Why are the Clinical Risk Groups at Risk?
Nurse Jenny Greenfield, Flu Lead/Lead Nurse Cervical Screening Improvement, Public Health Directorate, discusses why people in certain risk groups should have a flu vaccine to avoid the risk of serious illness.
| At Risk Group (Flu vaccination recommended from age six months or older) | Examples (this list is not a complete list - your GP or Practice Nurse will make a decision based on their clinical judgement and the latest advice from the Chief Medical Officer and the Department of Health, Green Book) | Risk |
| Chronic respiratory disease | People with chest problems, including asthmatics on steroid inhalers or steroid tablets, those with chronic bronchitis and emphysema and children who have previously been hospitalised for lower respiratory tract disease.1 | Illnesses that affect the lungs (known as respiratory diseases) also reduce someone's ability to cough, which can lead to a build up of fluid in the lungs and reduce how much oxygen is available. The flu virus can then get deep into the lungs and multiply. Patients are also prone to repeat infections, which can inflame the lungs and can make the condition worse.2 Finally, having flu puts the patient at risk of other complications, particularly pneumococcal infection.3 |
| Chronic heart disease | Congenital heart disease, high blood pressure (hypertension) with cardiac complications, chronic heart failure, those needing regular medication and/or follow up for ischaemic heart disease.1 | Heart disease stops the heart from pumping blood as well as it should and stops it picking up oxygen from the lungs. This can allow fluid to build up which makes it harder to clear the flu virus from the body. Infection with flu has also been linked to an increased risk of heart attack in such patients.4 Finally, having flu puts the patient at risk of other complications, particularly infection.3 |
| Chronic kidney disease | Chronic kidney disease at stage 3, 4, or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation.1 | Kidney disease puts patients at an increased risk of picking up infection, and infections are the second most common cause of death in such patients.5 Infection with flu could increase the risk of serious illness and the patient may need hospital treatment.5 Finally, having flu puts the patient at risk of other infections, particularly pneumococcal infection.3 |
| Chronic liver disease | Cirrhosis, biliary atresia, chronic hepatitis.1 | Flu could affect how well the liver is able to work in patients with chronic liver disease and could even damage the liver further. Liver disease also affects which flu treatment can be given to a patient, so prevention is better than trying to treat the illness. Finally, having flu puts the patient at risk of other complications, particularly pneumococcal infection.3 |
| Chronic neurological disease | Stroke, transient ischaemic attack (TIA), conditions where respiratory functions may be compromised. Clinicians should consider the individual needs of patients with cerebral palsy, multiple sclerosis and related or similar conditions, hereditary and degenerative diseases of the nervous system or muscles or severe neurological disability.1 | People with chronic neurological disease are likely to have an immune system that is weakened - making them more prone to infection.7 Also, children with neurological disease who get flu are at risk of breathing problems as their lungs may not function as well as they should.8 |
| Diabetes | Type 1 diabetes, Type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes.1 | Infection with flu can lead to a loss of control of diabetes, which could require a hospital stay.9 As diabetes changes the blood sugar levels and affects the patient's ability to fight off disease, bacteria can grow in the blood (septicaemia) and affect other organs.10 Finally, having flu puts the patient at risk of other complications, particularly pneumococcal infection.3 |
| Immunosuppression | Due to disease or treatment. Patients undergoing chemotherapy leading to immunosuppression; asplenia or splenic dysfunction; HIV infection at all stages; patients treated or likely to be treated with steroids at a dose equivalent to prednisolone at 20mg or more per day (any age) or for children less than 20kg a dose of 1mg or more per kg per day.1 | An immune system which has been suppressed could be overwhelmed by an infection like flu. Such patients could have repeat infections as their body is less able to build up immunity to the virus.11 Finally, having flu puts the patient at risk of other complications, particularly pneumococcal infection.3 |
| Pregnant women | All pregnant women at any stage of pregnancy.1 | Pregnant women are at increased risk of serious complications of influenza.12 |
| Those aged 65 and over | The immune system in the elderly is not as effective when compared to that of younger people, making the elderly at greater risk from infection.13 |
1. Department of Health. Immunisation again infectious disease. (Green Book) May 2011. TSO
2. Wesseling G. Occasional revew: influenza in COPD: pathogenesis, prevention and treatment. Int J Chron Obstruct Pulmon Dis. 2007;2(1):5-10
3. Musher DM. In Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 4th Edition Churchill Livingstone; 1995 p1811-1826
4. Corrales-Medina VF, Madjid M, Musher DM. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis 2010; 10:83-92
5. Kausz AT, Gilbertson DT. Overview of vaccination in chronic kidney disease. Advances in Chronic Kidney Disease 2006; 13(3): 209-214
6. Duchini A, et al. Influenza Infection in Patients Before and After Liver Transplantation. Liver Transplantation 2000; 6(5): 531-542
7. Harms H, Halle E, Meisel A. Post-stroke infections - Diagnosis, Prediction, Prevention and Treatment to Improve Patient Outcomes. Eur Neur Review 2010, 39-43
8. Keren R, Zaoutis TE, Bridges CB, Herrera G, Watson BM, Wheeler AB, Licht DJ, Luan XQ, Coffin SE. Neuro-logical and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection. JAMA. 2005 Nov 2;294(17):2188-94
9. Brydak LB, Machala M. Humoral immune response to influenza vaccination in patients from high risk groups. Drugs 2000; 60(1): 35-53
10. Smith SA, Poland GA. Use of influenza and pneumococcal vaccines in people with diabetes. Diabetes Care. 2000; 23(1):95-108
11. The Merck Manual of Patient Symptoms. App II. The Immunosuppressed Patient
12. Whitley R, Monto A. Prevention and Treatment of Influenza in High Risk Groups: Children, Pregnant Women, Immunocompromised Hosts, Nursing Home Residents. JID 2006:194 (Suppl 2) S133-S138
13. Aw D, Silva AB, Palmer DB. Immunosenescence: emerging challenges for an aging population. Immunology 2007;120:435-446