Flu season will soon be upon us once again. To answer any questions you may have about the influenza vaccine Sue Brown (formerly lead specialist nurse in Rheumatology at the Royal National Hospital of Rheumatic Diseases in Bath), Jane Hollis (Lupus Nurse Specialist at Addenbrooke’s Hospital), Dr David Jayne (Professor of Clinical Autoimmunity at Addenbrooke’s Hospital), Dr Kate Armon (Consultant Paediatric Rheumatologist at Addenbrooke’s Hospital) and Dr Rona Smith (Clinical Lecturer in Nephrology at Addenbrooke’s Hospital) have written the following article for us.
Why is the flu jab important in lupus?
For most people, flu is not usually serious and recovery is often expected within a week. However, for certain groups of people, especially those with diseases of the immune system such as lupus, symptoms can last longer and there could be an increased risk of developing complications such as bronchitis or pneumonia. The flu vaccine is available free of charge to everyone with lupus in the UK in order to protect you from the flu and any potential complications.
My partner has lupus. Should I have the flu vaccination as well?
This depends very much on how unwell your partner is with lupus, so it would be sensible to discuss this with your GP. It is possible you may be offered the flu vaccine in order to prevent any risk to your partner.
Will the flu vaccine cause my lupus to flare?
Sometimes the vaccine may make your symptoms a little worse, but this should settle in a few days. You cannot get flu from the flu vaccine as it does not contain live viruses.
Am I entitled to a free influenza vaccination because of my lupus diagnosis?
Yes. Patients who have lupus fall into the high risk group. They may be on immunosuppression, on steroids, and lupus disease will classify as being immunocompromised.
NHS England has recommended that adults aged 18 to under 65 in clinical at-risk groups are offered the quadrivalent influenza vaccine which protects against four strains of flu. This reflects current JCVI advice and Green Book guidance that was updated in October 2017 on the basis of cost-effectiveness data produced by Public Health England.
NHS England has recommended that the adjuvanted trivalent influenza vaccine (FLUAD) be made available to all those aged 65 and over in 2018/19. This is the most effective vaccine currently available for this group. This reflects current JCVI advice and Green Book guidance published in December 2017 by Public Health England. Note: JCVI considers FLUAD to be more effective and cost-effective than the non-adjuvanted vaccines in the elderly (including quadrivalent vaccine).
NHS Scotland has recommended that all adults aged 75 years or more will be offered an adjuvanted trivalent inactivated flu vaccine (FLUAD), all adults aged 65-74 years will be offered a trivalent inactivated vaccine and all those aged 18-64 years in clinical at-risk groups will be offered the
quadrivalent inactivated flu vaccine.
What do I do if my GP Surgery won’t give me a free influenza vaccine?
Discuss with your lupus team at the hospital who could send a copy of Department of Health guidelines to your GP with a letter of recommendation.
How does the flu jab work?
The flu jab causes your body’s immune system to make antibodies to fight the flu virus.
Antibodies are proteins that recognise and fight off germs that have invaded your blood, such as viruses. If you catch the flu virus later on, the immune system will recognise it and immediately produce the antibodies to fight it. It may take 10-14 days for your immune system to respond fully after you have had the flu injection. The antibodies against the flu strains will gradually decrease over time and the flu strains can change from year to year.
I was immunised last year. Do I need to be immunised again this year?
The flu virus continually changes and different types of flu virus circulate each winter, so it is recommended that you should have the latest strain of flu vaccine by intramuscular injection every year.
The World Health Organisation (WHO) makes an assessment every year of the strains of flu virus that are most likely to be circulating during the following winter. Based on this assessment, WHO recommends which three flu strains the vaccines should contain for the following winter. These flu jabs are used for the countries in the northern hemisphere, not just the UK.
I don’t normally get the flu so do I really need to be immunised?
Yes. Everyone can benefit from getting a seasonal flu vaccine every year. This improves your chances of having a flu free season and also avoids transmitting the virus to those at high risk.
Is the vaccine safe?
Yes. In all countries including the UK, all vaccines must go through a rigorous testing process, and meet stringent safety standards, before receiving approval for manufacture. After WHO recommendations are available, production of the vaccine starts in March each year and is usually available from your GP.
Who should NOT have the flu jab?
You should NOT have the flu jab in any of the following situations:
– If you have ever had an allergic reaction to a flu vaccine or one of its ingredients. This happens very rarely.
