Should I get a vaccine? Our nurse's guide

I am often asked by pituitary patients whether it is advisable and safe to have the winter flu jab and other vaccinations. 
Vaccination against pneumonia and influenza are commonly given to groups, such as the elderly or very young, or those who are most at risk. 
Replacement schedules of corticosteroids for people with adrenal insufficiency do not cause immunosuppression and are not, therefore, contraindications for administration of live vaccines. (Ref: Contraindications and special considerations. General contraindications to vaccination. January 2013) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147824/Green-Book-Chapter-6-v2_0.pdf 
Flu vaccine 
The flu vaccine changes every year to fight the latest strains of flu, so even if you had a jab last winter you need another one this year to stay ‘flu safe’. The jab doesn’t contain the ‘live’ virus so it cannot give you the flu. 
This vaccine is available for free on the NHS for: 
• anyone over the age of 65 
• pregnant women 
• anyone who is very overweight (with a body mass index over 40) 
• children and adults with an underlying health condition (particularly long-term heart or lung disease) 
• children and adults with weakened immune systems 
An annual flu vaccine nasal spray is also now offered to healthy children aged two, three and four years old, and to children in school years one and two. 
Although steroid dependent patients (whether primary Addison’s or secondary pituitary) are not mentioned in these lists, you definitely fall under the umbrella of requiring the flu vaccination. Your GP can assess you individually to take into account the 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. Speak to your GP or pharmacist about this. 
Remember, your steroids are a replacement therapy and therefore will not cause any interaction or problem with the vaccines. 
When should I have it? 
The best time to have the vaccine is in the autumn, between September and early November. There is no actual deadline but, where possible, it should be given to you before flu starts circulating in the community. 
Will I get any side effects? 
Serious side effects of the flu vaccine are very rare. You may have a slight temperature and aching muscles for a couple of days after having the jab, and your arm may be a bit sore 2 where you were injected. It is unlikely that you will require to increase your steroids during this time unless the symptoms persist and you are becoming increasingly unwell. 
Pneumococcal vaccine 
There is also the pneumococcal vaccine (or 'pneumo jab' / pneumonia vaccine) which protects against pneumococcal infections. A pneumococcal infection can affect anyone, and some people need this vaccination because they are at higher risk of complications. These include: 
• all children under the age of two 
• adults aged 65 or over 
• children and adults with certain long-term health conditions, such as a serious heart or kidney condition 
Please seek advice from your GP or endocrinologist if you are unsure whether or not you should have it. This vaccine is not given annually like the flu jab. People with a long-term health condition may need just a single one-off pneumococcal vaccination or five-yearly vaccination depending on their underlying health problem. 
The aim when you are steroid dependent is to protect yourself against illness if at all possible and therefore this is where getting vaccinated gives you the best chance of avoiding infections. 
If you succumb to a serious infection your recovery can be longer and more complex when you are steroid dependent. 
Top tips: 
• Basic hygiene plays an important part in preventing the spread of infection 
• Wash and dry your hands properly 
• Use hand sanitisers especially when out and about in the community 
• Use disposable tissues as opposed to cloth handkerchiefs 
Some flu facts:
 
• The flu jab can’t give you flu 
• The flu jab is safe 
• The flu virus changes, so you need a flu jab every year 
• If you’re pregnant, the flu jab doesn’t harm your unborn baby. In fact it can protect your baby from flu for the first few months of life 
• The flu jab also protects against swine flu 
• The flu jab isn’t just for older people – pregnant women, those with health conditions, carers, and those with weakened immunity should all have the jab 
• The flu jab protects people of all ages 
• Flu isn’t just a cold, it can be a really serious illness. 
Please feel free to contact me on the Endocrine Nurse Helpline if you would like me to give you a refresher on the sick day rules and when you should increase your steroids. Tel: 0117 370 1317 Mondays 10:00am – 1:00pm & 6:00pm – 9:00pm; Thursdays 9:00am – 1:00pm
 
For more information, speak to your GP or local pharmacist, or visit: http://www.nhs.uk/conditions/flu/Pages/Introduction.aspx 
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/543624/PHE_9901_Flu_Vaccination_A5_booklet_Winter2016_17.pdf 
Other vaccinations 
Shingles vaccine 
Anyone aged 70 can have this vaccine on the NHS. You become eligible for the vaccine from the first day of September after your 70th birthday. 
From September 1 2016, the shingles vaccine will be offered routinely to people aged 70 and, as a catch up, to those aged 78. You become eligible for the vaccine on the first day of September 2016 after you've turned 70 or 78. 
We recommend that you speak to your GP or endocrinologist to see if you are eligible for this vaccine. 
Travel vaccinations 
First, phone or visit your GP or practice nurse to find out whether your existing UK jabs are up-to-date (they can tell from your notes). Your GP or practice nurse may also be able to give you general advice about travel vaccinations and travel health, such as protecting yourself from malaria. For further information about travel immunisation, see: http://www.nhs.uk/Conditions/Travel-immunisation/Pages/Introduction.aspx 
Your GP or endocrinologist can also access National Travel Health Network and Centre for advice about travel vaccinations for you. 
There is also an advice line for health professionals:
Telephone: 0845 602 6712 
Monday – Friday (closed Wednesday afternoons and Bank Holidays 09.00-11:45 and 13:00-15:45 
Please note that they are unable to provide clinical advice to members of the public. Please contact your GP, pharmacist or travel health clinic for guidance, at least eight weeks ahead of travel.