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[[File:Influenza Vaccine.jpg|200px|thumb|right|This is CDC Clinic Chief Nurse Lee Ann Jean-Louis extracting Influenza Virus Vaccine, Fluzone® from a 5 ml. vial]] '''Influenza vaccines''', also known as '''flu shots''', are [[vaccine]]s 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.<ref name="WHO2012">{{citation | title=Vaccines against influenza WHO position paper – November 2012.|journal=Wkly Epidemiol Rec | date = Nov 23, 2012|volume=87|issue=46 | pages = 461–76|pmid=23210147 | url = http://www.who.int/wer/2012/wer8747.pdf}}</ref> A complete population study of Norway's 2009 mass vaccination has found no increased risk of [[ME/CFS]] associated with [[Influenza A virus subtype H1N1|H1N1 influenza]] vaccination.<ref name=":6" /> Limited research on vaccinating ME/CFS patients has found it safe and effective, producing an immunizing response similar to healthy controls.<ref name=":3" /> The [[Centers for Disease Control and Prevention]] (CDC) recommends flu vaccination for ME/CFS patients.<ref name=":8" /> Clinician advice varies. ==ME/CFS and Fibromyalgia patients== === Research === Limited available research on the subject has found influenza vaccination safe and effective for [[chronic fatigue syndrome]] (CFS) patients.<ref name=":3" /><ref name=":4" /><ref name=":5" /> 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."<ref name=":3" /> A 2012 study of [[immune response]] found "The [[Humoral immunity|humoral]] and [[Cellular immune response|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."<ref name=":5" /> 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."<ref name=":4" /> A 2015 study that immunized 19 [[fibromyalgia]] (FM/FMS) patients and 38 healthy controls with the influenza vaccine found no severe vaccination reactions and no worsening of FMS symptoms, as measured by pre- and six-weeks-post-vaccination [[fibromyalgia impact questionnaire]] (FIQ), the [[widespread pain index]] (WPI) checklist and the [[symptoms severity scale]] (SSS).<ref name=":7">{{Cite journal | last = Ablin | first = J.N. | last2 = Aloush | first2 = V. | last3 = Brill | first3 = A. | last4 = Berman | first4 = M. | last5 = Barzilai | first5 = M. | last6 = Caspi | first6 =D. | last7 = Mandelboim | first7 = M. | last8 = Levartovsky | first8 =D. | last9 = Polachek | first9 = A. | date = 2015-09-16 | title = Influenza vaccination is safe and effective in patients suffering from fibromyalgia syndrome | url = https://www.ncbi.nlm.nih.gov/pubmed/26492963|journal=Reumatismo|volume=67|issue=2 | pages = 57–61|doi=10.4081/reumatismo.2015.823|issn=0048-7449|pmid=26492963}}</ref> Meanwhile the study also found protective immune response in both fibromyalgia patients and health controls, and thus concluded "Influenza vaccination was both safe and effective in FMS patients. In view of these results, FMS patients should be encouraged to undergo influenza vaccination according to the standard [[World Health Organization|WHO]] recommendations."<ref name=":7" /> 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.<ref name=":6" /> === CDC guidance === In a 2006 joint press brief held by the [[CFIDS Association of America|Chronic Fatigue and Immune Dysfunction Syndrome Association of America]] and the U.S. [[Centers for Disease Control and Prevention|Centers for Disease Control]] (CDC), the CDC director Dr. [[Julie Gerberding]] urged ME/CFS patients, "Please get a flu shot," explaining, "Chronic fatigue syndrome is a [[chronic illness]] and it is an indication for influenza immunization."