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The Department of Health advises that people who fall into any of the following clinical risk groups should have a flu vaccine every year:1

Risk Group

Rationale for flu immunisation

People with chronic respiratory disease

Patients with chronic respiratory disease, such as asthma or COPD, are more likely to contract flu,2 and flu is likely to make chronic respiratory diseases much worse.3

Patients with chronic respiratory disease are also almost twice as likely to develop flu complications as healthy subjects,2 and are also more likely to be hospitalised or die.4

People with chronic heart, liver or kidney disease

Studies investigating the excess mortality associated with the flu season suggest that approximately 35–50% are due to cardiovascular disease.5

People with diabetes

Patients with diabetes have been found to have a 1.7 fold increase in the risk of complications associated with flu and a 2.2 fold increase in the risk of hospitalisation.6

During flu epidemics, death rates in unvaccinated people with diabetes may increase by 5-15%.7

People with an impaired immune response, asplenia or spleen dysfunction

Immunosuppression (e.g. from chemotherapy, HIV, asplenia or long-term steroid therapy) puts patients at risk of succumbing to flu complications if they contract the disease.1

People with neurological conditions, such as Parkinson's disease or motor neurone disease, or learning disability

There is evidence that receiving the annual flu vaccine reduces the risk of a stroke in patients with a history of stroke or transient ischaemic attack.8

Other groups advised to have the flu vaccine are:1


Rationale for flu immunisation

People aged 65 and over

The risk for serious complications and death is greatly increased in older people with flu. The decreased function of their immune system, as well as the higher incidence of underlying chronic diseases with age, affect their susceptibility to flu.9

The risk of hospitalisation for pneumonia and flu during the flu season is at least 5 times higher in those aged >65 years compared with those <65 years.10


The children’s flu immunisation programme began in 2013/14 with just pre-school children offered vaccination. The programme was extended each subsequent year, and in 2017/18 will apply to all children in reception year and school years 1-4. All two- and three-year-olds on 31 August 2017 will continue to be offered the vaccine through GP surgeries, while four-year-olds will be offered it via their schools. Additionally, all primary school aged children from reception class through to year 6 in former school pilot areas will be offered the vaccine.11

Research into the first two years of the programme, comparing pilot areas where the entire primary school age cohort was offered vaccination vs. non-pilot areas, showed vaccinating children of primary school age had a positive impact on flu transmission rates.11

Pregnant women

All pregnant women are recommended to receive the flu vaccine irrespective of their stage of pregnancy.11

Pregnant women are particularly vulnerable to severe complications of flu. There is also evidence that flu during pregnancy may be associated with premature birth and smaller birth size and weight, and that the flu vaccine may reduce this risk.11 Another benefit of antenatal flu immunisation is that it confers passive immunity to newborns during the first few months of life.11

People who are morbidly obese

From 2015, the Department of Health has recommended that adults with a Body Mass Index1 ≥40 kg/m2 be offered the flu vaccination. In many cases, these patients will also be at risk due to other conditions they contract due to complications of obesity.

Health and social care workers

NHS England has published a CQUIN covering 2017/18 and 2018/19 which includes an indicator to improve uptake of flu vaccination for frontline healthcare workers.11

Flu immunisation should be offered by NHS organisations to all employees directly involved in patient care, as part of their policy for preventing flu transmission to protect patients, staff and visitors.11

People in residential homes (excluding university residences)

Flu can spread rapidly from person to person when there are many people living at close quarters, and this likely to lead to significant morbidity and mortality.1

Carers i.e. people who look after someone who wouldn’t be able to get by without their help

Immunisation of people caring for elderly or disabled relatives or friends helps protect the people they are caring for, and protects the carers from falling ill and being unable to fulfil their care duties.1

1. Immunisation against infectious disease. Green Book. August 2015. Chapter 19. Influenza. Accessed June 2017.
2. Meier CR et al. Eur J Clin Microbiol Infect Dis 2000; 19: 834-842.
3. Cox NJ, Subbarao K. Lancet 1999; 354: 1277-1282.
4. Hak E et al. Clin Infect Dis 2002; 35: 370-377.
5. Warren-Gash C et al. Expert Rev Cardiovasc Ther 2010; 8: 143–146.
6. Irwin DE et al. BMC Health Serv Res 2001; 1: 8.
7. Diepersloot RJ et al. Diabetes Care 1990; 13(8): 876-882.
8. Siriwardena AN et al. Vaccine 2014;32(12):1354-61
9. Blank PR, Szucs TD. Expert Rev Vaccines 2009; 8: 425-433.
10. Simonsen L et al. J Infect Dis. 2000; 181: 831-837.
11. Department of Health’s Annual Flu letter 2017/18, 20 March 2017. NOTE: The flu letter link for 2017/18 is:

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