State-by-State TB & Immunization Requirements for Travel Nurses (2026)

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Introduction

Travel nurses must navigate a complex patchwork of federal guidelines and state-specific mandates when it comes to tuberculosis (TB) screening and immunization compliance. At the federal level, CDC recommendations and OSHA regulations provide a baseline: the CDC advises TB screening (risk assessment, symptom check, and TB test) upon hire and does not recommend routine annual TB testing unless there has been an exposure or ongoing transmission (CDC, 2023). OSHA's Bloodborne Pathogens standard requires employers to offer the hepatitis B vaccine to at-risk healthcare workers (CDC, n.d.). There is no blanket federal law compelling other vaccinations for healthcare personnel, but CMS (Medicare/Medicaid) and accreditation bodies expect facilities to follow CDC's immunization guidelines for healthcare workers. (Notably, CMS had mandated COVID-19 vaccination for healthcare facility staff in 2021-22, but this federal requirement was withdrawn in 2023. (California Hospital Association, 2023))

State and Local Authorities have the power to impose additional requirements. Some states mandate specific immunizations for healthcare workers (e.g. measles/mumps/rubella or annual flu shots), while others simply require hospitals to develop their own policies consistent with CDC recommendations (CDC, n.d.). In states without explicit mandates, hospital systems almost universally require proof of immunity or vaccination for a core set of vaccines - typically MMR (measles, mumps, rubella), Varicella (chickenpox), Hepatitis B, Tdap (tetanus, diphtheria, pertussis), and seasonal influenza (TRS Healthcare) - as part of the onboarding process. Many facilities also now include COVID-19 vaccination in their employee health requirements, although these policies vary and may change with public health guidance.

Industry Trends & Compliance Challenges: The past few years have seen rapid changes - for example, TB screening practices have shifted from annual skin tests to annual symptom/risk assessments in many states, aligning with updated CDC guidelines (Bond, Schoeneck, and King, 2020). The COVID-19 pandemic prompted temporary vaccination mandates in some jurisdictions and outright bans on mandates in others, creating potential confusion. Several states (e.g. Florida, Texas, Montana) have enacted "medical freedom" laws prohibiting employers from requiring certain vaccines (especially COVID-19) as a condition of employment (Florida, Office of the Governor, 2023). On the other hand, some states maintain strict requirements for traditional vaccines like MMR or Hepatitis B in healthcare settings. For healthcare staffing managers and compliance officers, this means closely tracking each state's rules and the policies of individual health systems.

Travel nurses often must maintain a comprehensive portfolio of immunization records and TB test results to meet the most stringent requirements they might encounter. In the following sections, we summarize TB testing and immunization requirements for travel nurses in each state, including state health department mandates and common hospital policies, with distinctions between initial onboarding and ongoing compliance.

Federal Baseline Requirements (CDC/OSHA)

Before diving into state specifics, it's important to note the baseline standards that apply nationwide:

• Tuberculosis (TB): The CDC recommends all healthcare personnel receive a TB risk assessment, symptom screen, and baseline TB test (two-step tuberculin skin test or IGRA blood test) upon hire. Routine annual TB testing is no longer recommended unless a worker is exposed to TB or in a setting with ongoing transmission. Instead, personnel should receive annual education about TB and undergo symptom screening, with testing only if exposure or symptoms occur. (State regulations may differ – some still require periodic testing – but the trend is toward risk-based screening.)

• Core Immunizations (CDC Guidelines): The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that all healthcare workers have documented immunity to measles, mumps, rubella (MMR); varicella (chickenpox); hepatitis B; and pertussis (Tdap vaccine), as well as receive annual influenza vaccinations. These are considered industry-standard requirements. Additionally, COVID-19 vaccination (including boosters) is recommended for healthcare workers to reduce disease spread, though requirements for it now depend on state laws and facility policies. The OSHA Bloodborne Pathogens Standard (a federal regulation) legally requires that employers offer the hepatitis B vaccine series at no cost to any healthcare worker with potential exposure to blood or body fluids. Workers may decline but must sign a declination; if they later opt in, the employer must provide the vaccine.

• COVID-19: There is currently no federal vaccine mandate for healthcare workers (the previous CMS mandate was rescinded in 2023). However, the CDC still urges healthcare personnel to stay up-to-date with COVID-19 vaccination, and many hospitals have made it a condition of employment. State approaches vary widely – some states had their own COVID vaccine mandates for healthcare that have since expired, while others passed laws forbidding healthcare vaccine mandates. Always verify the current COVID-19 policy in the state and facility.