– If you have had a confirmed very serious (anaphylactic) reaction to egg, have an egg allergy with uncontrolled asthma or another type of allergy to egg, your GP may decide you should be vaccinated with an egg-free vaccine.
– If no egg-free vaccine is available, your GP will identify a suitable vaccine with a low egg (ovalbumin) content, the details of which will be in the Green Book – Immunisation against infectious disease (see NHS Choices).
– Depending on the severity of your egg allergy, your GP may decide to refer you to a specialist for vaccination in hospital.
– If you are ill with a fever, do not have your flu jab until you have fully recovered.
How soon after I receive my flu jab will I be immune?
It takes about 10-14 days after your injection to develop protection against this year’s strain of the flu. Protection can last up to one year. The vaccine will not protect against colds and other respiratory illnesses that may be mistaken for influenza but are not caused by the influenza virus.
What are the possible side effects of the flu jab?
The flu jab does not normally cause side effects. Sometimes, it can cause mild fever and slight muscle aches for a day or so. It cannot cause flu as there are no active viruses in the vaccine. However, people sometimes are a little more at risk of catching other flu-like viruses, or very occasionally could catch flu before the vaccine takes effect. Allergic reactions to the vaccine are rare.
If you develop symptoms such as a high temperature, fever or chills:
Drink extra fluids such as water or fruit juice. Take a medication such as paracetamol to help treat headaches and reduce any high temperature. If your symptoms persist and you feel unwell, contact your GP or NHS Direct for further advice.
If you have a severe allergic reaction (anaphylaxis) including hives, swelling of the face, lips or throat, wheezing and/or shock (fall in blood pressure):
Contact the emergency services immediately as you may need to have medication to treat the anaphylactic reaction.
What if I’m allergic to latex?
There is no latex in the seasonal flu vaccine packaging or in the syringe.
Can the flu vaccine be given if I am on other medication?
Yes. The vaccine can safely be given when you are taking most medications. Discuss this with your doctor or nurse if you are unsure about this.
Rituximab treatment can reduce response to vaccinations. If you are receiving Rituximab you should have your vaccinations one month pre Rituximab or four months after your infusion.
Can the flu jab and other vaccines be given at the same time?
Yes. Flu vaccine can be given at the same time as other vaccines. Pneumococcal vaccine or routine childhood vaccines are often given at the same time as the yearly flu vaccine.
If I am currently taking an antiviral medication, is it safe to have the yearly flu jab?
Yes. It is safe to have the vaccine while taking an antiviral medication.
If I am due to have an operation, should I still have the flu jab?
Although it is safe to receive the flu jab prior to surgery, please check with your surgeon before being immunised to avoid the risk of cancellation of the surgery. Should you experience a side effect (such as a fever) from the influenza vaccine your surgery has the potential for being cancelled.
I am pregnant and planning to breastfeed, is it safe and recommended to have the flu jab?
Yes, all pregnant women should have the flu jab irrespective of whether they have lupus or not. Pregnant women are more at risk of developing the flu and there is evidence that the flu vaccine can be safely given in all stages of pregnancy. The vaccine does not carry risks for either mother or baby and there are some studies that suggest that for some babies, protection from the flu can be passed from mum to baby which lasts for the first few months of life.
My child has lupus. Should they have the flu vaccine as an injection or the nasal spray?
It is advised that children with lupus should have the flu vaccine injection rather than the nasal spray. The injection is an inactive ‘dead’ form of the flu virus, so it cannot cause an infection. The nasal spray vaccination is an attenuated ‘weakened’ form of the flu virus which could potentially pose a risk of infection in those with a compromised immune system.
Do I need to avoid contact with children who have been immunised with the nasal flu vaccine?
If you have lupus and have a child who is due to have the nasal flu vaccine, it is advised to speak with the doctor, nurse or pharmacist before vaccination to decide if it is suitable to go ahead.
If you have close contact with a child within two weeks of them receiving the nasal flu spray vaccination you may come into contact with the attenuated (weakened) virus, unless you have been vaccinated at least 14 days prior. It is an added incentive, therefore, for you to have your flu vaccination injection, and preferably early in the season to ensure that you are protected.
NHS Choices www.nhs.uk
World Health Organisation flu advice http://www.who.int/topics/influenza/en/
Department of Health immunisation advice https://www.gov.uk/government/collections/annual-flu-programme