A controversial new mandate will force thousands of health care workers in Contra Costa and Santa Clara counties to get flu shots this fall -- or wear a mask at work the entire influenza season.

San Francisco and Sacramento counties already have similar mask mandates aimed at curbing the spread of the deadly disease and convincing health care workers to practice what they preach. Alameda County is considering a similar rule.

While patient advocates applaud the new requirement, a nurses union said forcing employees to wear a mask on the job for five months of the year is ineffective and would stigmatize them with a scarlet letter.

The mandate comes after an analysis by this newspaper in December revealed that nearly one-third of employees at many Bay Area hospitals failed to get a flu shot during the 2010-11 season, and at some institutions, half of workers were unprotected.

"This is really to protect the most frail, and persons at highest risk in these facilities," said Dr. Marty Fenstersheib, health officer for Santa Clara County.

"The vaccine compliance rates in health care workers are just too low."

The new rule applies to all employees who have contact with patients in hospitals, clinics, ambulance companies, adult day health centers, nursing homes and other health facilities.

The national Centers for Disease Control and Prevention recommends that nearly everyone age six months and older receive a flu vaccination

Each year in the United States, five to 15 percent of people become ill with the flu, and nearly 36,000 die. Seniors, infants, pregnant women and those with chronic health conditions are at greatest risk.

Fenstersheib issued an order in July imposing the vaccination mandate for the upcoming flu season in Santa Clara County, from Nov. 1 to March 31.

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Health care workers in Santa Clara county must get flu shot or wear a mask