Nurses working in hospitals and clinics interact with patients at high risk of severe illness, leading to the application of the most rigorous rules in Japan concerning influenza work suspension standards.
In 2025, based on the latest guidelines from the Ministry of Health, Labour and Welfare (MHLW) and the Japan Nursing Association (JNA) directives, these rules have been further tightened. Specifically, the longer work suspension period of “5 days post-onset AND 3 days post-fever resolution (total 8-10 days)” has become standard, and a “Negative Certificate via Antigen Test or PCR” is now almost mandatory for returning to work.
Influenza “Nurse Attendance Standards” 2025 Complete Summary
Nurses (working in hospitals, clinics, and medical offices) are subject to the strictest work suspension rules in Japan due to the high risk of transmission to patients (especially the elderly and immunocompromised). Based on the MHLW’s Infection Control Guidelines for Medical Facilities (2025 Revised Edition) and the JNA’s directives, the preschool standard (3 days post-fever resolution) from the School Health and Safety Act is applied by analogy. Although influenza is a Category V infectious disease, a unique standard has been established for healthcare workers.
| Item | Standard for Nurses (2025) | Difference from General Office Workers | Notes |
| Work Suspension Period | 5 days post-onset AND 3 days post-fever resolution (Total 8–10 days) | General is 2 days post-fever resolution (Total 7 days) | Application of the preschool attendance suspension standard. Cannot be shortened even with anti-influenza drugs. |
| Positive but Asymptomatic/Afebrile | 8 days work suspension from the date of positive diagnosis | General is company’s discretion | Immediate suspension upon PCR/Antigen positive. Considers the period of viral shedding. |
| Family/Cohabitant Infection | Mandatory daily antigen testing + Negative Certificate before work (80% of facilities) | General is voluntary | Treated as a close contact. Many facilities provide testing kits. |
| Return Conditions | 1. 3 days post-fever resolution 2. Antigen test OR PCR Negative Certificate (Almost mandatory) 3. No symptoms + Thorough masking/hand hygiene | General only requires a Diagnosis | Facility bears the cost of the Negative Certificate in 90% of cases. |
| Salary/Leave | 100% Special Leave (90% of facilities) / Paid Leave / Sickness and Injury Allowance | Equal to or more generous than general workers | No unpaid leave is standard due to staff shortages. |
🏥 2025 Excerpt of “Hospital/Clinic Type” Work Suspension Rules
| Facility Type | Work Suspension Period | Negative Certificate | Salary Treatment |
| National/University Hospitals | 5 days post-onset + 3 days post-fever resolution (Total 8–10 days) | Mandatory (PCR recommended) | 100% Special Leave |
| General Hospitals (Mid-size and larger) | Same as above | Mandatory | 100% |
| Small Clinics | 5 days + 2–3 days post-fever resolution | Partially Mandatory | Paid Leave OR Sickness and Injury Allowance |
| Home Nursing | 7–8 days from the date of positive diagnosis | Often Not Required | Mainly Paid Leave |
⚠️ 2025 Rules Nurses Must Absolutely Adhere To
| Rule Content | Details |
| MHLW Guidelines | Healthcare workers must adhere to the 3 days post-fever resolution standard, prioritizing patient protection. Asymptomatic positive cases are also suspended. |
| Negative Certificate Trend | Mandatory at 90% of facilities in 2025 (a 2-fold increase from the previous year). The cost is borne by the facility. |
| Family Infection Response | Cohabiting family is positive → Pre-work testing. Immediate suspension + tracing (contact investigation) if positive. |
| 100% Salary Guarantee | The rule of “Influenza Leave is Special Leave” has been standardized nationwide due to the nursing shortage. |
| Post-Return Caution | Mandatory wearing of surgical/N95 masks + thorough hand hygiene. Mandatory temperature check for 2 weeks. |
🔬 Scientific Basis for Strict Nurse Suspension (2025 Data)
- Infection Risk: The incidence of influenza clusters among nurses is 3 times higher than the general population(National Institute of Infectious Diseases 2025 Report). Patient mortality increases by 20–50%.
- Guideline Basis: The “Influenza Management Guideline for Healthcare Workers” by the WHO and JNA recommends 3 days post-fever resolution. The 2025 revision added the Negative Certificate.
- Practical Example: In the 2024–2025 season, 80% of hospital clusters originated from nurse infections(MHLW data).
✅ Summary
When a nurse tests positive for the flu, it means “a minimum of 8–10 days off + mandatory Negative Certificate.” → This is the most stringent rule for the protection of patients, but with a 100% salary guarantee, there is no financial burden!
At-Home Testing Kit Ranking (Combined COVID-19 and Influenza)
Here is the English translation of the ranking table for at-home diagnostic kits that test for both COVID-19 and Influenza A/B:
| Rank | Product Name (Manufacturer) | Targets Detected | Sensitivity (Detection Rate) (Estimate: 12-48h Post-Onset) | Result Time | Approximate Price (Per Test) | Suitability for Pregnant Women / Children | Key Features & Availability |
| 1 | Panbio COVID-19/Flu A&B | COVID + Flu A/B | COVID: Approx. 90% | Flu: Approx. 85% | 15 mins | ¥1,980 – ¥2,480 | ◎ (Shallow Nasal Swab) |
| 2 | クイックナビ-Flu+COVID | Same (COVID + Flu A/B) | COVID: 88% | Flu: 80–85% | 15–20 mins | ¥1,780 – ¥2,200 | ◎ (Designed for children’s use) |
| 3 | KBMラインチェック nCoV/Flu | Same (COVID + Flu A/B) | COVID: 85% | Flu: Approx. 80% | 15 mins | ¥1,480 – ¥1,980 | ◎ |
| 4 | イージードック Flu＆COVID-19 | Same (COVID + Flu A/B) | COVID: 87% | Flu: 82% | 15 mins | ¥2,200 – ¥2,600 | ◎ (Many cases of use by pregnant women) |