With this foundation in mind, we now detail each state's requirements. Each state listing distinguishes between TB screening (initial hiring vs. annual follow-up) and immunizations (what's mandated by state law vs. commonly required by hospitals). If a state's guidance is minimal, we note the prevailing hospital policies that travel nurses should expect. All states below assume that standard vaccines (MMR, Varicella, Hep B, Tdap, Flu) are required by healthcare employers unless stated otherwise.

Alabama

• TB Testing: Baseline TB testing is required at hire, with most facilities following CDC risk-based annual screening rather than mandatory yearly tests.
• Immunizations: No state vaccine list exists, but hospitals require standard HCP vaccines (MMR, Varicella, Hep B, Tdap, Flu) per CDC guidance.
• COVID-19: COVID vaccination is not state-mandated, so requirements depend entirely on the hospital system.

Alaska

• TB Testing: New hires must complete baseline TB screening, with ongoing testing typically based on exposure risk rather than annual mandates.
• Immunizations: Alaska specifically requires rubella immunity, and hospitals commonly require the full standard vaccine set.
• COVID-19: COVID vaccine policies vary by facility, with no statewide mandate.

Arizona

• TB Testing: Baseline TB testing is required for onboarding, while annual testing is generally facility-driven rather than state-mandated.
• Immunizations: Arizona has no statutory vaccine list, but hospitals require standard HCP immunizations and must offer Hep B.
• COVID-19: COVID vaccination is not mandated by the state, so facility policies apply.

Arkansas

• TB Testing: Hospitals require baseline TB clearance, with annual testing usually handled through facility policy and risk assessment.
• Immunizations: Hep B must be offered, while other vaccines are typically required through hospital onboarding standards.
• COVID-19: No statewide mandate exists, and many facilities accept alternatives like exemptions or testing.

California

• TB Testing: Baseline TB testing is mandatory, and some facilities still maintain annual screening due to Title 22 requirements.
• Immunizations: Cal-OSHA requires hospitals to offer key vaccines (MMR, Varicella, Tdap, Flu) and ensure strong flu compliance.
• COVID-19: The state mandate ended in 2023, but many hospitals still require COVID vaccination internally.

Colorado

• TB Testing: Baseline TB screening is standard, with ongoing testing typically based on CDC risk guidance.
• Immunizations: Colorado mandates strong annual flu vaccination compliance in licensed healthcare facilities.
• COVID-19: No active state mandate exists, but many health systems maintain their own requirements.

Connecticut

• TB Testing: New hires must complete TB screening, with annual testing usually replaced by symptom-based assessments.
• Immunizations: Hospitals require standard vaccines under CDC guidance, with Hep B offered per OSHA.
• COVID-19: COVID vaccine rules are employer-specific, with many systems still requiring it.

Delaware

• TB Testing: Baseline TB testing is required, with ongoing screening generally symptom-based unless exposure occurs.
• Immunizations: Delaware has no state mandate list, but hospitals require the standard immunization portfolio.
• COVID-19: COVID vaccination is not state-mandated, so facility rules govern.

Florida

• TB Testing: Baseline TB clearance is standard for employment, while annual testing is typically facility-dependent.
• Immunizations: Florida law restricts employer vaccine mandates, making most immunizations voluntary rather than enforceable.
• COVID-19: COVID vaccine mandates are prohibited for employment, so hospitals cannot require them.

Georgia

• TB Testing: Facilities require TB testing at hire, with ongoing screening generally risk-based.
• Immunizations: No state vaccine mandates exist, but hospitals require standard vaccines for credentialing.
• COVID-19: COVID policies vary widely by facility, with no state mandate.

Hawaii

• TB Testing: TB clearance is required for healthcare employment, often needing recent documentation within 12 months.
• Immunizations: Hospitals follow CDC standards and require full vaccine documentation despite no state mandate list.
• COVID-19: No statewide mandate exists, but many facilities still require vaccination.

Idaho

• TB Testing: Baseline TB screening is required, with annual testing generally not routine unless risk warrants.
• Immunizations: Idaho relies on employer policies, and hospitals still expect standard HCP immunizations.
• COVID-19: Idaho restricts COVID vaccine mandates, so requirements are typically optional.

Illinois

• TB Testing: Baseline TB screening is required, with annual testing replaced by symptom/risk assessment in most settings.
• Immunizations: Illinois requires strong facility immunization programs and annual flu vaccination offering with documentation.
• COVID-19: No active state mandate exists, but many hospitals continue internal requirements.

