If you have Addison's disease or another form of adrenal insufficiency, which vaccines should you have? Is it safe to be vaccinated? What do you need to know before you go for a jab?

Our medical trustees advise that vaccines are usually safe. There are lots of useful links and some helpful advice below to help you explore any particular concerns and understand what you need to consider.

Should people with Addison's and Adrenal Insufficiency have the flu jab?

Everyone with Addison's disease and adrenal insufficiency (so is steroid-dependent), should get their free NHS flu jab to reduce the risk of getting the flu, as flu can trigger an adrenal crisis. You can’t get the flu from the flu jab, but it takes two weeks to work so it’s important to get the flu jab as soon as you can. 

Every year an endocrinologist writes for our website and members magazine, a helpful reminder to book your flu jab and why it is important to get your flu jab for that year.

Read our 2023 Flu Jab Guide

It's also a good idea to put a reminder in your calendar every year to make sure you book your appointment early.

How can I make sure I receive an automatic invitation for a flu jab from my GP every year?

It's not always possible to ensure you'll be included in annual GP vaccine programmes every year. This can be the case even if you've requested to be included in a priority flu or COVID-19 vaccine group previously. Many GP surgeries vary in the computer systems and procedures they use for issuing invitations for different vaccination programmes.

As there is no single national system you'll need to ask about how things work at your local surgery. If your surgery is not able to add a marker in their system that you are eligible for a flu vaccine due to Addison's disease and adrenal insufficiency (steroid-dependency) you may find that you need make it an annual part of your routine to inform them when their vaccine programme starts. 

We appreciate this is a frustrating situation and adds to the admin of living with a long-term health condition. You may like to read our tips on working with your GP practice. As a charity we continue to work with our partners in umbrella organisations to highlight and resolve these system issues with the NHS. While this situation exists, we work to equip you our members with information and resources which you can use to influence your healthcare professionals directly to act on your behalf to improve your chance of getting the care you need. You can become a member to hear direct about our resources and updates.

Share this flu guide with your healthcare professionals to help them understand why you would be eligible. You can also let them know about the free RCGP GP Education module, which will give them more information on the management of Addison's and adrenal insufficiency. It's a good idea to provide feedback to the surgery on any issues you are facing in obtaining the vaccine and see what they are able to do to help.

It's important to remember that there are many pharmacies where you can also go and get a flu jab.

Where and when to book your flu jab

Book your flu jab appointment for early autumn if possible (September onwards). Contact your GP to book your jab if they haven't already got in touch. Or if it’s quicker and easier, get one from your local pharmacy. Click on the following links to book your flu jab at Asda, Lloyds PharmacyTesco or Boots.

“My GP won’t give me the free NHS Flu jab" - Next Steps  

Due to Addison's and adrenal insufficiency being a rare disease, medical professionals don't always have the information they need to make certain decisions. With over 7,000 rare diseases, it isn't possible for your GP to be an expert on your condition and have opportunity to access the latest information. 

With this in mind, our charity exists to give you the information and support, should you need it, to send to your GP or healthcare professional, so you can work together.  

If after passing on the information on this webpage, you are still advised you will not receive the free NHS flu jab, here is a guide to the next steps you can follow: 

  1. Endocrinologist Support Letter: Ask your Endocrinologist/ medical team to write a special covering letter/ email referencing the information on this page and in the 'Managing You Addison’s' leaflet (flu is referenced under section 7) to send on to your GP. Points to include are noting your specific medical conditions so it is relevant for your circumstances. If doing by email, be sure to include the endocrinology secretary department as so many endocrinologists are very busy in their NHS roles.
  2. Next steps with GP inc PALs: After sending this email/letter from your endocrinologist to the GP –  if the GP still goes on to refuse - ask the GP to answer why they are going against the expert advice and guidance of the Addison's Clinical Advisory Panel (CAP) and your Endocrinologist. This is so you have their response in writing and helps provide clarity. Let your GP know it is your intention to include their answer when writing formally to PALs about their unsafe management of your Addison’s or adrenal insufficiency. 
  3. Care Opinion Website: It can help to post some informal feedback on the Care Opinion website as well as going through the formal trust process via PALs. Every comment on the Care Opinion website that mentions adrenal insufficiency or adrenal crisis – positive or negative – helps to put the needs of adrenal patients on the map, and all patient feedback on their site is searchable as a reference with the aim to contribute to improving standards of care in the future.  

This is also a reminder that each person with Addison's or adrenal insufficiency needs to have sufficient supplies of medication to cover any period of ill health with flu, including up-to-date supplies of vials for individuals own hydrocortisone emergency injection kit. 

Should I increase my glucocorticoid dose before having a vaccine?

