The Hospice Clinician Blog

As flu season begins questions arise as to whether or not hospice patients should be vaccinated. There is no clear recommendation that applies to all hospice patients. Hospice patients are not uniform and have varying states of health, life expectancy, and variable risks of contracting or transmitting the flu depending upon where they reside and the condition of their immune system. The decision to vaccinate a hospice patient should be approached individually on a case by case basis. A hospice patient with a short life expectancy and minimal exposure to others probably should not be vaccinated, conversely a hospice patient with a reasonable current quality of life, functionality, and a life expectancy measured in months may benefit from a vaccination.   

The CDC does not provide any specific guidance pertaining to hospice patients and the flu vaccine. They recommend vaccination for the following:

• Children 6 months to 18 years
• Adults over 50
• Anyone living in a long-term care facility
• Anyone with a weakened immune system
• People who have frequent contact with the public
• Pregnant women
• Anyone with a chronic medical condition
• Caregivers, health care workers, family members, and friends of individuals considered high risk

Residents in long-term care facilities, regardless of whether they are on hospice or not, are almost always vaccinated. This is done not only as a measure to protect the individual from influenza infection, but also to prevent transmission to other residents. The decision to vaccinate hospice patients residing in long-term care facilities may have more to do with reducing transmission throughout the facility, than protecting the individual from infection. Many hospice patients have significantly weakened immune systems, however, they may still be able to mount some response to the vaccination that would confer benefits against disease. The inactivated virus vaccine for injection (flu shot) is recommended for patients with a weakened immune system. The nasal spray (FluMist) is a live weakened virus that is not generally recommended for hospice patients due to increased risk for this product to induce actual infection in the immuno-compromised patient. 

Flu vaccine is definitely NOT recommended for the following people:

• Anyone allergic to eggs
• Anyone who has a history of GBS (Guillain-Barre Syndrome)
• Anyone who has had an adverse reaction to the vaccine
• Infants under 6 months old

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