must maintain a record or attestation, as applicable, of influenza
vaccinations and medical exemptions for each employee. The Department will address
through rulemaking proper procedures for submitting data to the Department.
Non-vaccinated Staff
The facility must require any employee who does not receive an influenza
vaccination to wear a surgical or procedural mask when in direct contact with patients
and in common areas, as specified in facility policy, or to be removed from direct patient
care responsibilities during influenza season.
Educational Program
The Statute requires facilities to provide an educational component that is
designed to inform employees about: influenza vaccination; non-vaccine influenza
control measures; and the symptoms, transmission, and potential impact of influenza.
Facilities are to begin creating and implementing an educational component
immediately. Facilities are to annually evaluate the program with the goal of increasing
rate of vaccination among its employees.
Influenza Vaccine
_______________________________________________________________________________________________________________________________________
Medical Exemption Statement for Health Care Personnel
Instructions:
1. Complete information (name, DOB, etc.).
2. Complete contraindication/precaution information.
3. Complete date exemption ends, if applicable.
4. Complete medical provider information. Retain copy for file. Return original to facility or person requesting form.
Name of Health Care Facility_____________________________________________________________________________________
Guidance for medical exemptions for influenza vaccination can be obtained from the contraindications, indications, and
precautions described by the most recent recommendations of the Advisory Committee on Immunization Practices (ACIP)
available in the Centers for Disease Control and Prevention publication, Morbidity and Mortality Weekly Report. They can be
found at the following website: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html.
Contraindications are conditions that indicate when vaccines should not be given. A contraindication is a condition that
increases the chance of a serious adverse reaction. A precaution is a condition that might increase the chance or severity of
an adverse reaction or compromise the ability of a vaccine to produce immunity. An indication is a condition that increases
the chance of serious complications due to influenza infection. If an individual has an indication for influenza vaccination, it is
recommended that they be immunized.
The following are not considered contraindications to influenza vaccination:
• Minor acute illness (e.g., diarrhea and minor upper respiratory tract illnesses, including otitis media).
• Mild to moderate local reactions and/or low-grade or moderate fever following a prior dose of the vaccine.
• Sensitivity to a vaccine component (e.g. soreness, redness, itching, swelling at the injection site).
• Current antimicrobial therapy.
• Disease exposure or convalescence.
• Pregnant or immunosuppressed person in the household.
• Breastfeeding.
• Family history.
• Any condition which is itself an indication for influenza vaccination.
Contraindications to all influenza vaccines include the following:
• Severe allergic reaction after a previous dose or to a vaccine component.*
Precautions to all influenza vaccines include the following:
• History of Guillain Barré Syndrome.
• Current moderate or severe acute illness with or without fever (until symptoms have abated).
*A severe allergic reaction is characterized by a sudden or gradual onset of generalized itching or erythema (redness), hives; angioedema
(swelling of the lips, face or throat); severe bronchospasm (wheezing); shortness of breath; shock; abdominal cramping; or cardiovascular
collapse.
3 Date exemption ends (only if applicable):
4 By signing below, I affirm that I have reviewed the current ACIP Contraindications and Precautions and that the stated
contraindication(s)/precaution(s) is/are enumerated by the ACIP and consistent with established national standards for
vaccination practices. I understand that I might be required to submit supporting medical documentation. I also understand
that any misrepresentation might result in referral to the New Jersey State Board of Medical Examiners and/or appropriate
licensing/regulatory agency.
Healthcare Provider Name (please print): _________________________________________________________
Specialty: ____________________________________
NPI Number: ______________________________License Number: ____________________________________
State of Licensure: ___________________________________________Phone: ___________________________
Fax: ______________________________________Email: ____________________________________________
Address: ___________________________________________________________City: _____________________
State: ____________________________________Zip: _______________________________________________
Signature: __________________________________________________Date: ____________________________
For Facility Use ONLY Medical Exemption Status: Accepted Not Accepted
Reason:
Date
