The Department of Health, 2011 recommendations for the administration of influenza vaccines include the following 'at risk' categories.
- aged 65 or over
- all those aged six months or over in a 'clinical risk' group
- pregnant women
- living in long-stay residential care homes or other long-stay care facilities
- those in receipt of a carer's allowance, or who are a main carer of an elderly or disabled person
- health and social care staff directly involved in patient care
Clinical risk groups:
Chronic respiratory disease
Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission. Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Children who have previously been admitted to hospital for lower respiratory tract disease.
Chronic heart disease
Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease.
Chronic kidney disease
Chronic kidney failure, nephrotic syndrome, kidney transplantation.
Chronic liver disease
Cirrhosis, biliary artesia, chronic hepatitis.
Chronic neurological disease
Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised (e.g. polio syndrome sufferers).
Clinicians should consider on an individual basis the clinical needs of patients including individuals with cerebral palsy, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles.
Diabetes
Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes.
Immunosuppression
Immunosuppression due to disease or treatment. Patients undergoing chemotherapy leading to immunosuppression. Asplenia or splenic dysfunction, HIV infection at all stages. Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age) or for children under 20kg a dose of 1mg or more per kg per day.
It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of influenza and should be offered flu vaccination. This decision is best made on an individual basis and left to the patient’s clinician. Some immunocompromised patients may have a suboptimal immunological response to the vaccine.
Pregnant women
All pregnant women should receive the influenza vaccine for the 2010/11 influenza season. Pregnant women are at increased risk from the H1N1v strain, which is expected to be the predominant circulating influenza strain in the 2010/11 influenza season and they may not be protected should they not have already received influenza A (H1N1)v containing vaccine.
Generally fit and healthy, people under 65 years old who don’t fall into any of the ‘clinical risk’ categories, should not need a vaccine.