Indiana

• TB Testing: Baseline TB testing is required, with most facilities using CDC-style risk-based follow-up.
• Immunizations: Hospitals require standard vaccines through onboarding even without explicit state mandates.
• COVID-19: COVID requirements vary by health system, with no statewide mandate.

Iowa

• TB Testing: New hires must have TB clearance, with annual screening typically symptom-based.
• Immunizations: No state mandate list exists, but hospitals require standard vaccines and annual flu compliance.
• COVID-19: COVID mandates are limited by broad exemption protections, making requirements uncommon.

Kansas

• TB Testing: Baseline TB screening is required, with ongoing testing based on facility risk assessments.
• Immunizations: Standard vaccines are required by hospital policy rather than state statute.
• COVID-19: COVID vaccine mandates are rare due to broad exemption allowances.

Kentucky

• TB Testing: Baseline TB testing is required, with ongoing screening generally symptom-based unless exposure occurs.
• Immunizations: Hospitals require the standard vaccine set even without state mandates.
• COVID-19: COVID requirements vary, with some facilities still maintaining policies.

Louisiana

• TB Testing: TB screening is required at hire, with annual testing typically replaced by risk-based approaches.
• Immunizations: No state vaccine list exists, but hospitals require standard immunizations for staff.
• COVID-19: COVID vaccination is employer-driven, with many facilities still expecting it.

Maine

• TB Testing: Baseline TB screening is mandatory, with ongoing evaluation based on risk.
• Immunizations: Maine legally requires proof of immunity for multiple vaccines (MMR, Varicella, Hep B) for healthcare employment.
• COVID-19: COVID vaccination has been treated as a required healthcare immunization in many facilities.

Maryland

• TB Testing: TB testing is required at onboarding, with annual testing typically symptom-based.
• Immunizations: Hospitals require standard vaccines, with strong annual flu compliance expectations.
• COVID-19: Many Maryland systems continue COVID vaccination policies despite no state mandate.

Massachusetts

• TB Testing: Baseline TB screening is required, with annual testing mainly in higher-risk or LTC settings.
• Immunizations: Massachusetts enforces annual flu vaccination expectations and strong immunity documentation.
• COVID-19: Most major systems require COVID vaccination as a condition of employment.

Michigan

• TB Testing: Baseline TB clearance is required, with annual testing generally risk-based.
• Immunizations: Hospitals require standard vaccines through employee health programs.
• COVID-19: COVID requirements vary, but many large systems still enforce vaccination policies.

Minnesota

• TB Testing: New hires complete baseline TB screening, with annual testing uncommon unless exposure occurs.
• Immunizations: Standard vaccines and annual flu compliance are expected through facility policy.
• COVID-19: Many large systems continue requiring COVID vaccination for staff.

Mississippi

• TB Testing: TB screening is required at hire, with follow-up generally symptom-based.
• Immunizations: Hospitals require the standard vaccine set through onboarding policy.
• COVID-19: COVID vaccination is generally optional in most facilities.

Missouri

• TB Testing: Baseline TB testing is required, with annual testing usually limited to high-risk settings.
• Immunizations: No state mandates exist, but hospitals require standard immunizations.
• COVID-19: COVID requirements are uncommon, with most facilities treating vaccination as voluntary.

Montana

• TB Testing: Baseline TB screening remains standard despite past legal confusion around mandates.
• Immunizations: Hospitals generally require standard vaccines now that healthcare facilities are exempt from broad vaccine discrimination bans.
• COVID-19: COVID vaccination is rarely required, reflecting the state's strong personal-choice environment.

Nebraska

• TB Testing: Baseline TB clearance is required, with ongoing testing typically symptom-based.
• Immunizations: Hospitals require standard vaccines through policy rather than statute.
• COVID-19: COVID requirements are generally optional and facility-dependent.

Nevada

• TB Testing: New hires must complete TB testing, with annual screening typically risk-based.
• Immunizations: Standard immunizations are required through hospital onboarding programs.
• COVID-19: COVID policies vary by employer, with some systems still requiring vaccination.

New Hampshire

• TB Testing: Baseline TB screening is required, with annual testing uncommon unless exposure occurs.
• Immunizations: Hospitals require standard vaccines under CDC-based policies.
• COVID-19: Many facilities still require COVID vaccination as an internal policy.

New Jersey

• TB Testing: Baseline TB screening is required, with repeat testing generally risk-based.
• Immunizations: Strong flu vaccination and standard immunity documentation are expected across facilities.
• COVID-19: Many systems continue requiring COVID vaccination despite no active state mandate.

