Patients at high risk of influenza-related complications*
| Clinical risk category | Examples |
|---|---|
| *The high risk groups described in this Appendix are largely based on data from interpandemic influenza. During the course of a pandemic, the definition of “high risk” groups may differ. If so, details of the “high risk” patient group will be altered according to relevant clinico-epidemiological data. Users are strongly advised to refer to the latest version of these guidelines at all times. | |
| Age 65 years or older | |
| Chronic respiratory disease, including asthma | This includes chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema, and such conditions as bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Asthma requiring 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 | This includes congenital heart disease, hypertension with cardiac complications, chronic heart failure and individuals requiring regular medication and/or follow-up for ischaemic heart disease |
| Chronic renal disease | Including nephrotic syndrome, chronic renal failure, renal transplantation |
| Chronic liver disease | Including cirrhosis, inflammatory bowel disease |
| Diabetes and chronic metabolic disorders | Diabetes mellitus requiring insulin or oral hypoglycaemic drugs |
| Immunosuppression and malignancy | Due to disease or treatment. Including asplenia or splenic dysfunction, HIV infection at all stages, malignancy. Patients undergoing chemotherapy leading to immunosuppression |
| Individuals on or likely to be on systemic steroids for more than a month at a dose equivalent to prednisolone at 20 mg or more per day (any age) or for children under 20 kg a dose of 1 mg or more per kg per day | |
| Long-stay residential care homes residents | This does not include prisons, young offender institutions, university halls of residence |
| Others | Doctors retain discretion in identifying additional individual patients who they recognise as at high risk of serious complications should they develop influenza; for example patients with haemoglobinopathies, neurological diseases with muscle weakness, cerebral palsy or children on long term aspirin who are at increased risk of Reye’s syndrome |