<ref name=":8">{{Cite web | url = https://www.cdc.gov/media/transcripts/t061103.htm | title = CDC Press Briefing Transcripts November 3, 2006 | last = | first = | authorlink = | date = November 3, 2006 | website = [[Centers for Disease Control and Prevention]]|language=en-US|archive-url=|archive-date=|url-status=|access-date=2019-02-09}}</ref> === Clinician advice === Individual doctors offer varying advice on whether patients with ME/CFS or fibromyalgia should have a flu shot. In 2014, the International Association for Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis released "ME/CFS: A Primer for Clinical Practitioners" chaired by [[Fred Friedberg]], Ph.D., and co-authored by Dr. [[Lucinda Bateman]], Dr. [[Alison Bested]], [[Todd Davenport]],D.P.T., O.C.S., [[Kenneth Friedman|Kenneth Friedman,]] Ph.D., Dr. [[Alan Gurwitt]], [[Leonard Jason]], Ph.D., Dr. [[Charles Lapp]], [[Staci Stevens]], M.A., [[Rosemary Underhill]], M.B., B.S., and [[Rosamund Vallings]], M.B., B.S., which advised ME/CFS patients "consider avoiding all but essential immunizations particularly with live vaccines" out of concern for post-vaccination relapse; however, the primer qualifies this advice by noting that during a flu epidemic, the decision should "balance the health hazards of becoming ill against the possibility of symptom-worsening due to immunization."<ref>{{Cite web | url = https://www.iacfsme.org/primer_post_2014_conference/ | title = ME/CFS:A Primer for Clinical Practitioners | last = Friedberg | first = Fred | authorlink=Fred Friedberg | last2 = Bateman | first2 = Lucinda | authorlink2 = Lucinda Bateman | date = 2014 | website = IACFSME|publisher=International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis | page = 30|archive-url=|archive-date=|url-status=|access-date=February 9, 2019 | last3 = Bested | first3 = Alison | authorlink3 = Alison Bested | last4 = Davenoport | first4 = Todd | authorlink4 = Todd Davenport}}</ref> The general guidance is relying on your past experience with the influenza vaccine and your known allergies. * 2011, [https://www.healthcentral.com/article/flu-shots-should-you-get-one-if-you-have-fibromyalgia Flu Shots: Should You Get One if You Have Fibromyalgia?]<ref name=":0">{{Cite web | url = https://www.healthcentral.com/article/flu-shots-should-you-get-one-if-you-have-fibromyalgia | title = Flu Shots: Should You Get One if You Have Fibromyalgia? - Daily Life - Chronic Pain {{!}} HealthCentral | last = Richards | first = Karen Lee | date = Oct 11, 2011 | website = healthcentral.com|language=en-US|archive-url=|archive-date=|url-status=|access-date=2018-08-24}}</ref> <blockquote>[[Charles Shepherd]], MD, a U.K. doctor who is a member of the Chief Medical Officer's Working Group on [[CFS/ME]] at the [[Department of Health and Social Care (UK)|U.K. Department of Health]], agrees with [[Charles Lapp|Dr. Lapp]]. He has found that a substantial percentage of his ME/CFS patients have mild-to-moderate relapses after receiving flu vaccinations.<ref name=":0" /></blockquote><blockquote>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.<ref name=":0" /></blockquote> *2014, [https://www.ei-resource.org/news/chronic-fatigue-syndrome-news/flu-vaccination-and-chronic-fatigue-syndrome-mecfs/ FLU Vaccination and Chronic Fatigue Syndrome]<ref name=":1">{{Cite web | url = https://www.ei-resource.org/news/chronic-fatigue-syndrome-news/flu-vaccination-and-chronic-fatigue-syndrome-mecfs/ | title = FLU Vaccination and Chronic Fatigue Syndrome | last = Hogg | first = Matthew | date = Apr 24, 2014 | website = ei-resource.org|language=en-gb|archive-url=|archive-date=|url-status=|access-date=2018-08-24 | authorlink = Alison Bested | last2 = Bested | first2 = Alison | authorlink2 = }}</ref> <blockquote>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-like symptoms|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 [[Health Canada|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.<ref name=":1" /></blockquote> *2017, [https://www.meassociation.org.uk/2017/10/the-flu-and-m-e-all-you-need-to-know-about-the-201718-flu-vaccine-04-october-2017/ The Flu and M.E. – all you need to know about the 2017/18 flu vaccine]<ref name=":2">{{Cite web | url = https://www.meassociation.org.uk/2017/10/the-flu-and-m-e-all-you-need-to-know-about-the-201718-flu-vaccine-04-october-2017/ | title = The Flu and M.E. – all you need to know about the 2017/18 flu vaccine {{!