Our Addison's Clinical Advisory Panel (CAP) and Society for Endocrinology have advised that there is no need to routinely increase glucocorticoid dose in patients with adrenal insufficiency at the time of vaccination if no significant symptoms. However if you are particularly anxious/ stressed before, this will "use up" your cortisol so you should up-dose in response to how you feel. It's different for everyone, as every body is different - so please listen to your body and do what is right for you.

But if you were to feel unwell after vaccination, increase your glucocorticoid, take paracetamol to help reduce your symptoms making them easier to manage, factor in plenty of time to rest and drink plenty of fluids, all as you would normally for the sick day rules

Can I have the COVID-19 booster and flu jab at the same time?

It is safe to have both vaccines together, but it is advised to get them in different arms. It is important to take up the offer of both free NHS vaccines, to reduce your risk of becoming ill with coronavirus and flu at the same time. However, if you're aware from experience that your body requires extra rest after vaccines, you may wish to leave a couple of days between vaccine appointments to suit your circumstances. Visit our 'Coronavirus vaccines' page to learn more about the COVID-19 booster.

On our online forum, members have been sharing their experiences of receiving both vaccines. So if you'd find it reassuring to hear others' experiences direct, please visit our online forum to join the conversation.

Am I eligible for the Shingles vaccine? 

People with Addison’s and adrenal insufficiency are only eligible for the shingles vaccine when offered by age. They are not eligible to have the shingles vaccination on the grounds of immunosuppression. To help answer any questions you may have about shingles we spoke to Chair of the Addison's Clinical Advisory Panel (CAP), Professor John Wass, about what this means for those with Addison's and adrenal insufficiency. Read our shingles article.

Should people with Adrenal Insufficiency have the Pneumonia jab?

People with adrenal insufficiency who take daily steroids are not currently in an at risk group requiring a pneumonia jab. The pneumovax vaccination available from healthcare professionals and pharmacies does not protect against the viral pneumonia that can be caused by COVID-19. Recent studies have set out to prove definitively if those with adrenal insufficiency are at greater risk of bacterial Pneumonia than those without. There is yet to be any information to change the advice provided the the NHS. If you feel concerned about pneumonia, discuss it with your healthcare team who can advise on risks and vaccine requirements specific to your circumstances. Pneumonia vaccines are available to buy from some pharmacies. NHS advice on Pneumonia vaccines.

Can vaccines cause bad reactions?

We are all different and some people may have a reaction. They might have an allergy to the ingredients. Always ask your healthcare professionals to discuss the ingredients with you to make sure you are comfortable with the ingredients. If you are poorly you are advised to rearrange your vaccination until have recovered so that you avoid complications. You can find out more about reactions to vaccines and the Yellow Card scheme for reporting them on the NHS website.

Are people with Adrenal Insufficiency at greater risk of bad reactions to vaccines?

Everyone is different and there are lots of factors at the time of having a vaccine that may make it appear it is related to the vaccine such as food poisoning or a stomach bug. As with all bouts of illness or physical stress on your body, you should follow the sick day rules

There is some research suggesting patients with Addison’s disease have a small increased risk of infections, but this is not to the same degree as patients who are immunocompromised.  

It is important to remember that those with Addison’s and adrenal insufficiency are unable to mount a response to infection without extra steroid medication. So if your steroid replacement is not increased at the first sign of illness, you will become unwell until your steroid medication is increased.

This is why people with Addison's and adrenal insufficiency are eligible for the free NHS flu vaccine and are classified as "Clinical risk group" for COVID vaccines. People with Addison’s and adrenal insufficiency benefit hugely from the protection provded by these vaccines. 

Fludrocortisone: some members have got to in touch concerned having read online that you should not have vaccinations if taking fludrocortisone. Our medics have confirmed these rumours are incorrect. When taking fludrocortisone as replacement therapy for Addison's or any form of adrenal insufficiency you should still receive vaccinations when offered by your healthcare professionals.

What about live vaccines?

Live vaccines contain a live version of the virus it is designed to protect you from. According to NICE people receiving immunosuppressive doses of corticosteroids should avoid live vaccines. People who have adrenal insufficiency alone usually take daily doses of steroids that are not immunosuppressive so are on replacement corticosteroids treatment - replacing what your body would naturally produce.

It’s important to check the latest advice about any other conditions you have in combination with adrenal insufficiency. The flu jab for adults is not a live vaccine. You can check the NHS website for more details about various types of vaccines.

For more information, our Clinical Advisory Panel have put together guidance about the flu vaccination under section 7 in our 'Managing Your Addison's' leaflet. 

Click to download the 'Managing Your Addison's' leaflet

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