As healthcare professionals, safeguarding public health is at the heart of what we do, especially when it comes to preventing the spread of infectious diseases like influenza. The NHS Flu Vaccination Programme is a critical initiative designed to protect the most vulnerable populations through targeted vaccination efforts. Prioritising clinical risk groups for vaccination is essential to mitigating severe outcomes and alleviating the burden on our healthcare system.
Clinical Risk Groups: Who Are They?
Clinical risk groups are those identified as being at higher risk of severe illness, complications, or death from the flu. In the UK, individuals aged 6 months to 64 years within these clinical risk groups are prioritised for vaccination, given that influenza can significantly worsen underlying health conditions, leading to hospitalisations and increased mortality rates.
The UK Health Security Agency (UKHSA) Green Book: Chapter 19 on Influenza provides detailed guidance on who would fall into these clinical risk groups and offers examples in each case. The Green Book notes however, that the list is not exhaustive, and healthcare professionals should use clinical judgement to assess how influenza might exacerbate a patient’s underlying conditions and the potential for serious illness from influenza itself.
In this blog we will explore some of these clinical risk groups and look at why it is so important to ensure that these groups are protected.
Individuals with Chronic Respiratory Diseases
Patients with chronic respiratory diseases are particularly vulnerable during flu season. Those with asthma requiring ongoing steroid use or who have a history of severe exacerbations are at higher risk of severe flu complications.
Similarly, individuals with Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and emphysema, as well as conditions like bronchiectasis, cystic fibrosis, and interstitial lung fibrosis, face increased risks. The flu can severely exacerbate their existing respiratory issues, leading to heightened risks of hospital admission and complications like pneumonia.
Individuals with Chronic Heart Disease and Vascular Conditions
Patients with chronic heart conditions, such as heart failure, coronary artery disease, and congenital heart disease, are also at a higher risk of severe complications during the flu season. The influenza virus can place additional strain on the cardiovascular system, potentially exacerbating existing conditions and increasing the likelihood of serious complications such as heart attacks, strokes, and worsening heart failure. The added stress of a flu infection can precipitate acute cardiac events, sometimes with life-threatening consequences. Those with hypertension, atrial fibrillation, peripheral vascular disease, or a history of venous thromboembolism are also at increased risk of severe complications due to the flu. In these patients, the flu can destabilise their cardiovascular health, leading to significant complications such as arrhythmias, thromboembolic events, and even sudden cardiac arrest.
Individuals with Diabetes
For individuals with diabetes—whether Type 1 or Type 2—the flu can also lead to serious complications. When they contract the flu, the body’s response to the infection can lead to significant fluctuations in blood sugar levels, often resulting in hyperglycaemia or hypoglycaemia. This instability can be difficult to manage and may increase the risk of severe complications such as diabetic ketoacidosis (DKA), or hyperosmolar hyperglycaemic state (HHS), both of which are medical emergencies. Even those with diet-controlled diabetes or related endocrine disorders, such as Addison’s disease or adrenal insufficiency, are at risk. The stress of a flu infection can exacerbate their conditions and lead to severe health issues.
Individuals with Chronic Kidney Disease (CKD)
Individuals with chronic kidney disease (CKD) at stages 3, 4, or 5 can be particularly vulnerable to severe complications from the flu due to their already compromised renal function. The flu can exacerbate kidney issues, leading to a decline in kidney function, increased proteinuria (excess protein in the urine), and a heightened risk of acute kidney injury.
For patients with advanced CKD, the stress of a flu infection can result in significant health deterioration, potentially precipitating or worsening kidney failure and other related conditions, such as nephrotic syndrome. Additionally, those who have undergone kidney transplantation are at increased risk of flu-related complications, as their immune system may be suppressed due to anti-rejection medications.
Individuals with Chronic Liver Disease
Patients with chronic liver disease, including cirrhosis, biliary atresia, and chronic hepatitis, are also at an increased risk of severe complications from the flu. The liver plays a crucial role in managing the body’s immune response and processing infections, so when it is compromised by chronic liver conditions, its ability to cope with additional stressors like the flu is diminished. This increased vulnerability can lead to hepatic decompensation, where the liver’s ability to function properly deteriorates, potentially resulting in severe complications such as liver failure or encephalopathy. Moreover, patients with chronic liver diseases are more susceptible to secondary infections, including bacterial infections, as their immune system is often weakened. The flu can exacerbate these risks, leading to a higher likelihood of severe respiratory infections and other flu-related complications.
