Influenza Increases Health Risk For People with Non-Communicable Diseases

Many Malaysians are afflicted with non-communicable diseases (NCDs). According to our Ministry of Health’s National Health and Morbidity Survey 2015, some 3.5 million and 6.1 million Malaysians suffer from diabetes mellitus and hypertension, respectively[1]. As for cardiovascular diseases, they continue to be the leading cause of mortality, accounting for 36% of deaths in the country[2].

For people with NCDs, managing their disease is of utmost importance. This typically includes having regular follow-ups with the doctor, taking one’s medication as prescribed, and maintaining a healthy lifestyle. Furthermore, doctors also recommend annual influenza (or flu) vaccinations to help keep these individuals healthy[3].

While influenza can seriously worsen pre-existing NCDs and bring on a variety of medical emergencies, vaccination can have a valuable protective effect[3]. In a study of over 35,000 older adults with NCDs, influenza vaccination was found to reduce death rates from stroke, diabetes, chronic obstructive pulmonary disease (COPD), and heart disease, by 65%, 55%, 45% and 22% respectively[4].

Flu Can Trigger Heart Attacks

The American Heart Association and the American College of Cardiology recommend annual influenza vaccination for cardiovascular disease patients with coronary and other atherosclerotic vascular disease, the two most common forms of cardiovascular diseases[5],[6]. The rationale is clear.

Patients with cardiovascular disease who are infected by influenza are six times more likely to be hospitalised from a heart attack[7]. Moreover, influenza can also significantly increase their risk of death[8].

Influenza vaccination is also recommended for people suffering from heart failure, a condition that develops when the heart muscles become weak due to hypertension and repeated heart attacks[6].

When people with heart failure get a bout of influenza, the infection may put a great deal of stress on the heart and bring on a heart attack[7][9]. Influenza vaccination has been shown to help reduce hospitalisations in patients with pre-existing heart failure[10].

Flu and Diabetes: A Dangerous Combination

Diabetes mellitus is a disease that occurs when your blood glucose (sugar) is persistently high[11]. Influenza is a serious threat to people with diabetes, including those who are managing their disease well[12].

A bout of influenza can cause blood glucose levels to rise to dangerously high levels (hyperglycaemia). This increases the risk of secondary infection, and the likelihood of life-threatening diabetes complications[13],[14],[15].

People with diabetes may not recover easily or quickly from an influenza infection. Also, certain flu medications may worsen their hyperglycaemia or even increase their risk of heart problems and stroke[14].

Therefore, it is advisable for people with diabetes to prevent influenza, by getting vaccinated against the disease each year. After all, influenza vaccination among type 2 diabetics has been found to result in 24% lower death rates compared with those who are unvaccinated[16].

Flu Deteriorates Kidney Function

Diabetes and high blood pressure are the leading causes[17] of chronic kidney disease which often results in end-stage kidney failure requiring dialysis treatment[17].

Kidney disease can also develop from a serious infection, such as influenza[18]. The infection can cause muscle to break down and create toxic byproducts that damage the kidney tubules[18]. In a study of 47 H1N1 patients, two-thirds of them were found to have experienced kidney injury or kidney failure, while 11% needed to undergo dialysis to help filter their blood[18].

Regardless of the cause, people with kidney diseases have weakened immune systems. This may be due to the presence of residual toxins, poor nutritional status, or immunosuppressive medications[19].

Therefore, to help maintain their health, people with kidney diseases are encouraged to vaccinate against influenza. Vaccination not only helps to reduce hospitalisations but also lowers overall mortality, especially among dialysis patients[20].

[1]Ministry of Health Malaysia (2015). National Health & Morbidity Survey Fact Sheet. Retrieved from
[2]WHO (2014). World Health Organization – Noncommunicable Diseases (NCD) Country Profiles. Malaysia. Retrieved from
[3]CDC (2017). Adults With Chronic Conditions: Get Vaccinated. Retrieved from
[4]Palache et al (2014). The Link between Seasonal Influenza and NCDs: Strategies for Improving Vaccination Coverage. Health Journal, 6, 2724-2735.
[5]AHA (2015). Flu and Pneumonia Prevention. Retrieved from
[6]New York State Department of Health (2012). Types of Cardiovascular Disease. Retrieved from
[7]Kwong et al (2018). Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. The New England Journal of Medicine
. 378:345-53.
[8]Mertz et al (2013). Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ;347:f5061. DOI: 10.1136/bmj.f5061
[9]Majdid et al (2007). Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34 892 subjects. European Heart Journal 28, 1205–1210
[10]Kagoglou et al (2017). Influenza infection and heart failure—vaccination may change heart failure prognosis? Heart Fail Review. 22(3): 329–336.
[11]NIDDK (2016). What is Diabetes? Retrieved from
[12]CDC (2017). Flu and People with Diabetes. Retrieved from
[13]Hulme et al (2017). Influenza Virus and Glycemic Variability in Diabetes: A Killer Combination? Frontiers in Microbiology, 8: 861
[14] (nd). Flu and diabetes. Retrieved from
[15]Lupsa et al (2014). Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome. Endocrine Emergencies: Recognition and Treatment, pp15-31. DOI 10.1007/978-1-62703-697-9_2
[16]Vamos et al (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ, DOI:
[17]National Kidney Foundation Malaysia (2017). Kidney Failure. Retrieved from
[18]National Kidney Foundation (2010). Serious Kidney Injury Common in Very Ill H1N1 Patients. Retrieved from
[19]Indian Society of Nephrology Vaccination Work Group (2016). Guidelines for Vaccination in Chronic Kidney Disease. Indian Journal of Nephrology; Suppl. 1: S2
[20]Kausz et al (2004). The Value of Vaccination in Chronic Kidney Disease. Seminars in Dialysis Vol 17, No 1, pp. 9–11

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