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Influenza vaccine
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=== 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>
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