What precautions should individuals with epilepsy take during flu season to prevent triggering seizures?

Epilepsy and Influenza: Essential Precautions During Flu Season

Individuals with epilepsy should receive annual influenza vaccination as the primary preventive measure, as influenza infection itself poses a significantly greater seizure risk than vaccination. 1

Primary Prevention: Influenza Vaccination

All individuals with epilepsy should receive annual influenza vaccination unless specifically contraindicated. The evidence demonstrates that:

• Influenza A infection causes febrile seizures in 19.5% of hospitalized children, with 28% experiencing multiple seizures during the same illness—substantially higher than other respiratory viruses 2
• In healthy adults, influenza can trigger seizures even without encephalitis, though this remains rare 3
• Vaccination carries minimal seizure risk: no increased risk was found in people with established epilepsy after pandemic influenza vaccination (relative incidence 1.01) 4

Vaccination Timing and Considerations

• Begin vaccination efforts early in fall, as 74% of influenza seasons peak in January or later 5
• Continue vaccination throughout the season, as activity often doesn't occur until February or March in many communities 5
• For children with epilepsy receiving inactivated influenza vaccine (IIV), expect a modest, transient increase in seizure-related emergency visits 0-2 days post-vaccination (relative incidence 1.5), which is far outweighed by protection against influenza itself 6

Specific Vaccination Precautions for Epilepsy Patients

Young Children (6 months - 4 years) with Epilepsy

Be aware of febrile seizure risk when co-administering vaccines, but do not delay vaccination. 1

• Risk of febrile seizures is increased on days 0-1 after IIV when co-administered with PCV13 or DTaP, peaking at approximately 16 months of age 1
• This risk is <1 per 1,000 children vaccinated—substantially lower than seizure risk from influenza infection itself 1
• The Advisory Committee on Immunization Practices (ACIP) explicitly recommends continuing simultaneous administration despite this small risk, as febrile seizures rarely have long-term sequelae 1
• Do not separate vaccine administration to avoid febrile seizures, as studies show delaying IIV by 2 weeks does not reduce fever prevalence 1

Children 2-4 Years with Epilepsy and Asthma

• Avoid live attenuated influenza vaccine (LAIV/FluMist) if the child has had wheezing or asthma diagnosed in the past 12 months 1
• Use inactivated influenza vaccine (IIV) instead 1

Adults and Children ≥5 Years with Epilepsy

• No increased risk of seizures after influenza vaccination has been observed in this age group 1
• Any licensed age-appropriate influenza vaccine is acceptable 1

Secondary Prevention: Infection Control Measures

Implement rigorous personal protective measures during flu season to prevent influenza infection, which is the actual seizure trigger. 1

Strongly Recommended Measures

• Regular handwashing (most strongly supported intervention) 1
• Good respiratory hygiene: cover mouth and nose when coughing/sneezing, use tissues and dispose properly 1
• Early self-isolation at home when feeling unwell and feverish during influenza circulation 1
• Maintain distance (≥1 meter) from people with respiratory symptoms 1

Healthcare Setting Precautions

• Wear masks in healthcare settings if experiencing acute respiratory symptoms 1
• Avoid close contact with individuals who have confirmed influenza 1

Critical Clinical Pitfalls to Avoid

Do not withhold or delay influenza vaccination in people with epilepsy due to seizure concerns. The evidence is clear:

• Influenza infection causes seizures far more frequently than vaccination 2, 6
• Even complex febrile seizures associated with influenza A may have better prognosis than complex febrile seizures from other causes 2
• During peak influenza months, influenza A accounts for 35-44% of all febrile seizure hospitalizations 2

Do not avoid co-administration of influenza vaccine with other routine vaccines in children with epilepsy. 1

• The benefits of timely, simultaneous vaccination outweigh the minimal increased risk of febrile seizures 1
• Surveillance continues to show reassuring safety profiles 1

Special Populations

Children with Prior Febrile Seizures (Not Epilepsy)

• These children have a 2-5% lifetime risk of febrile seizures from various causes 1
• The small additional risk from vaccination (when co-administered with PCV13) is negligible compared to their baseline risk and the protection vaccination provides 1

Pregnant Women with Epilepsy

• Influenza vaccination is recommended and has reassuring safety profiles 1
• Pregnant women are at higher risk for influenza complications, making vaccination particularly important 5