Can Individuals with G6PD Deficiency Receive the Influenza Vaccine?
Yes, individuals with G6PD deficiency can and should receive the influenza vaccine—there are no contraindications to influenza vaccination based on G6PD deficiency status alone. 1
Why G6PD Deficiency Is Not a Contraindication
The only absolute contraindication to influenza vaccination is anaphylactic or serious allergic reaction to any vaccine component. 1 G6PD deficiency does not appear on any list of contraindications or precautions for influenza vaccination in major guidelines from the Advisory Committee on Immunization Practices (ACIP) or the American Academy of Pediatrics. 1
Influenza vaccines (both inactivated and live attenuated) do not contain oxidative agents or medications known to trigger hemolysis in G6PD-deficient individuals. 2 The seven medications with solid evidence for causing hemolysis in G6PD deficiency are: dapsone, methylthioninium chloride, nitrofurantoin, phenazopyridine, primaquine, rasburicase, and tolonium chloride—none of which are vaccine components. 2
G6PD deficiency is classified as a hemoglobinopathy, and patients with hemoglobinopathies are specifically identified as having medical indications FOR influenza vaccination, not against it. 1 This is because individuals with chronic conditions like hemoglobinopathies are at higher risk for severe influenza complications. 1
Important Clinical Context
Infections themselves can trigger hemolytic crises in G6PD-deficient individuals. 3, 4 Influenza infection poses a greater oxidative stress risk than the vaccine, making vaccination particularly important for this population to prevent the infection-related hemolysis that can occur. 3
The benefits of preventing influenza far outweigh any theoretical concerns. 1 Influenza causes substantial morbidity including hospitalizations (200-300 per million in healthy adults, up to 10,000 per million in elderly) and deaths (300-1,500 per million in those over 65). 1
Practical Vaccination Approach
Administer either inactivated influenza vaccine (IIV) or live attenuated influenza vaccine (LAIV) based on age and other medical conditions, not G6PD status. 1 For children under 2 years or adults over 50 years, use IIV; for healthy individuals aged 2-49 years, either vaccine type is appropriate. 1
Standard vaccination precautions apply: All vaccines should be administered in settings where personnel and equipment for managing acute hypersensitivity reactions are available, but this is routine practice for any vaccine recipient. 1
The only precaution relevant to some patients is a history of Guillain-Barré syndrome (GBS) within 6 weeks of previous influenza vaccination—this applies to all patients regardless of G6PD status. 1, 5 For patients with prior GBS not at high risk for severe influenza, avoiding vaccination may be prudent, but for high-risk patients (including those with chronic conditions), vaccination benefits likely outweigh risks. 1
Common Pitfall to Avoid
- Do not confuse G6PD deficiency with immunodeficiency requiring special vaccine considerations. While severe G6PD deficiency can rarely cause chronic granulomatous disease-like immunodeficiency, 4 standard G6PD deficiency does not alter vaccine recommendations. The confusion may arise because both conditions involve oxidative stress pathways, but they require different clinical management approaches.