New York is requiring anyone who might come in contact with patients at hospitals and other health care facilities to get a vaccine or wear masks during the upcoming flu season, an ambitious effort to control the flu in the places it is known to spread.

The New York Health Department rule applies to more than 4,000 hospitals, clinics, diagnostic centers, nursing homes, hospices and home care agencies statewide. And it specifically applies beyond doctors and nurses to students, volunteers, contractors and even some cafeteria workers.

"I've never missed a year. I already got mine," said Dr. Dennis McKenna, medical director at Albany Medical Center and since 1997 a physician in the emergency room where he's exposed to cases coming through the door. "I've never gotten the flu."

McKenna also cited good precautionary measures. They typically include hand-washing, keeping work areas clean and avoiding the droplets spread by infected patients coughing, sneezing and touching objects.

Health facilities are required to document their employee compliance and vaccination status during the flu season, which ran from late November to April last year. The rules carry no immediate penalties or sanctions and do not apply to hospital visitors.

Albany Medical Center, with about 7,000 employees, provides the vaccine free to anyone who works or volunteers there, McKenna said. It had a 70 percent vaccination rate last year, higher than the statewide average. The hospital is not mandating shots, but those who opt out will have to wear masks, and the hospital has acquired a large supply.

New York recorded 45,352 confirmed cases and 9,537 patients hospitalized with influenza last season, when the flu was considered widespread for 22 weeks and cited in 14 pediatric deaths. After a spike in flu cases in January, Gov. Andrew Cuomo declared a public health emergency.

The flu vaccine takes about two weeks to establish virus-resistant antibodies. The vaccine typically contains three common strains of flu virus. Federal health officials said last year's vaccine was about 62 percent effective at preventing infections.

Rhode Island adopted a similar policy last year with a provision to fine both workers and facilities $100 for each violation, said Alexandra Stewart, health policy professor and researcher at George Washington University. The state did not collect any fines and saw a substantial increase in the number of workers who were vaccinated, she said.

Seventeen other states have regulations, mostly requiring hospitals provide flu shots free to staff and some requiring immunizations or else individual exemptions because of health concerns or religious beliefs, according to the U.S. Centers for Disease Control. The CDC says the shots are safe, have not been shown to harm pregnant women or their babies, and do not raise the risk of Guillain-Barre syndrome, a rare immune system disorder that can damage nerves. A study showed that the 1976 swine flu vaccine resulted in a small increased risk for the syndrome.

The agency collects reports on adverse vaccine reactions, showing 457 serious incidents out of 122 million doses distributed last season, including 31 cases of severe allergic reactions or seizures in those suspected of having egg allergies and 72 of Guillain-Barre.

Several unions representing health care workers opposed New York's regulation, calling the requirement coercive. While recommending its members get vaccinated for their protection, the New York State Nurses Association said "the prudent strategy" is to provide for paid sick time so sick personnel can stay home while they're infectious.