People at High Risk for Complications from Flu

The following people are at high risk for complications from the flu and should be vaccinated:

• People 65 years and older;
• People who live in nursing homes and other long-term care facilities that house those with long-term illnesses;
• Adults and children 6 months and older who have chronic heart or lung conditions, including asthma;
• Adults and children 6 months and older who needed regular medical care or were in a hospital during the previous year because of a metabolic disease (like diabetes), chronic kidney disease, or weakened immune system (including immune system problems caused by medicines or by infection with human immunodeficiency virus [HIV/AIDS]);
• Children between 6 months and 18 years of age who are on long-term aspirin therapy. (If given aspirin while they have the flu, they are at risk of a severe illness called Reye syndrome .) ;
• Women who will be pregnant during the influenza season; and
• All children 6 to 23 months of age.

People 50 to 64 Years Old

Nearly one-third of people 50 to 64 years of age in the United States have one or more medical condition that place them at increased risk for serious complications from the flu. For that reason, since 2000, it has been recommended that all people 50 to 64 years of age get vaccinated each year to increase the number of high-risk 50 to 64 year olds who are protected against the flu.

People Who Can Give the Flu to Others at High Risk for Complications

To help prevent spreading the flu to those at high risk for complications from the illness, the following people should get vaccinated:

• Anyone (including children 6 months and older) who lives with someone in a high-risk group;
• Doctors, nurses, and other employees in hospitals and doctors’ offices, including emergency response services;
• People who work in nursing homes and long-term care facilities who have contact with patients or residents;
• People who work in assisted living and other residences for people in high-risk groups; and
• Anyone who provides care to those in high-risk groups (including children under the age of 2).

Pregnancy, Flu and Flu Vaccine

Pregnant women are at increased risk for complications from the flu and are more likely to be hospitalized from flu complications than non-pregnant women of the same age. In previous worldwide outbreaks of influenza (like the pandemics of 1918-19 and 1957-58), there were many deaths among pregnant women associated with influenza. It is not known why pregnant women are at higher risk, but pregnancy can change a woman’s immune system and affect her cardiovascular system (heart and lung function). These changes may place a pregnant woman at increased risk for complications from the flu. Because of the increased risk for flu-related complications, ACIP recommends that women who will be pregnant during the flu get vaccinated. One study conducted among more than 2,000 pregnant women vaccinated at varying stages of pregnancy found no adverse fetal events associated with vaccination with the inactivated vaccine. Thus, the ACIP recommends that vaccination with the inactivated vaccine can take place in any trimester.

Children 6 to 23 Months of Age

Studies have shown that healthy children under the age of 2 years are at increased risk for flu-related hospitalization compared with older healthy children. Because of this increased risk, it’s recommended that all children (even healthy children) 6 to 23 months of age get vaccinated. (The influenza vaccine is not approved by the Food and Drug Administration (FDA) for use in children younger than 6 months. This is why the recommendation is limited to children 6 to 23 months rather than all children less than 2 years old.)

Note: Children under the age of 9 receiving the vaccine for the first time will require two doses . The first dose “primes” the immune system. A second dose is required to produce a protective immune response.

Vaccine Information for Other Groups

General Population
Anyone who wants to lower their chances of getting the flu can get vaccinated. People who provide essential community services (such as police officers and firefighters) should consider getting a vaccinated to minimize disruption of key public-service activities during flu outbreaks. Students who live in dormitories or anyone who lives in an institutional setting should be encouraged to get vaccinated because crowded living conditions may mean that the flu can spread more easily.

Breastfeeding Mothers

It is safe for breastfeeding women to get vaccinated. Antibody against influenza viruses are passed in breast milk and may offer additional protection against the flu for infants.

Travelers

The risk of getting the flu during travel depends on the destination and time of travel. In the tropics, the flu can occur at any time of year. In the Southern Hemisphere, most influenza activity occurs from April through September. In the Northern and Southern hemispheres, travelers also can be exposed to the flu during the summer, especially when traveling as part of large tourist groups that include people from areas of the world where influenza virus is circulating. Depending on their health condition, providers should consider vaccinating travelers at high risk for flu-related complications, especially if they plan to:

• travel to the tropics;
• travel with large tourist groups at any time of year; or
• travel to the Southern Hemisphere from April through September

People 50 years and older who are at high risk for complications from the flu should talk to their doctor before they travel to find out about the symptoms and risks of influenza and whether they should carry antiviral medications with them for either prevention or treatment.

Who Should Not Be Vaccinated

There are some people who should not be vaccinated. These include:

• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination in the past.
• People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
• Children less than 6 months of age.
• People who are sick with a fever. (These people can get vaccinated once their symptoms lessen.)

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