Occupational immunization strategies: integrating evidence, bioethical principles, and occupational health practice to improve adult vaccination uptake

**Background:** Vaccination is a key element of occupational health programmes, especially for workers exposed to infectious hazards and those caring for people at high risk of severe vaccine-preventable disease. Uptake depends on access, organizational and behavioral factors, confidence, and legal and ethical context. **Objective:** To synthesize evidence on occupational immunization strategies for healthcare workers and other groups with relevant biological exposure, integrating clinical, organizational, behavioral, ethical, and legal considerations. **Methods:** A structured narrative review examined literature and official guidance on occupational and adult vaccination, workplace interventions, vaccine hesitancy, biological risk, informed consent, and vaccination policy. Evidence from January 2020 to February 2025 was prioritized, supplemented by key earlier studies and authoritative legal and policy documents. Heterogeneous findings were synthesized thematically. **Results:** Systematic reviews and meta-analyses suggest that multicomponent interventions can improve healthcare-worker vaccination uptake, although effects vary by setting, vaccine, baseline coverage, and implementation. Convenient access, reminders, active invitation, and behavioral facilitation are most useful when paired with credible communication and institutional support. Ethical and legal sources stress proportionality, informed consent, confidentiality, equity, and context-specific assessment of restrictive policies. Spanish occupational-health law centers prevention on risk assessment and worker protection while safeguarding health surveillance and confidentiality. **Conclusions:** Occupational vaccination should form part of biological-risk management rather than operate solely as an annual campaign. The most transferable model combines risk assessment, equitable access, behavioral support, evidence-based counseling, confidentiality, and continuous evaluation. Restrictive measures require separate legal and ethical assessment and should not be generalized across jurisdictions or occupational settings.