Risk groups

Clinical risk groups

Those with certain long-term conditions should have a flu jab annually. Some health conditions make people more vulnerable to becoming seriously ill if they develop flu. This is why the Department of Health advises the following groups to have a flu jab every year:1

  • CHRONIC LUNG CONDITIONS

    For people with chronic lung conditions, flu can bring on asthma attacks and will make chronic bronchitis much worse. If they get flu, a secondary infection like pneumonia can set in. If they go on to develop pneumonia, the risk of developing further complications could be higher.2

    Some examples of chronic lung conditions include asthma, chronic obstructive pulmonary disease (COPD), bronchitis, emphysema, cystic fibrosis.

  • CHRONIC HEART, KIDNEY, OR LIVER DISEASE

    Changes or abnormalities in heartbeat rhythm may be experienced with flu, which indicates a possible problem with the heart muscles.3 Studies have suggested that people with heart disease are less likely to have a heart attack if they have a flu jab, compared to those that develop flu.4

    For people with chronic kidney disease, contracting flu can make their condition worse.5

    For people with liver disease, contracting flu may increase the likelihood of developing complications or worsen their condition.6

    Some examples of these conditions include chronic heart failure, high blood pressure with heart complications, chronic kidney failure, hepatitis, liver cirrhosis.

  • DIABETES

    The death rate among people with diabetes can increase by between 5% and 15% when there is a flu outbreak.7

    This includes people with both type 1 and type 2 diabetes.

  • LOW IMMUNE SYSTEM

    If someone is receiving chemotherapy or steroid treatment, have no spleen, or if they have HIV/AIDS, their immune system is already considerably weakened. Contracting flu will further reduce their capacity to fight infections.1

    This includes people whose immune system has been affected by illness (such as HIV), by the absence of a spleen or a spleen that does not work correctly, or by treatment such as chemotherapy or steroid treatment.

  • NEUROLOGICAL CONDITIONS

    There is evidence that receiving the annual flu jab reduces the risk of a stroke in patients with a history of stroke.8

    Some examples of people with these conditions include stroke and transient ischaemic attack (TIA).

For people with chronic lung conditions, flu can bring on asthma attacks and will make chronic bronchitis much worse. If they get flu, a secondary infection like pneumonia can set in. If they go on to develop pneumonia, the risk of developing further complications could be higher.2

Some examples of chronic lung conditions include asthma, chronic obstructive pulmonary disease (COPD), bronchitis, emphysema, cystic fibrosis.

Changes or abnormalities in heartbeat rhythm may be experienced with flu, which indicates a possible problem with the heart muscles.3 Studies have suggested that people with heart disease are less likely to have a heart attack if they have a flu jab, compared to those that develop flu.4

For people with chronic kidney disease, contracting flu can make their condition worse.5

For people with liver disease, contracting flu may increase the likelihood of developing complications or worsen their condition.6

Some examples of these conditions include chronic heart failure, high blood pressure with heart complications, chronic kidney failure, hepatitis, liver cirrhosis.

The death rate among people with diabetes can increase by between 5% and 15% when there is a flu outbreak.7

This includes people with both type 1 and type 2 diabetes.

If someone is receiving chemotherapy or steroid treatment, have no spleen, or if they have HIV/AIDS, their immune system is already considerably weakened. Contracting flu will further reduce their capacity to fight infections.1

This includes people whose immune system has been affected by illness (such as HIV), by the absence of a spleen or a spleen that does not work correctly, or by treatment such as chemotherapy or steroid treatment.

There is evidence that receiving the annual flu jab reduces the risk of a stroke in patients with a history of stroke.8

Some examples of people with these conditions include stroke and transient ischaemic attack (TIA).

Recommended groups

In addition to the clinical risk groups above, there are other age groups and/or people with certain conditions who are recommended to have a flu jab1,9 to help them avoid the flu.

  • PREGNANT WOMEN

    There is good evidence that pregnant women are at increased risk from complications if they get flu. There is also evidence that flu during pregnancy may be associated with premature birth and smaller birth size and weight. Additionally, a flu jab may reduce the likelihood of prematurity and smaller infant size at birth.9 This includes women at any stage of their pregnancy.

  • AGED 65+

    Death from flu is most common in people over 65 – they are more likely to have complications and be admitted to hospital than younger patients.10,11

  • CHILDREN

    Children are ‘super spreaders’ of flu (commonly picked up or spread at school or nursery), so by cutting down the number of cases of flu in children, fewer cases will be passed onto adults who might be at greater risk from flu.9 Remember, any child who falls into any of the clinical risk categories should have a flu jab.

There is good evidence that pregnant women are at increased risk from complications if they get flu. There is also evidence that flu during pregnancy may be associated with premature birth and smaller birth size and weight. Additionally, a flu jab may reduce the likelihood of prematurity and smaller infant size at birth.9 This includes women at any stage of their pregnancy.

Death from flu is most common in people over 65 – they are more likely to have complications and be admitted to hospital than younger patients.10,11

Children are ‘super spreaders’ of flu (commonly picked up or spread at school or nursery), so by cutting down the number of cases of flu in children, fewer cases will be passed onto adults who might be at greater risk from flu.9 Remember, any child who falls into any of the clinical risk categories should have a flu jab.

Occupational and carer groups

People in that are in regular contact with others at risk or who may already have flu, due to occupation or living arrangements, are also recommended to have a flu jab.1,9

Those with direct patient contact are advised to have the flu jab to help protect people in their care at greater risk from the effects of flu.9

Flu can spread rapidly from person to person when there are many people living in close quarters, such as in care homes.1 This does not include university halls of residence.

Carers (i.e. people who look after someone who wouldn’t be able to get by without their help) are advised to have a flu jab to help protect those they are caring for.1

  • HEALTH AND SOCIAL CARE WORKERS

    Those with direct patient contact are advised to have the flu jab to help protect people in their care at greater risk from the effects of flu.9

  • CARE HOMES

    Flu can spread rapidly from person to person when there are many people living in close quarters, such as in care homes.1 This does not include university halls of residence.

  • CARERS

    Carers (i.e. people who look after someone who wouldn’t be able to get by without their help) are advised to have a flu jab to help protect those they are caring for.1

If you are unsure whether you should have a flu jab, contact your GP surgery or ask your local pharmacy team for advice.

References

  • 1.Public Health England. Influenza: the green book, chapter 19. 1 December 2017. https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19.
  • 2.Mallia P, Johnston SL. Int J Chron Obstruct Pulmon Dis. 2007; 2: 55-64.
  • 3.Chang TY, et al. Heart Rhythm 2016; 13: 1189-94.
  • 4.Macintyre CR, et al. Heart 2013; 99: 1843-8.
  • 5.Gilbertson DT, et al. Kidney Int. 2003; 63: 738-43.
  • 6.Papic N, et al. Influenza Other Respir Viruses 2012; 6: e2–e5.
  • 7.Diepersloot RJ, et al. Diabetes Care 1990; 13: 876-882.
  • 8.Siriwardena AN, et al. Vaccine 2014; 32: 1354-61.
  • 9.Department of Health and Social Care, Public Health England, NHS England. National flu immunisation programme 2018 to 2019 letter. 26 March 2018. https://www.gov.uk/government/publications/national-flu-immunisation-programme-plan.
  • 10.Blank PR, Szucs TD. Expert Rev Vaccines 2009; 8: 425-433.4
  • 11.Simonsen L, et al. J Infect Dis. 2000; 181: 831-837.