People with cardiovascular disease

Potential benefits in specific high-risk groups

People with heart disease have an increased risk of hospitalisation and death from influenza infection, and cardiovascular mortality increases during influenza epidemics.^3,9 In addition, infections - particularly of the upper respiratory tract - often precede myocardial infarction or stroke, both of which also peak during winter months.^12,19 Evidence suggests that chronic inflammation may promote atherosclerotic disease and acute infection may temporarily increase the risk of vascular events.²⁰ Influenza infection has been proposed as one possible explanation for a rise in ischaemic events during the winter months, although further research is needed to show causation.²¹

Influenza vaccination of persons with coronary artery disease has been associated with a reduction in the risk of myocardial infarction, sudden death and stroke.^19,22 A population-based case-control study found that influenza vaccination was associated with a reduction in the risk of primary cardiac arrest,⁹ while another case control study reported a significant reduction in the risk of stroke in those vaccinated during the year of the study and in those vaccinated during the last 5 years.²³

Results of the FLUVACS study demonstrated that influenza vaccination at the time of hospitalisation may reduce the risk of future ischaemic events and death in people suffering from myocardial infarction or undergoing angioplasty.²⁴ In this prospective study, influenza vaccination was given at the start of the influenza season, and the benefits were still evident at one-year follow up. Australian recommendations The Australian Immunisation Handbook1 recommends annual influenza vaccination for children 6 months of age and older and adults with chronic cardiac conditions including coronary artery disease, congestive heart failure and cyanotic congenital heart disease.

Australian recommendations

The Australian Immunisation Handbook¹ recommends annual influenza vaccination for children 6 months of age and older and adults with chronic cardiac conditions including coronary artery disease, congestive heart failure and cyanotic congenital heart disease.

Contraindications to influenza vaccination¹

• Severe allergy to eggs, causing an anaphylactic reaction.
   

• Severe allergy to any of the products in the vaccines, causing an anaphylactic reaction.
   

• An illness with fever over 38.5°C. Flu vaccine can be given once the fever and symptoms of the illness have settled down. Flu vaccine can also be given to people if they have a minor illness without a fever.
   

• History of Guillain-Barre Syndrome which first appeared around the time of a flu vaccination.

Please review the product information before prescribing any influenza vaccination.