Individuals with Chronic Neurological Diseases
Chronic neurological conditions, such as stroke, transient ischemic attack (TIA), and various neuromuscular diseases can also increase susceptibility to severe flu complications. These conditions often involve compromised respiratory function or impaired mobility, which can make it more difficult for patients to manage the effects of the flu. For example, stroke survivors and those with conditions like multiple sclerosis, cerebral palsy, and severe learning disabilities may have impaired respiratory function or difficulty swallowing, which can be exacerbated by the flu.
Additionally, conditions such as Parkinson’s disease, motor neurone disease, and other hereditary or degenerative diseases of the nervous system or muscles contribute to a higher risk of severe illness from the flu. The flu can worsen existing neurological symptoms, lead to respiratory distress, and significantly impact overall health, increasing the risk of hospitalisation or even death.
Individuals with Immunosuppression
Those with immunosuppression, whether due to disease or treatment, are at a heightened risk of severe flu complications. This includes patients undergoing chemotherapy, radiotherapy, organ transplants, or those with conditions like HIV, multiple myeloma, or genetic immune disorders. Immunosuppressive therapies can significantly weaken the immune system, increasing the risk of severe infections, prolonged illness and complications such as secondary bacterial infections.
Individuals with Asplenia or Splenic Dysfunction
Individuals with asplenia (absence of the spleen) or splenic dysfunction are at increased risk during flu season. Conditions like homozygous sickle cell disease, hereditary spherocytosis, thalassemia major, and coeliac syndrome can impair spleen function, making it harder to fight infections. This increased vulnerability can lead to severe complications such as pneumonia or sepsis.
Individuals with Morbid Obesity
Morbid obesity, or Class III obesity, characterised by a Body Mass Index (BMI) of 40 kg/m² or greater, presents significant health challenges, especially during flu season. Individuals with this level of obesity are at an increased risk of severe flu-related complications due to several factors.
Excess body weight can lead to chronic inflammation, impaired immune function, and reduced respiratory capacity, which can exacerbate the effects of the flu. Obesity often complicates the management of respiratory illnesses, increasing the likelihood of severe outcomes such as pneumonia and respiratory failure. Additionally, individuals with morbid obesity may have comorbid conditions like diabetes, hypertension, or cardiovascular disease, which further elevate their risk of flu complications.
Other Key Risk Groups
Other key risk groups for flu vaccination include all over 65’s, children 2-17 years of age and all pregnant women. Our previous blog (Pregnant) Women and Children First: Optimising Flu Vaccine Protection explored the reasons for why this years flu vaccination is recommended to commence from the 1st September for all pregnant women and children.
Household contacts of immunosuppressed individuals, who live with or regularly come into close contact with someone with compromised immunity, are also prioritised to help prevent the spread of flu to these vulnerable individuals. Additionally, primary carers—those eligible for carer’s allowance or who are the main caregivers for elderly or disabled individuals—are considered high-priority for vaccination, as their health is critical to the well-being of those they care for. These groups are included to enhance protection against the flu and reduce the risk of severe illness and transmission.
Why Vaccination is so Important for these Risk Groups
Vaccination against the flu is crucial for these clinical risk groups due to the high likelihood of severe illness, complications, and increased mortality associated with the flu virus. Vaccination helps prevent severe symptoms, reduce the risk of complications, and ease the burden on the healthcare system. It also prevents secondary infections, such as pneumonia, that can arise from the flu.
As healthcare professionals, our role is vital in the successful implementation of the NHS Flu Programme. We must:
- Identify eligible patients: Ensure that those at risk are aware of the importance of vaccination.
- Educate patients: Provide clear information about the benefits and risks of vaccination.
- Facilitate timely vaccination: Ensure that eligible patients receive the vaccine in a timely manner.
The 2024-2025 flu season offers a critical opportunity to protect vulnerable populations through targeted vaccination. By actively participating in this programme, we can help protect those most at risk, help to reduce severe flu-related complications and hospitalisations and contribute to the overall health and safety of our community. Let’s work together to try to increase vaccination rates and ensure those vulnerable are protected!
Flu Training – Plan Ahead This Season!
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