Can you be fired for refusing a flu shot?

File photo of H1N1 flu shot.

Missouri is beginning to receive doses of the H1N1 flu vaccine. That has some companies considering new policies to keep their employees healthy.

But can your employer force you to get a swine flu shot? And what happens if you refuse?

The H1N1 flu has created a few new problems for HR departments who have to juggle their needs with their employees' health concerns.

If you don't want to get a swine flu vaccine, your employer does in fact have the right to fire you, according to Amy Susan, with the Missouri Department of Labor.

"The employer can change the terms and conditions at any time," said Susan. "And again the employee can either adhere to those terms and conditions or refuse them and face termination."

Susan says employers can mandate that you get a flu shot with a couple exceptions. For example, if getting the shot violates your religious beliefs or if you're allergic to vaccines.

Because Missouri is an employment "at-will" state, you can be fired at any time for any reason - as long as you're not being discriminated against by state and federal laws, like the Americans with Disabilities Act.

So will an employer fire you for refusing a flu shot? Perhaps. But it's more likely they'll recommend you get one instead of canning you for saying no.

"We haven't heard anything yet," said Susan. "Simply because this is something new to our state and new to the country. And we're all experiencing these questions and trying to figure out how to deal with them."

Still, employers do have reason to be fearful. A recent study found that a mild pandemic affecting 1.4 million people could cost the global economy $330 billion.

The H1N1 flu vaccine will be administered primarily as a nasal spray. But there will be injections available for people who are at higher risk, including pregnant women and those with compromised immune systems.