What is the mortality risk associated with the influenza vaccine?

Mortality Risk from Influenza Vaccination

The influenza vaccine itself poses an extremely minimal mortality risk—essentially zero—while substantially reducing death from influenza by 20-65% across different populations. 1, 2

Direct Vaccine-Related Mortality Risk

The influenza vaccine has no established direct mortality risk. The only theoretical concern involves Guillain-Barré Syndrome (GBS), which has an extremely low association:

• Risk of GBS: approximately 1 additional case per million vaccinated persons 1, 2
• GBS has a 6% case-fatality rate that increases with age 1, 2
• This translates to roughly 0.06 deaths per million vaccinations (1 in 16.7 million)
• No evidence indicates GBS case-fatality differs between vaccinated and unvaccinated persons 1

The 1976 swine influenza vaccine showed increased GBS risk (<10 cases per million), but no substantial increase in GBS has been documented with any influenza vaccine since 1976 1

Mortality Benefits of Vaccination

Pediatric Population

• 65% reduction in influenza-associated death among all children (95% CI: 54-74%) 1
• 51% reduction in death among children with underlying high-risk conditions (95% CI: 31-67%) 1
• 75% reduction in severe, life-threatening influenza requiring ICU admission 1
• During 2017-2018, only 22% of pediatric deaths occurred in vaccinated children, despite 48% vaccination coverage 1

Older Adults (≥65 years)

• 20-34% reduction in all-cause mortality following laboratory-confirmed influenza 3
• Complete elimination of mortality association with circulating influenza in vaccinated elderly (mortality ratio 1.16 in unvaccinated vs no association in vaccinated) 4
• 56% reduction in all-cause mortality during influenza epidemics 5
• Specific reductions: stroke mortality (65%), renal disease (60%), diabetes (55%), pneumonia (53%), COPD (45%), heart disease (22%) 5

Cardiovascular Disease Patients

• 25% relative risk reduction in all-cause mortality 1
• 18% reduction in cardiovascular mortality 1
• 19-45% reduction in acute myocardial infarction risk 1

Risk-Benefit Context

The mortality risk from influenza itself vastly exceeds any vaccine-related risk:

• Influenza-associated hospitalization rates: 200-300 per million for healthy adults aged 5-44 years 1
• Hospitalization rates: 2,000-10,000 per million for persons ≥65 years 1
• Death rates during epidemics: 300-1,500 per million persons ≥65 years 1
• Persons ≥65 years account for >90% of all influenza-associated deaths 1

The potential benefits of influenza vaccination in preventing serious illness, hospitalization, and death greatly outweigh the possible risks for developing vaccine-associated complications 1, 2

Common Pitfalls to Avoid

Temporal coincidence is not causation: When sudden deaths occur on vaccination day, epidemiological analysis shows these are expected background deaths. In one Dutch analysis, the probability of four sudden deaths occurring on vaccination day across different age groups was 0.016—small but real without causal link 6

Do not withhold vaccination based on GBS history alone: For high-risk patients with prior GBS, the established benefits of preventing influenza death justify yearly vaccination for most individuals 1

Severe allergic reactions are rare: Immediate hypersensitivity reactions occur rarely and are primarily in persons with severe egg allergy requiring physician evaluation 1