Influenza vaccination clinical risk groups

Clinical risk groups	Examples (decision based on clinical judgement)
Pregnancy	All pregnant women
Chronic Respiratory Disease	Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD) Asthma – with disease which requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission Children who have previously been admitted to hospital for lower respiratory tract disease
Chronic Heart Disease	Congenital heart disease Hypertension with cardiac complications Chronic heart failure Individuals requiring regular medication and/or follow-up for ischaemic heart disease
Chronic Renal Disease	Chronic renal failure Nephrotic syndrome Renal transplantation
Chronic liver disease	Cirrhosis Biliary atresia Chronic hepatitis
Chronic Neurological Disease	Stroke Transient ischaemic attack (TIA)
Diabetes	Type 1 diabetes Type 2 diabetes requiring insulin or oral hypoglycaemic drugs Diet controlled diabetes
Immunosuppression	Immunosupression due to disease or treatment Patients undergoing chemotherapy leading to immunosuppression Asplenia or splenic dysfunction HIV infection Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age) or for children under 20kg a dose of 1mg or more per kg per day. Some immunocompromised patients may have a suboptimal immunological response to the vaccine

• Those living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality (this does not include prisons, young offender institutions, university halls of residence etc.)
• Those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. This should be given on an individual basis at the GP’s discretion in the context of other clinical risk groups in their practice.