}} 04 October 2017 | last = Shepherd | first = Charles | date = Oct 4, 2017 | website = [[The ME Association]]|language=en-US|archive-url=|archive-date=|url-status=|access-date=2018-08-24 | authorlink = Charles Shepherd}}</ref> <blockquote>There are anecdotal reports of people with ME/CFS suffering a relapse, or even developing ME/CFS, after a flu vaccination.</blockquote><blockquote>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.</blockquote><blockquote>Vaccines are designed to mimic the infection they are designed to protect against and so they also trigger an immune system response.</blockquote><blockquote>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.</blockquote><blockquote>An ME Association online poll carried out in November 2008 asked how the flu vaccine had affected M.E. symptoms. There were 191 responses: </blockquote> ::::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. <blockquote>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.<ref name=":2" /></blockquote> == 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.<ref name=":3">{{Cite journal | last = Sleigh | first = K.M. | last2 = Danforth | first2 =D.G. | last3 = Hall | first3 = R.T. | last4 = Fleming | first4 = J.A. | last5 = Stiver | first5 = H.G. | date = Sep 2000 | title = Double-blind, randomized study of the effects of influenza vaccination on the specific antibody response and clinical course of patients with chronic fatigue syndrome | url = https://www.ncbi.nlm.nih.gov/pubmed/18159300|journal=The Canadian Journal of Infectious Diseases = Journal Canadien Des Maladies Infectieuses|volume=11|issue=5 | pages = 267–273|issn=1180-2332|pmc=2094778|pmid=18159300}}</ref> * 2002, Influenza vaccination: is it appropriate in chronic fatigue syndrome?<ref name=":4">{{Cite journal | last = Sleigh | first = Kenna M. | last2 = Marra | first2 = Fawziah H. | last3 = Stiver | first3 = H. Grant | date = 2002 | title = Influenza vaccination: is it appropriate in chronic fatigue syndrome? | url = https://www.ncbi.nlm.nih.gov/pubmed/14720070|journal=American Journal of Respiratory Medicine: Drugs, Devices, and Other Interventions|volume=1|issue=1 | pages = 3–9|issn=1175-6365|pmid=14720070}}</ref> * 2012, Humoral and cellular immune responses after influenza vaccination in patients with chronic fatigue syndrome.<ref name=":5">{{Cite journal | last = Prinsen | first = Hetty | last2 = de Vries | first2 = I. Jolanda M. | last3 = Torensma | first3 = Ruurd | last4 = Pots | first4 = Jeanette M. | last5 = Mulder | first5 = Sasja F. | last6 = van Herpen | first6 = Carla M.L. | last7 = Elving | first7 = LammyD. | last8 = Bleijenberg | first8 = Gijs | last9 = Stelma | first9 = Foekje F. | date = 2012-12-17 | title = Humoral and cellular immune responses after influenza vaccination in patients with chronic fatigue syndrome | url = https://www.ncbi.nlm.nih.gov/pubmed/23244635|journal=BMC immunology|volume=13 | pages = 71|doi=10.1186/1471-2172-13-71|issn=1471-2172|pmc=3534525|pmid=23244635}}</ref> * 2015, Influenza vaccination is safe and effective in patients suffering from fibromyalgia syndrome.<ref name=":7" /> * 2015, Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with [[pandemic influenza]] infection, but not with an adjuvanted pandemic influenza vaccine.<ref name=":6">{{Cite journal | last = Magnus | first = Per | last2 = Gunnes | first2 = Nina | last3 = Tveito | first3 = Kari | last4 = Bakken | first4 = Inger Johanne | last5 = Ghaderi | first5 = Sara | last6 = Stoltenberg | first6 = Camilla | last7 = Hornig | first7 = Mady | last8 = Lipkin | first8 = W. Ian | last9 = Trogstad | first9 = Lill | date = 2015-11-17 | title = Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine | url = https://www.ncbi.nlm.nih.gov/pubmed/26475444|journal=Vaccine|volume=33|issue=46 | pages = 6173–6177|doi=10.1016/j.vaccine.2015.10.018|issn=1873-2518|pmid=26475444}}</ref> == Learn more == * [https://www.cdc.gov/flu/prevent/misconceptions.htm Misconceptions about Flu vaccines] - CDC == See also == * [[Influenza]] * [[Influenza A virus subtype H1N1]] * [[Vaccine]] * [[Immune system]] ==References== {{Reflist}} [[Category:Virology]] [[Category:Vaccines]] [[Category:Immunology]]
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