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Predetermined medical contraindications include hypersensitivity to eggs, prior hypersensitivity reaction to influenza vaccine, and history of Guillan-Barré syndrome.

Medical exemption requests were reviewed by occupational health nurses and their medical directors.

Fewer employees sought medical or religious exemptions than had signed declination statements during the previous year.

A standardized medical exemption request form would simplify the request and review process for employees, their physicians, and occupational health and will be used next year.200,000 hospitalizations in the United States annually [1, 2].

Reasons for medical exemption included allergy to eggs (107 [33%]), prior allergic reaction or allergy to other vaccine component (83 [26%]), history of Guillan-Barré syndrome (15 [5%]), and other (116 [36%]), including 14 because of pregnancy.

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