Influenza vaccine

Influenza vaccines, also known as flu shots, are vaccines that protect against influenza. A new version of the vaccine is developed twice a year as the influenza virus rapidly changes. While their effectiveness varies from year to year, most provide modest to high protection against influenza. A complete population study of Norway's 2009 mass vaccination has found no increased risk of ME/CFS associated with H1N1 influenza vaccination. Limited research on vaccinating ME/CFS patients has found it safe and effective, producing an immunizing response similar to healthy controls.

Research
Limited available research on the subject has found influenza vaccination safe and effective for CFS patients. A 2000 double-blind, randomized control trial of 40 CFS patients and 21 health controls studying antibody response found "influenza immunization is safe, not associated with any excess early reactions, and stimulates an immunizing response comparable with that of healthy volunteers." A 2012 study of immune response found "The humoral and cellular immune responses upon influenza vaccination were comparable in CFS patients and healthy controls...Standard seasonal influenza vaccination is thus justified and, when indicated, should be recommended for patients suffering from CFS." A 2002 survey on CFS patients' views of the vaccine noted that CFS patients in both treatment and placebo groups for influenza vaccination reported four times the adverse effects of healthy controls in the treatment group (i.e. healthy people who were vaccinated) and "data re-analysis revealed that this finding was related to the overlap of common, post-influenza immunization symptoms and CFS constitutional symptoms," putting CFS patients at risk of misattributing causality and "reject[ing] disease prevention strategies such as immunization."

A 2015 complete population study of data from 2009 to 2012 in Norway, following the country's mass vaccination during the 2009 influenza A (H1N1) pandemic, found that vaccination produced no increased risk of subsequent CFS/ME diagnosis. By contrast, infection with influenza more than doubled the risk of developing CFS/ME.

Clinician advice
Individual doctors offer varying advice on whether patients with ME/CFS or fibromyalgia should have a flu shot. The general guidance is relying on your past experience with the influenza vaccine and your known allergies. "Charles Shepherd, MD, a U.K. doctor who is a member of the Chief Medical Officer's Working Group on CFS/ME at the U.K. Department of Health, agrees with Dr. Lapp.   He has found that a substantial percentage of his ME/CFS patients have mild-to-moderate relapses after receiving flu vaccinations.""On the other hand, Anthony Komaroff, MD, Professor of Medicine at Harvard Medical School, and Jacob Teitelbaum, MD, the medical director of the Fibromyalgia and Fatigue Centers, feels the benefits outweigh the risks because the effects of the flu on FM and ME/CFS patients can be severe and long lasting." "If you decide you would like to be vaccinated, then I recommend starting with an injection of one third the usual adult dose. If there are no side effects, then the same dose can be repeated in a month's time, and the same again after one further month. The reason for this is that Physicians specializing in ME/CFS, including myself, have reported cases of flu symptoms in some patients with ME/CFS for 4 or more weeks after the full dose of flu vaccine has been given. It is unknown whether patients with Fibromyalgia or Environmental Sensitivities and/or Intolerances are more prone to such a response. However overlap of these conditions with ME/CFS has been repeatedly reported in the medical literature, and so caution is probably wise. Having symptoms for this length of time is not normal after a flu shot. It is called an adverse vaccine event and needs to be reported to the Department of Health. There is an Adverse Vaccine Event Form that must be filled out by the doctor. Each region has its own Department of Public Health." "There are anecdotal reports of people with ME/CFS suffering a relapse, or even developing ME/CFS, after a flu vaccination.""This could be due to the fact that research into immune system dysfunction in ME/CFS has found evidence of what is called immune system activation – which equates to a persisting and overactive immune response to a triggering infection.""Vaccines are designed to mimic the infection they are designed to protect against and so they also trigger an immune system response.""In a small survey carried out by the ME Association among its members a few years ago, seven out of 21 people had no problems at all, 13 reported an exacerbation of symptoms ranging from mild (3) or moderate (7) through to a severe relapse in three cases. Interestingly, there was one report of a teenager who noticed a slight improvement in symptoms following vaccination.""An ME Association online poll carried out in November 2008 asked how the flu vaccine had affected M.E. symptoms. There were 191 responses:"
 * 2011, Flu Shots: Should You Get One if You Have Fibromyalgia?
 * 2014, FLU Vaccination and Chronic Fatigue Syndrome
 * 2017, The Flu and M.E. – all you need to know about the 2017/18 flu vaccine


 * 86 (45%) reported no change


 * 52 (27%) said they were much worse


 * 42 (22%) said they were slightly worse


 * 7 (4%) said they were slightly better and,


 * 4 (2%) said they were much better after the jab.

"Some doctors believe that this may be more likely to occur if you still have on-going flu-like/infection symptoms such as enlarged glands, sore throats, problems with temperature control, etc."

Immune system involvement in ME/CFS and Fibromyalgia
ME/CFS

The Centers for Disease Control and Prevention ME/CFS page: "Immune system abnormalities – some people with ME/CFS have impaired natural killer cell function and/or T cell function, chronic higher production of inflammatory cytokines, and in some cases slight increase in some autoantibodies (rheumatic factor, anti-thyroid antibodies, anti-gliadin, anti-smooth muscle antibodies, and cold agglutinins)."Fibromyalgia

In 2018, Zhang et al. research found inflammatory genes were involved in FM. Their paper SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study concluded: "SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM."There is ongoing immune system research of fibromyalgia.

Studies

 * 2000, Double-blind, randomized study of the effects of influenza vaccination on the specific antibody response and clinical course of patients with chronic fatigue syndrome.
 * 2002, Influenza vaccination: is it appropriate in chronic fatigue syndrome?
 * 2012, Humoral and cellular immune responses after influenza vaccination in patients with chronic fatigue syndrome.
 * 2015, Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine.

Learn more

 * Wikipedia