Healthcare Personnel Working with Flu-like Illness

Posted on by Sophia Chiu, MD, MPH

Most of the United States is experiencing widespread and intense influenza activity. Indicators used to track influenza-like-activity are higher than what was seen during the peak of the 2014-2015 season, the most recent season characterized as being of “high” severity. A NIOSH study recently published in the American Journal of Infection Control found that more than 40 percent of health care personnel with influenza-like-illness (ie, fever and cough or sore throat) continued to work while sick during the 2014-2015 influenza season.

The study used a national opt-in Internet panel survey of 1,914 healthcare personnel during the 2014-15 influenza season. The study found that 414 (22%) respondents had self-reported influenza-like illness. These healthcare workers missed a median of 2 days of work, 57% visited a medical provider for symptoms relief, and 25% were told they had influenza.

Of the 414 healthcare personnel with self-reported influenza-like illness, 183 (41%) reported working during their illness for a median of 3 days. Pharmacists (67%) and physicians (63%) had the highest frequency of working with influenza-like illness. Compared with physicians, a lower proportion of assistants and aides (41%), nonclinical healthcare providers (40%), nurse practitioners/physician assistants (38%), and other clinical healthcare providers (32%) reported working with influenza-like illness.

Working while ill, or presenteeism, increases the likelihood of influenza transmission to coworkers and patients. The five most common reasons cited for working with influenza-like illness were “I could still perform my job duties,” “I wasn’t feeling bad enough to miss work,” “I did not think I was contagious or could make other people sick,” “I have a professional obligation to my coworkers,” and “It is difficult for me to find someone to cover for me.” Healthcare personnel in long-term care settings most frequently cited “I could not afford to lose the pay.”

CDC recommends that personnel be excluded from work until at least 24 hours after they no longer have a fever without the use of anti-pyretics. Workers with respiratory symptoms without fever, or who have ongoing respiratory symptoms, may require evaluation by occupational health. Given that more than half of healthcare personnel with influenza-like illness sought medical attention, clinical encounters are opportunities for medical providers to reinforce recommendations to HCP to refrain from working with influenza-like illness.

For people who have not already received seasonal influenza vaccination, the Centers for Disease Control and Prevention recommends annual vaccination against seasonal influenza for all persons 6 months of age and older who do not have a medical reason for not getting a flu shot, including healthcare providers.


Sophia Chiu, MD, MPH, is a Medical Officer in the NIOSH Division of Surveillance, Hazard Evaluations, and Field Studies.


For More Information

NIOSH Topic Page: Influenza (Flu) in the Workplace

CDC:  Prevention Strategies for Seasonal Influenza in Healthcare Settings



Posted on by Sophia Chiu, MD, MPH

4 comments on “Healthcare Personnel Working with Flu-like Illness”

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    Only because they have to, even though the employer says to stay home if you have a fever of 101 and not feeeling good, but that’s just to their themselves sort of a CYA , just like bad blizzard storms, they say to stay home if you don’t feel safe or come in to the work area and tell you, you can go home , usually at the height of the storm and you’ve been their for 6 hour working, sure they will let you go with no pay or you can make it up or you can use your pto, lol such a caring institution or facility you work for, anyway . You call out and when return to work your gaslighted by the supervisor and all of management, your return becomes a living hell. As for me I’d rather share with my fellow coworkers and the place I picked it up at. Maybe if they (employer) would steamclean their carpets and ventilation system once in a while this could be avoid. Tests confirmed mold and bacteria from their test and my private testing. But that’s swept under the carpet, lol.

    In Denmark, it very different. employes are incuraged to stay home, if they feel flu symptoms, to prevent spread.
    There is of cause a limit to how many times in a year you can call in sick.

    Kind regards

    Many hospital systems penalize healthcare workers who call in sick, so workers are likely to come to work sick. Then these employers permit clearing sick workers to remain on their jobs. This occurred widely during H1N1 in 2009, even as CDC and state health departments urged workers to stay home. NIOSH should investigate the role of these employer policies and make recommendations for their elimination.

    The fall brings with itself allergies of the cold. There are more than 100 different types of cold viruses and when we contract them we get different types of symptoms. However, most have the same characteristics which include stuffy nose, running nose, sore throat, sneezing, itchy eyes, body pain, fever and headache. Dr.Morlawar

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Page last reviewed: April 14, 2020
Page last updated: April 14, 2020