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Influenza (flu) vaccinations in lupus

Influenza (flu) vaccinations in lupus

Flu season is 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 and Jane Hollis, Lupus Nurse Specialist at Addenbrookes 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 flare my lupus?

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.

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.

The article has been adapted from the Lupus Courier October 2011 edition, published by Lupus Society of Alberta and from the NHS Choices website.

NHS Choices

World Health Organisation flu advice

Department of Health immunisation advice

19 Replies

Thank you for this information, I will be booking my jab this week.

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Can you have a flu jab while on methotrexate? I heard you can't have vaccines as it contains the virus and could make you ill while immune systems weak


Hi ell1,

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. The flu vaccine is not a 'live' vaccine so doesn't contain the live virus. Therefore you cannot catch the flu from the vaccine.


I listened to Jeremy Vine on radio 2 sometime last year , they were discussing Lupus and he said its unusual for Lupus sufferers to get colds and flu..., I personally have never had flu , and haven't had a cold in over 5years ?? Am I unusual or just lucky??? 😃


I remember the show, it was really good. There do seem to be some people with lupus who report that they get very few viruses/bugs. I don't believe that this is the majority however. Many people with lupus are more prone to infection because lupus can actually result in fewer white blood cells and many medications for it have a suppressing effect on the immune system.

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Dear Paul,

My hematologist says NO flu shot! My immune system is just about nil, and he said he didn't know how I would react to the flu shot. My husband takes one to protect me, and I keep Tamiflu in the house just in case. I had a tetanus shot because I cut my leg on branches, and my arm blew up for 2 weeks. Lupus can do strange things when something "strange" is injected into the body. I use alcohol to clean all of my eye make-up and try to stay out of crowds. I haven't taken a flu shot in a few years now. Even before my diagnosis, I always had a bad reaction to the flu shot. Not taking chances anymore. I have much too much to deal with- so many medical issues!


If you have had bad reactions to the flu shot in the past then it is your choice to balance that against the risk of the flu. It sounds like you have taken what precautions you can without the vaccine. This information has been provided and approved by lupus specialists for patients in the UK, but if anybody is ever in any doubt they should always consult their own medical professionals.


During the many years before 2011 when my infant onset lupus finally got daily systemic immunosuppressant treatment, I got colds, flu, pleurisy, tracheitis, bugs galore....and I always had the flu jab. Since starting daily hydroxy + myco + pred tapers: hardly any colds at all. And now immunology has figured out that I have been living with both lupus + early onset immunodeficiency even before I started immunosuppression 4 years ago. I just had my flu jab free on the NHS last week.


I rarely get colds or flu either. The last time I got flu was when returning from India, around ten years ago. I think I probably got that because of the different strain.


Great Post Paul I always have the Flu jab and so does my husband to also protect me.

Lupus UK is fantastic and giving people great advice. That you for being there all the team at Lupus UK. Ordered the gold pin badges from Lupus UK to raise awareness I am giving them also to my work colleagues as a way of thanking them for supporting me.

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I'm glad that you like the article. Thank you so much for your kind words and also for supporting the charity by ordering some pins. I think that giving them to colleagues is a really lovely way to raise some awareness of the condition.


Sorry to ask but are people with sjogrens syndrome entitled to a free flu vac, i have sjogrens fibro and query lupus. thanks in advance


Hi julie1234,

I'm afraid I don't know. If you are on any immunosuppressant treatment, then you would be entitled to a free one, but I'm not sure if the condition itself is considered high risk. It may be worth contacting the British Sjogren's Syndrome Society at


i am on hydroxochloraquine.


I believe that if you are taking hydroxychloroquine then you should be entitled to a free flu jab.


hi paul thanks for your reply i did indeed get my flu jab on the nhs

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I was diagnosed with Sjögren's syndrome 15 years ago and have had the flu jab every year since then. I am still under 65. Check with your doctor. I live in Scotland and it's never been a problem

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I always had sicker years that I got the free flu jab, whether with more flare ups or actual flu. I quit getting them 3 years ago. this year I wont get the flu vax either. I have lived thru 3 monster flu bugs but found I was naturally immune for several years after. these bouts I had were about 7 years apart. my daughter no longer gets flu vax. she is type one diabetic, so naturally when she was young we used it as a back up. we stopped her now too and her health improved. with the vax she got many head colds during the winter. after no more vaccines, absolutely no head colds thru the winter and same with myself.


Anyone who has tier immune system suppressed is entitled to the flu jag and thier partner to

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