A Missouri nurse has been fired for not getting a flu shot.

The woman–who has not been named–had previously been granted a religious exemption for her annual vaccine. But after her hospital was acquired by another this year, her request was declined, the St. Louis Post-Dispatch reported.

In a statement, the hospital said it granted most of the 170 requests for medical or religious exemptions it received this year, but in the cases where a request was declined, employees were notified this week.

“The point of our flu vaccination policy is simple: Protection against the flu virus saves lives, especially those of our most vulnerable patients,” the statement says. “Requiring health care co-workers to be vaccinated for the flu is a best practice across the U.S. to ensure the safety of patients, co-workers, and community members.”

It’s actually quite common for health care facilities to do just that. According to a 2018 study published in JAMA Network Open, more than 60% of hospitals in the U.S. now require influenza vaccination among their employees. The Centers for Disease Control and Prevention (CDC) continues to recommend annual flu vaccines for health care workers, writing: “Since health care workers may care for or live with people at high risk for influenza-related complications, it is especially important for them to get vaccinated annually.”

Last year, 78% of health care professionals were vaccinated against the flu, according to the CDC. (Compare that to about 47% of the general population.) Perhaps unsurprisingly, that number was even higher among employees of health care facilities that require vaccination at 94.8%.

Demonstrators outside of the hospital were angered by this mandatory vaccination policy, but infectious diseases experts have called out religious exemptions as “bogus.” Which made us wonder: What is an acceptable reason to not get the flu shot, considering it’s still the best option we have to prevent the spread of and complications from the flu? Here’s what the CDC says.

If you're too young

Plain and simple: The flu shot is not approved for kids younger than 6 months. The nasal spray flu vaccine is not approved for kids under 2 and adults over 50. (Pregnant women should not get the nasal spray vaccine either, but they’re all clear for the shot.)

If you have a life-threatening allergy

Anyone who has ever had a severe allergic reaction to the flu vaccine or any of its ingredients should not get the vaccine. “This might include gelatin, antibiotics, or other ingredients,” according to the CDC. (People with egg allergies can and should get vaccinated.)

If you're currently really sick–but don't worry, you can get it later

If you just have a case of the sniffles on the day you were planning to get your flu shot, you’re probably A-OK to go ahead and get vaccinated as scheduled. But if you’re really sick–especially with flu-like symptoms–your health care provider might tell you to hold off “to avoid confusing signs and symptoms of their illness with side effects of the vaccine,” Aidtya Gaur, MD, associate faculty member in the infectious diseases department at St. Jude Children’s Research Hospital in Memphis, Tennessee told Health in a prior interview. If that’s the case, reschedule for after you’ve recovered.

Other people need to talk to their doctors before getting a flu shot

Some people with the autoimmune disease Guillain-Barré syndrome should not get the flu vaccine, although others still can. Have a convo with a health care provider if you have a history of GBS before getting your shot or spray.

There are also a handful of other restrictions on who can and cannot get the flu vaccine nasal spray specifically. That includes people with certain health conditions and who are taking certain medications, for example. Depending on your personal situation, your doctor may tell you you’re better suited to the shot.

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