At what point is it recommended to stop receiving influenza (flu) vaccines, particularly in patients with a history of severe allergic reactions or certain chronic health conditions, such as heart disease, lung disease, or diabetes, and in demographics like older adults aged 65 and above, pregnant women, and individuals with weakened immune systems, such as those with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) or undergoing chemotherapy?

When to Stop Influenza Vaccination

There is no upper age limit for stopping influenza vaccination—annual vaccination should continue throughout life, including in adults aged 65 years and older, as this population experiences the highest rates of serious illness and death from influenza. 1, 2

Core Recommendation: Lifelong Annual Vaccination

• The Advisory Committee on Immunization Practices (ACIP) explicitly recommends that all persons aged ≥65 years receive annual influenza vaccination every year without an upper age cutoff. 1, 2
• Older adults have the highest mortality rates from influenza, with over 80% of influenza-related deaths occurring in persons aged ≥65 years. 3
• Vaccination in elderly persons reduces hospitalization for pneumonia and influenza by 51%, all respiratory condition hospitalizations by 33%, and all-cause mortality by 45%. 3

High-Risk Populations Should Never Stop

Patients with chronic conditions (heart disease, lung disease, diabetes, HIV/AIDS, immunosuppression from chemotherapy) should continue annual vaccination indefinitely, as they face substantially elevated risk for influenza-related complications. 1

• Influenza vaccination coverage among adults aged 18-64 years with high-risk conditions remains suboptimal at only 49.5%, despite clear evidence of benefit. 1
• Vaccination reduces cardiovascular events in patients with existing heart disease and should be offered as "a simple once-annual protective therapy." 1
• Immunocompromised patients (HIV/AIDS, transplant recipients, chemotherapy patients) should receive inactivated influenza vaccine annually—only the vaccine type changes (inactivated instead of live attenuated), not the recommendation to vaccinate. 4, 2

Pregnant Women: Continue Vaccination

• Pregnant women should receive influenza vaccination during any trimester to protect themselves and their newborns. 1
• There is no contraindication to vaccination during pregnancy; in fact, pregnancy is an indication for vaccination. 1

The Only True Contraindication: Severe Allergic Reactions

The only reason to permanently stop influenza vaccination is a history of severe allergic reaction (anaphylaxis) to a previous dose of influenza vaccine or to vaccine components (including eggs). 1, 4

• History of Guillain-Barré Syndrome (GBS) within 6 weeks of a previous influenza vaccination is a precaution, not an absolute contraindication, but warrants careful risk-benefit discussion. 1, 4
• Mild egg allergy is no longer considered a contraindication to vaccination. 4

Special Considerations for Vaccine Selection (Not Cessation)

Certain populations should avoid specific vaccine types but should still receive alternative formulations:

• Live attenuated influenza vaccine (LAIV/FluMist) should not be used in: 1, 4

  • Persons aged <5 years or >50 years
  • Immunocompromised individuals
  • Pregnant women
  • Persons with chronic pulmonary or cardiovascular disease
  • Persons with asthma or reactive airways disease

• These patients should receive inactivated influenza vaccine instead—vaccination should not stop. 1, 4

Enhanced Vaccines for Older Adults

• Adults aged ≥65 years should preferentially receive high-dose or adjuvanted influenza vaccines, which provide enhanced immune responses in the setting of immunosenescence. 5, 6
• High-dose vaccine is the only licensed influenza vaccine to demonstrate superior efficacy versus standard-dose vaccine in preventing laboratory-confirmed influenza in randomized controlled trials. 6

Common Pitfalls to Avoid

• Do not discontinue vaccination in "very old" patients (age 85+, 90+, etc.)—the benefits of preventing hospitalization and death persist even in the oldest old. 3, 7, 8
• Do not stop vaccination in nursing home residents—vaccine effectiveness against pneumonia is 46%, hospital admission is 45%, and deaths from influenza or pneumonia is 42% in this setting. 8
• Do not withhold vaccination from patients with autoimmune conditions like Hashimoto's thyroiditis—autoimmune thyroid disease is not a contraindication. 2
• Do not stop vaccination in patients with multiple comorbidities or frailty—these patients benefit most from vaccination. 6, 7

The Evidence for Lifelong Vaccination

• Well-matched vaccines in community-dwelling elderly prevent hospital admission for influenza and pneumonia (vaccine effectiveness 26%) and all-cause mortality (vaccine effectiveness 42%). 8
• After adjustment for confounders, vaccine effectiveness for all-cause mortality in elderly persons is 47%. 8
• Few preventive interventions for adults match or exceed the benefits of influenza vaccination in reducing hospitalizations, deaths, and healthcare costs. 3