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November 2, 2020

High-risk Groups for Influenza Complications

Author Affiliations
  • 1Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA. 2020;324(22):2334. doi:10.1001/jama.2020.21869

Many groups of people are at high risk of complications from influenza.

Persons considered to be at increased risk of complications from influenza include young children, pregnant women and postpartum women up to 2 weeks after delivery, older adults, people with certain chronic medical problems, people who live in nursing homes, and certain racial and ethnic minority groups. From 2009 to 2019, non-Hispanic Black people had the highest influenza hospitalization rates, followed by non-Hispanic American Indian or Alaska Native people, then Hispanic or Latino people, and then non-Hispanic White people.

Prevention of Influenza in High-risk Groups

The best way to prevent influenza is by getting an influenza vaccination each year. While everyone aged 6 months or older is recommended to receive influenza vaccination, it is particularly important for people who are at increased risk of complications. Most influenza vaccines are produced using influenza viruses grown in eggs. Several kinds of influenza vaccines are available that protect against 4 influenza A and B virus strains (quadrivalent vaccines), including inactivated standard-dose vaccines for people aged 6 months or older, live-attenuated vaccines for healthy nonpregnant people aged 2 to 49 years, tissue cell culture–grown and recombinant vaccines not produced in eggs that are options for people with severe egg allergies, and high-dose and adjuvanted vaccines for people aged 65 years or older that may improve immune response and vaccine effectiveness. Because people in certain minority groups may be at increased risk of influenza or developing severe illness, influenza vaccination is especially important for these communities. Influenza vaccination is recommended by the end of October, but unvaccinated persons are encouraged to receive vaccination in November and December, and later if influenza viruses are circulating and vaccine is available.

What Should People in High-risk Groups Do When Sick?

If respiratory illness symptoms begin during flu season, people who are at increased risk of complications should contact their primary care clinician right away. Fever is not always present with influenza in people of any age, especially in older adults and people with weakened immune systems.

Influenza can worsen underlying chronic medical conditions, such as chronic obstructive pulmonary disease, asthma, heart failure, and diabetes. A telemedicine appointment or an in-person visit can assess whether influenza or another cause might be responsible for a respiratory illness. A clinician can determine whether testing for influenza or other causes is needed.

Antiviral Treatment of Influenza in High-risk Groups

Antiviral treatment of influenza can reduce risk of some complications, especially when started within 2 days of symptom onset. Therefore, people in high-risk groups should contact their primary care clinician as soon as respiratory symptoms begin. If influenza is diagnosed and antiviral treatment is prescribed, patients should begin treatment as soon as possible.

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Article Information

Published Online: November 2, 2020. doi:10.1001/jama.2020.21869

Conflict of Interest Disclosures: None reported.

Disclaimer: The views expressed are those of the author and do not necessarily represent the official policy of the Centers for Disease Control and Prevention.

1 Comment for this article
Influenza Vaccine Failure
Gerald Fay, MD | Providence St Peter Hospital Olympia
In over 40 years of practicing primary care internal medicine I have seen numerous patients every year who have been vaccinated for influenza still get the disease. I have also learned to be very practical.

In prior years all my patients were instructed, whether vaccinated or not, to notify the office for any symptoms of Influenza (combination of fever, myalgias, and cough). PCR testing is highly accurate in making the diagnosis (much more so than influenza antigen testing which is at best 60% reliable). If PCR positive, therapy with oseltamivir would almost universally result in rapid symptom

Unfortunately, despite the implication of this article, there will be no way to distinguish viral infection with influenza from covid-19. In addition, this year there will be shortage of media for PCR testing as a large proportion will be dedicated for covid-19.

Because testing will be complicated I am advocating that all patients, this year in particular, receive influenza vaccination, but suspect the actual number of cases will be reduced significantly by following the guidelines for prevention of covid-19