Take the flu seriously – get the shot!

Everyone can benefit from getting a flu shot each year. Getting the shot improves chances of having a flu-free winter and also avoids transmitting the virus through contacts with people, especially those at high risk of flu-related complications.

Each year, a new flu vaccine must be prepared that will be effective against the flu virus strain circulating the globe. Find out how the flu shot makes its way from the lab to the doctor's office.

Certain groups should not be vaccinated. These include children under six months of age and people who have had an anaphylactic reaction to a previous dose or to any of the vaccine components, with the exception of egg allergy.

Egg-allergic individuals may be vaccinated against influenza using the trivalent inactivated influenza vaccine, without a prior influenza vaccine skin test, based on an assessment of risk for a severe allergic reaction to guide the method of vaccination.

Flu shots are especially important for:

1. People at high risk:
   • Adults and children with chronic health conditions
   • People with morbid obesity
   • People who are residents of nursing homes and other chronic care facilities
   • People > 65 years of age
   • Healthy children 6 to 23 months of age
   • Pregnant women
   • Aboriginal peoples
2. People capable of transmitting influenza to those at high risk
3. People who provide essential community services
4. People in direct contact during culling operations involving poultry infected with avian influenza.

People at Risk

Adults and children with chronic health conditions

A number of chronic health conditions are associated with increased risk of influenza-related complications and influenza can lead to exacerbation of the chronic disease.
These conditions especially include:

• Heart disease;
• Lung disorders (including bronchopulmonary dysplasia, cystic fibrosis and asthma);
• Diabetes and other metabolic diseases;
• Cancer;
• Immune compromising conditions (due to underlying disease and/or medical therapy);
• Kidney disease;
• Blood disorders such as anemia or hemoglobinopathy;
• Conditions that make it difficult to swallow properly or keep the airways clear of mucus; and
• Children and adolescents with conditions treated for long periods with acetylsalicylic acid (Aspirin^®).

People with morbid obesity

Some studies have concluded that severely obese persons with and without chronic conditions are at increased risk for respiratory hospitalizations during influenza seasons.
NACI recommends the inclusion of those who are morbidly obese (body mass index [BMI] ≥40) among high-priority recipients of influenza vaccine.

People who are residents of nursing homes and other chronic care facilities

Such residents often have one or more chronic medical condition and live in institutional environments that may facilitate spread of the disease.

People > 65 years of age

Seniors have the highest rate of hospitalization and death from the flu.  Common complications of the flu for seniors include bacterial infection and pneumonia.  Getting the flu shot helps to reduce the risk of serious complications and life-threatening illness.   Research shows that the flu vaccine may be less effective in preventing infection in seniors.  This means that it is important for all members of the family, health professionals and caregivers to get the flu shot to better protect seniors.

Healthy children 6 to 23 months of age

Children aged 6- 23 months should receive a flu shot because they are particularly susceptible to complications from the flu and are more likely to be hospitalized because of them.
Some symptoms of flu complications in children include, difficulty breathing, sudden paleness, fever or low temperature, inability to drink or breastfeed, vomiting more than 2-3 times in 24 hours, a stiff neck, lethargy or confusion, and convulsions or seizures.

Pregnant women

Expectant mothers at any stage of pregnancy, including those with high risk conditions, should get a flu shot to protect themselves and their babies from the influenza virus. It is particularly important that women who will be in the later stages of their pregnancies (second and third trimester) during the flu season (November-April) are immunized because these women are at greater risk of hospitalization from flu complications.

Pregnant women who contract the flu may develop pneumonia and require hospitalization. In its recommendations for 2011-2012, Canada's National Advisory Committee on Immunization noted that while the risk of hospitalization due to flu is not significantly increased during the first trimester of pregnancy, it increases as the pregnancy advances. The highest risk of hospitalization from influenza is during the third trimester.

Aboriginal peoples

Historically, Aboriginal status has been associated with increased risk of influenza-related complications including death. Similar findings were identified during the 2009 influenza A (H1N1) pandemic.

Based on the body of evidence indicating a higher rate of influenza-associated hospitalization and death among Aboriginals, NACI recommends the inclusion of Aboriginal peoples among high-priority recipients of influenza vaccine.

People capable of transmitting influenza to those at high risk

People who are potentially capable of transmitting influenza to those at high risk should receive an annual vaccination, regardless of whether the high-risk person has been immunized.

• Health care and other care providers in facilities and community settings. This group includes regular visitors, emergency response workers, those who have contact with residents of continuing care facilities or residences, those who provide home care for persons in high-risk groups and students of related health care services.
• Household contacts (adults and children) of individuals at high risk of influenza complications, whether or not the individual at high risk has been immunized. These individuals include household contacts of individuals at high risk of influenza-related complications or hospitalization: household contacts of infants <6 months of age (who are at high risk of complications from influenza but for whom influenza vaccine is not authorized); and members of a household expecting a newborn during the influenza season.

People who provide essential community services

Vaccination for these individuals should be encouraged in order to minimize the disruption of routine activities during annual epidemics. Employers and their employees should consider yearly influenza immunization for healthy working adults, as this has been shown to decrease work absenteeism due to respiratory and other illnesses.

People in direct contact during culling operations involving poultry infected with avian influenza

Refer to the recommendation for 2011-2012 for more information.

Related information:

• Vaccine Safety Frequently Asked Questions (FAQs)
• What happens if the strains of the influenza virus included in the annual vaccine do not perfectly match the strains that are circulating and causing illness in Canada?