Cold season advice With winter and colder weather, everyone becomes more susceptible to illnesses such as viral infections like influenza (flu) or rhinovirus (common cold). Patients suffering from diseases which compromise or weaken their immune system, such as Aplastic Anaemia (AA), are at higher risk of contracting these infections or having more serious health-related complications because of them. Is the seasonal flu jab safe? Seasonal flu vaccines protect against influenza viruses that research indicates will be most common during the upcoming cold season. The decision about whether patients with AA should receive the flu vaccination is widely debated and you should always discuss with your haematologist first about whether you should get a ‘flu shot’ or not. What are the risks? There is a theoretical risk of relapse of Aplastic Anaemia, or an increased risk of a drop in your blood counts to become more cytopenic following any vaccination, particularly the flu jab. However, the evidence is limited and is based on anecdotal case reports, as well as an awareness that a viral attack is likely to be an important trigger in the development of the disease. In most circumstances the advice is not to receive the flu vaccination except for patients who have received a haematopoietic stem cell transplant. In these cases, you should/and will be routinely re-vaccinated as per a schedule which is recommended for all post-transplant patients. Having a viral infection, such as the flu, can be problematic for AA patients as it can further suppress your blood counts or make you more likely to get secondary bacterial chest infections. Certain viral infections can be treated with antiviral medications but your haematology team may review your circumstances and infection before prescribing them for you. In some cases, you may need to be hospitalised. In certain instances, antibiotics are also prescribed to help prevent secondary infections. Some common-sense advice on how to prevent the flu To help reduce your risk of contracting the flu and other illnesses, there are a few steps you can take. Many of these are steps you should already be taking to protect yourself from COVID-19 Practice good hand hygiene by washing your hands regularly with soap and water or alcohol-based hand gels – encourage everyone you come into contact with to do the same. Avoid touching your eyes, nose or mouth as germs can spread easily this way. Avoid contact with people who are displaying flu-like symptoms. If any of your family or friends have a flu-like illness, it’s best if they abstain from visiting you until they’re fully recovered. If anyone is displaying Covid symptoms, they should be isolating themselves according to government advice. Avoid going out in public places at peak times or with high numbers of people. If you are neutropenic we'd usually recommend you wear a respiratory face mask in these circumstances (during the current pandemic we recommend masks are worn by everyone, in line with the law and with government advice.) Where possible, try to stay in well-ventilated areas. Cover your nose and mouth with a tissue when you cough or sneeze; promptly throw the tissue in the bin after you use it. Where possible ask your family members or others in close contact with you to get the flu vaccination as this may reduce your chances of getting the flu. Try to practice good health habits: eat nutritious foods and drink plenty of fluids. Try to get plenty of sleep and exercise well – stay active! Avoid cold temperatures, wrap up warm when going outside and regulate your temperature appropriately. Monitor your body temperature closely and treat any fevers as an emergency, seeking immediate medical attention if you develop a temperature of ≥38.0 ˚c. Remember if you develop any flu-like symptoms to contact your haematology team as you may need to be hospitalised, and in some instances, even isolated in a negative pressure room, where you may receive treatment for this involving medication. Advice developed with the Haematology Team at King's College Hospital, London, October 2018. This page was updated in October 2020 by our team - pending clinical review. More advice Parents of children with aplastic anaemia may find the recording of this webinar useful: The impact of Covid-19 on children with aplastic anaemia - in which Dr Sujith Samarasinghe, consultant paediatric haematologist at Great Ormond Street Hospital, discusses whether he would theoretically recommend a Covid-19 vaccination to children with AA, and vaccinations in general. You can find more resources on Covid-19 here.