Influenza (flu) vaccinations in lupus

Flu season is upon us once again so here is an article from the Spring 2012 edition of News & Views Magazine by Sue Brown, lead specialist nurse in Rheumatology at the Royal National Hospital of Rheumatic Diseases in Bath.

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.

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.

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.

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 nhs.uk

NHS Direct nhsdirect.nhs.uk

World Health Organisation flu advice who.int/topics/influenza/en

Department of Health immunisation advice dh.gov.uk/en/Publichealth/I...

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  • thank you , very helpful

  • Really great post thank you very helpful.

  • Hi I had the flu jab on Tuesday, my arm was painful, a red lump developed for 48 hours and now Saturday, it is just itchy. I feel that no other side effects, I suppose the proof will be in the pudding as time goes on, but I really do have my fingers crossed that after the last 18 months of catching everything this will be my little helper.

  • Hello, I was wondering where does the following information come from: 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. above come from:

    I have been repeatedly refused the flu vaccine from my GP surgery because I don't qualify because I don't take immunosuppressants (I have SLE, APS and Sjorgren's). I was even told that even if I want to pay, I have to wait until December. Meanwhile I did get the vaccine from a pharmacy. Is there a piece of information about lupus patients qualifying for the vaccine?

  • The information was written by specialist lupus nurse, Sue Brown.

    The following information is taken from the NHS Choices website;

    "The injected flu vaccine is offered free of charge on the NHS to anyone with a serious long term health condition. That includes these types of illnesses:

    - chronic (long-term) respiratory disease, such as asthma (that requires inhaled or tablet steroid treatment or has led to hospital admission in the past), chronic obstructive pulmonary disease (COPD) or bronchitis

    - chronic heart disease, such as heart failure

    - chronic kidney disease

    - chronic liver disease, such as hepatitis

    - chronic neurological conditions, such as Parkinson's disease or motor neurone disease

    - diabetes

    - problems with your spleen – for example, sickle cell disease, or if you have had your spleen removed

    - a weakened immune system due to conditions such as HIV and AIDS, or as a result of medication such as steroid tablets or chemotherapy

    This list of conditions isn't definitive. It's always an issue of clinical judgement. Your GP can assess you individually to take into account your risk of flu exacerbating any underlying illness you may have, as well as your risk of serious illness from flu itself. The vaccine should always be offered in such cases, even if you are not technically in one of the risk groups above."

    Flu can exacerbate lupus and trigger a flare, so you should be entitled to a free vaccination. Since it is not one of the listed conditions the receptionists/nurses at your practice may not offer it to you, but your GP should.

  • Thank you for clarification, my GP did not offer that but it is good to know that there is something that I can refer to next time I will ask for it. However, I have a feeling that it may not be a pleasant conversation.

  • Hi bluebell99. I'm not medically trained, so can't advise you on that vaccine. Here is a link to the NHS choices website with information about that vaccine. nhs.uk/Conditions/vaccinati...

    If you're still unsure, I would advise you to ask your doctor.

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