Despite considerable influenza-related morbidity and mortality, the recent introduction of a novel influenza A/H1N1 virus, and transmission of oseltamivirresistant seasonal and (rarely) pandemic influenza A viruses, unacceptably few healthcare workers (HCWs) receive influenza vaccination [1,2]. Although evidencebased recommendations have been made to remedy this important problem, data from a recent survey by the CDC indicate that in 2007 only 44% of USA HCWs were vaccinated against influenza [3,101]. This is despite CDC recommendations since 1981 that all HCWs be vaccinated annually against influenza [4], and the significant visibility given to this issue by numerous recent calls by federal bodies and professional societies for HCWs to receive annual influenza vaccination [102]. These recommendations are derived from evidence that inf luenza vaccination of HCWs reduces influenza infection, presenteeism (reporting to work ill) and absenteeism among the vaccinees, reduces transmission to other staff and, most importantly, prevents morbidity and mortality among the patients they care for [5–8]. In addition, influenza immunization is cost effective [9]. Here, we brief ly review the problem, report proposed solutions, and provide recommendations which we believe best achieve the goals of patient safety and HCW protection. The problem Seasonal influenza epidemics result in an average of more than 200,000 hospitalizations and 36,000 deaths in the USA every year [10,11]. The total economic burden of annual influenza epidemics in the USA has been estimated at US$87.1 billion [12]. Influenza-related morbidity and mortality are significantly increased in populations served by HCWs, including the elderly, infants and young children, immunocompromised and pregnant patients, as well as those with chronic medical conditions [13].