New Mexico

• TB Testing: Baseline TB clearance is required, with ongoing testing based on exposure risk.
• Immunizations: Hospitals require the standard vaccine portfolio through onboarding.
• COVID-19: Many facilities still expect COVID vaccination as part of employment compliance.

New York

• TB Testing: New York requires baseline TB testing with annual risk/symptom screening rather than routine yearly tests.
• Immunizations: Measles/rubella immunity and annual flu compliance are tightly regulated in healthcare employment.
• COVID-19: COVID vaccination has been treated as effectively required across most NY healthcare settings.

North Carolina

• TB Testing: Baseline TB screening is required, with annual testing generally replaced by symptom-based screening.
• Immunizations: Hospitals require standard vaccines through credentialing.
• COVID-19: Many major systems still require COVID vaccination for staff.

North Dakota

• TB Testing: Baseline TB testing is required, with ongoing testing usually symptom-based.
• Immunizations: Standard vaccines are expected through hospital policy.
• COVID-19: COVID mandates are uncommon due to broad exemption protections.

Ohio

• TB Testing: Baseline TB clearance is required, with annual testing typically limited to exposure-driven situations.
• Immunizations: Hospitals require standard vaccines and often enforce annual flu vaccination.
• COVID-19: COVID requirements vary, with exemptions widely available.

Oklahoma

• TB Testing: Baseline TB screening is required, with ongoing testing based on facility risk assessments.
• Immunizations: Standard immunizations are required through hospital onboarding policy.
• COVID-19: COVID vaccination is generally voluntary in Oklahoma facilities.

Oregon

• TB Testing: Baseline TB testing is required, with annual screening typically symptom-based.
• Immunizations: Hospitals require standard vaccines and strong flu compliance through policy.
• COVID-19: State mandates ended in 2023, but many facilities still maintain requirements.

Pennsylvania

• TB Testing: Baseline TB clearance is required, with annual testing mainly in LTC or high-risk settings.
• Immunizations: Hospitals require standard immunizations and annual flu vaccination through policy.
• COVID-19: Many large systems continue requiring COVID vaccination for staff.

Rhode Island

• TB Testing: Baseline TB screening is mandatory, with annual symptom evaluation required.
• Immunizations: Rhode Island enforces one of the strictest healthcare vaccine compliance frameworks (MMR, Varicella, Tdap, Flu).
• COVID-19: COVID vaccination remains strongly expected across healthcare facilities.

South Carolina

• TB Testing: Baseline TB screening is required, with ongoing testing typically symptom-based.
• Immunizations: Standard vaccines are required through facility onboarding.
• COVID-19: COVID vaccination is generally optional post-federal mandate.

South Dakota

• TB Testing: Baseline TB clearance is required, with ongoing testing largely exposure-driven.
• Immunizations: Hospitals require standard vaccines and annual flu compliance.
• COVID-19: COVID vaccination is generally voluntary in most facilities.

Tennessee

• TB Testing: Baseline TB testing is required, with annual screening usually symptom-based.
• Immunizations: Hospitals require standard vaccines through policy.
• COVID-19: Tennessee law prohibits COVID vaccine mandates for employment in most cases.

Texas

• TB Testing: Baseline TB clearance is required, with annual testing increasingly risk-based.
• Immunizations: Facilities must maintain vaccine-preventable disease policies requiring standard immunizations with exemptions allowed.
• COVID-19: Texas law prohibits COVID vaccine mandates, making vaccination voluntary.

Utah

• TB Testing: Baseline TB screening is required, with ongoing testing generally symptom-based.
• Immunizations: Hospitals require standard vaccines through employer policy.
• COVID-19: COVID mandates are limited by broad exemption protections.

Vermont

• TB Testing: Baseline TB clearance is required, with annual testing uncommon unless exposure occurs.
• Immunizations: Hospitals require standard immunizations with strong flu compliance.
• COVID-19: Many facilities still expect COVID vaccination through internal policy.

Virginia

• TB Testing: Baseline TB screening is required, with ongoing testing risk-based under infection control policy.
• Immunizations: Hospitals must maintain employee immunization programs consistent with CDC guidance.
• COVID-19: COVID requirements vary by employer, with many systems still requiring it.

Washington

• TB Testing: Baseline TB clearance is required, with annual symptom screening replacing routine yearly tests.
• Immunizations: Hospitals require standard vaccines and enforce strong flu compliance.
• COVID-19: State mandates ended in 2022, but many facilities still prefer or require vaccination.

