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Question answered:17/01/08
The Green Book chapter on influenza [1] includes a table (19.2) which lists clinical risk groups who should receive the vaccine. This includes the following chronic liver diseases: cirrhosis, biliary atresia and chronic hepatitis.
The CKS guideline on influenza [2] indicates that those with liver disease are at increased risk of developing complications from flu. However, it does specifically list fatty liver.
In March 2007 the CMO released the annual influenza immunisation letter [3] and this reported:
“Provision for payment for all diabetics and for patients with stroke and TIA is already made under QOF. In order to provide the vaccine to individuals with chronic liver disease, cerebrovascular disease (principally stroke and TIA), Multiple Sclerosis and related conditions, hereditary and degenerative disease of the Central Nervous System and carers; Primary Care Trusts should consider offering contractors a Local Enhanced Service to cover these groups.”
Again the document does not specifically mention fatty liver but lists cirrhosis, biliary atresia and chronic hepatitis as examples (decision based on clinical judgement).
We spoke to the oncall doctor at the Centre for Infections at the Health Protection Agency and they reported that, unless the disease has progressed, then fatty liver (of either type) is not considered a chronic disease and therefore doesn’t fall into the category of chronic liver disease. You can contact the oncall doctor for further information via 020 8200 4400
References
1) http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=116105&Rendition=Web
2) http://cks.library.nhs.uk/influenza/view_whole_guidance
3) http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=137431&Rendition=Web
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