Is the flu vaccine safe for a patient with Glucose-6-phosphate dehydrogenase (G6PD) deficiency?

Influenza Vaccine Safety in G6PD Deficiency

Yes, the influenza vaccine is safe and recommended for patients with G6PD deficiency—there are no contraindications to influenza vaccination based on G6PD deficiency status alone. 1

Primary Recommendation

Patients with G6PD deficiency should receive annual influenza vaccination without any special precautions related to their enzyme deficiency. 1 The American Academy of Pediatrics and the Advisory Committee on Immunization Practices (ACIP) explicitly state that G6PD deficiency is not a contraindication to influenza vaccination. 2, 1

Why Vaccination is Particularly Important

• Individuals with G6PD deficiency are at higher risk for severe influenza complications due to their chronic condition, making vaccination especially important for this population. 1
• The benefits of preventing influenza far outweigh any theoretical concerns, with influenza causing substantial morbidity including 200-300 hospitalizations per million in healthy adults and up to 10,000 per million in elderly populations. 1
• Influenza vaccination significantly reduces influenza-related hospital admissions and mortality in patients with chronic diseases. 2

Vaccine Selection

Choose between inactivated influenza vaccine (IIV) or live attenuated influenza vaccine (LAIV) based on age and other medical conditions—not G6PD status. 1

• IIV is recommended for children under 2 years or adults over 50 years. 1
• Either vaccine type is appropriate for healthy individuals aged 2-49 years. 1
• For adults ≥65 years, high-dose quadrivalent inactivated influenza vaccine may provide additional benefit. 2

Actual Contraindications (Unrelated to G6PD)

The only absolute contraindication to influenza vaccination is anaphylactic or serious allergic reaction to any vaccine component. 2, 1

Common allergens that may cause reactions include:

• Egg protein (residual from vaccine production) 2
• Gelatin 3
• Thimerosal 2

Important Precautions (Apply to All Patients, Not G6PD-Specific)

History of Guillain-Barré syndrome (GBS) within 6 weeks of previous influenza vaccination is a precaution, regardless of G6PD status. 2, 1

• For patients with prior GBS who are not at high risk for severe influenza, avoiding vaccination may be prudent. 1
• However, for high-risk patients with chronic conditions (including G6PD deficiency), vaccination benefits likely outweigh risks. 2, 1
• The estimated risk of GBS from current influenza vaccines is approximately one additional case per million persons vaccinated. 2

Common Pitfalls to Avoid

Do not confuse G6PD deficiency with medication-induced hemolysis risk. While certain medications (dapsone, nitrofurantoin, primaquine, rasburicase) can trigger hemolysis in G6PD-deficient patients 4, influenza vaccines contain none of these compounds and pose no hemolytic risk. 1

Do not defer vaccination due to mild illness. Minor illnesses with or without fever are not contraindications to influenza vaccination. 2 Only moderate-to-severe febrile illness warrants deferral until resolution. 2

Administration Guidelines

Administer vaccines in settings where personnel and equipment for managing acute hypersensitivity reactions are available. 1 This is standard practice for all vaccinations, not specific to G6PD deficiency.

For patients on high-dose corticosteroids (≥20 mg prednisone daily), influenza vaccination should still be administered without deferral, unlike other non-live attenuated vaccines which may be deferred. 2