West Virginia

• TB Testing: Baseline TB testing is required, with annual testing generally symptom-based.
• Immunizations: Hospitals require standard immunizations and strong flu compliance.
• COVID-19: COVID vaccination policies vary, with many facilities still expecting it.

Wisconsin

• TB Testing: Baseline TB clearance is required, with annual testing typically exposure-driven.
• Immunizations: Wisconsin requires rubella immunity programs, and hospitals enforce standard vaccine compliance.
• COVID-19: Many large systems continue COVID vaccination policies.

Wyoming

• TB Testing: Baseline TB screening is required, with ongoing testing generally risk-based.
• Immunizations: Hospitals require standard vaccines through facility policy.
• COVID-19: COVID vaccination is generally voluntary in most Wyoming facilities.

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If you'd like, I can convert this into a downloadable compliance checklist for staffing teams.

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Conclusion: Making Credentialing Easier in 2026

Keeping up with TB testing, immunizations, and COVID-19 requirements across 50 different states can feel like trying to pack for every climate at once. Even when state mandates are limited, individual hospital systems often have strict onboarding and ongoing compliance expectations, which means travel nurses and staffing agencies must stay organized, proactive, and ready to document everything.

This is where BlueHive can make a real difference.

With BlueHive, healthcare staffing teams can simplify the credentialing process by:

• Centralizing compliance documentation so TB test results, vaccine records, and immunity titers are always easy to access.
• Streamlining scheduling and service delivery through a nationwide provider network, helping travel nurses complete screenings quickly no matter where their next assignment is.
• Reducing delays in onboarding by automating reminders and ensuring requirements are met before day one.
• Improving visibility for hospital partners with customizable portals that help facilities confirm compliance without endless email chains.
• Supporting clinicians and employee health teams with BlueHive AI tools that reduce administrative burden and help prevent burnout.

In a staffing environment where speed matters and compliance is non-negotiable, BlueHive helps agencies move from "paperwork panic" to a smoother, more reliable credentialing experience.

The bottom line: travel nurses should be focused on patient care, not chasing down vaccination records, and staffing teams should be building workforce readiness, not wrestling with spreadsheets. BlueHive helps make that possible.

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Sources

California Hospital Association. (2023). CMS removes COVID-19 vaccination requirements for health-care workers. https://calhospital.org/cms-removes-covid-19-vaccination-requirements-for-health-care-workers/

Centers for Disease Control and Prevention. (2023, December 15). Clinical testing guidance for tuberculosis: Health care personnel. https://www.cdc.gov/tb-healthcare-settings/hcp/screening-testing/index.html

Centers for Disease Control and Prevention. (n.d.). State immunization laws for healthcare workers and patients: Immunization administration requirements for hospital employees. https://www2a.cdc.gov/vaccines/statevaccsApp/AdministrationbyPatientType.asp?PatientTypetmp=Hospital%20Employees

Florida Office of the Governor. (2023). Governor Ron DeSantis signs strongest legislation in nation for medical freedom. https://www.flgov.com/eog/news/press/2023/governor-ron-desantis-signs-strongest-legislation-nation-medical-freedom

TRS Healthcare. (n.d.). Travel nursing compliance credentials guide. https://trshealthcare.com/blog/travel-nursing/compliance-credentials-guide/

State Sources

Centers for Disease Control and Prevention. (2024). Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings. https://www.cdc.gov/tb/topic/infectioncontrol/default.htm

Centers for Disease Control and Prevention. (2024). Immunization of health-care personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

Centers for Disease Control and Prevention. (2025). Tuberculosis screening and testing of health care personnel. https://www.cdc.gov/tb/topic/testing/healthcareworkers.htm

Centers for Disease Control and Prevention. (2025). Vaccines and immunizations for healthcare workers. https://www.cdc.gov/vaccines/adults/rec-vac/hcw.html

Centers for Medicare & Medicaid Services. (2024). Infection prevention and control guidance for healthcare facilities. https://www.cms.gov/medicare/health-safety-standards

Occupational Safety and Health Administration. (2024). Bloodborne pathogens standard (29 CFR 1910.1030). https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030

Occupational Safety and Health Administration. (2024). Hepatitis B vaccination requirements. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030

State Departments of Health. (2024–2025). Healthcare worker tuberculosis and immunization requirements (individual state statutes and administrative codes). https://www.cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html

The Joint Commission. (2024). Infection prevention and control standards for hospitals. https://www.jointcommission.org/standards/standard-faqs/hospital-and-hospital-clinics/infection-prevention-and-control/

U.S. Department of Health & Human Services. (2024). Healthcare-associated infection prevention resources. https://www.hhs.gov