Influenza vaccine

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
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 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.[1] A complete population study of Norway's 2009 mass vaccination has found no increased risk of ME/CFS associated with H1N1 influenza vaccination.[2] Limited research on vaccinating ME/CFS patients has found it safe and effective, producing an immunizing response similar to healthy controls.[3] The Centers for Disease Control and Prevention (CDC) recommends flu vaccination for ME/CFS patients.[4] Clinician advice varies.

ME/CFS and Fibromyalgia patients[edit | edit source]

Research[edit | edit source]

Limited available research on the subject has found influenza vaccination safe and effective for chronic fatigue syndrome (CFS) patients.[3][5][6] 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."[3] 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."[6] 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."[5]

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).[7] 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 WHO recommendations."[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.[2]

CDC guidance[edit | edit source]

In a 2006 joint press brief held by the Chronic Fatigue and Immune Dysfunction Syndrome Association of America and the U.S. 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."[4]

Clinician advice[edit | edit source]

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, 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."[8]

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.[9]

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.[9]

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.[10]

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:

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.[11]

Studies[edit | edit source]

  • 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.[3]
  • 2002, Influenza vaccination: is it appropriate in chronic fatigue syndrome?[5]
  • 2012, Humoral and cellular immune responses after influenza vaccination in patients with chronic fatigue syndrome.[6]
  • 2015, Influenza vaccination is safe and effective in patients suffering from fibromyalgia syndrome.[7]
  • 2015, Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine.[2]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. "Vaccines against influenza WHO position paper – November 2012." (PDF), Wkly Epidemiol Rec, 87 (46): 461–76, November 23, 2012, PMID 23210147
  2. 2.0 2.1 2.2 Magnus, Per; Gunnes, Nina; Tveito, Kari; Bakken, Inger Johanne; Ghaderi, Sara; Stoltenberg, Camilla; Hornig, Mady; Lipkin, W. Ian; Trogstad, Lill (November 17, 2015). "Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine". Vaccine. 33 (46): 6173–6177. doi:10.1016/j.vaccine.2015.10.018. ISSN 1873-2518. PMID 26475444.
  3. 3.0 3.1 3.2 3.3 Sleigh, K.M.; Danforth, D.G.; Hall, R.T.; Fleming, J.A.; Stiver, H.G. (September 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". The Canadian Journal of Infectious Diseases = Journal Canadien Des Maladies Infectieuses. 11 (5): 267–273. ISSN 1180-2332. PMC 2094778. PMID 18159300.
  4. 4.0 4.1 "CDC Press Briefing Transcripts November 3, 2006". Centers for Disease Control and Prevention. November 3, 2006. Retrieved February 9, 2019.
  5. 5.0 5.1 5.2 Sleigh, Kenna M.; Marra, Fawziah H.; Stiver, H. Grant (2002). "Influenza vaccination: is it appropriate in chronic fatigue syndrome?". American Journal of Respiratory Medicine: Drugs, Devices, and Other Interventions. 1 (1): 3–9. ISSN 1175-6365. PMID 14720070.
  6. 6.0 6.1 6.2 Prinsen, Hetty; de Vries, I. Jolanda M.; Torensma, Ruurd; Pots, Jeanette M.; Mulder, Sasja F.; van Herpen, Carla M.L.; Elving, LammyD.; Bleijenberg, Gijs; Stelma, Foekje F. (December 17, 2012). "Humoral and cellular immune responses after influenza vaccination in patients with chronic fatigue syndrome". BMC immunology. 13: 71. doi:10.1186/1471-2172-13-71. ISSN 1471-2172. PMC 3534525. PMID 23244635.
  7. 7.0 7.1 7.2 Ablin, J.N.; Aloush, V.; Brill, A.; Berman, M.; Barzilai, M.; Caspi, D.; Mandelboim, M.; Levartovsky, D.; Polachek, A. (September 16, 2015). "Influenza vaccination is safe and effective in patients suffering from fibromyalgia syndrome". Reumatismo. 67 (2): 57–61. doi:10.4081/reumatismo.2015.823. ISSN 0048-7449. PMID 26492963.
  8. Friedberg, Fred; Bateman, Lucinda; Bested, Alison; Davenoport, Todd (2014). "ME/CFS:A Primer for Clinical Practitioners". IACFSME. International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. p. 30. Retrieved February 9, 2019.
  9. 9.0 9.1 9.2 Richards, Karen Lee (October 11, 2011). "Flu Shots: Should You Get One if You Have Fibromyalgia? - Daily Life - Chronic Pain | HealthCentral". Retrieved August 24, 2018.
  10. 10.0 10.1 Hogg, Matthew; Bested, Alison (April 24, 2014). "FLU Vaccination and Chronic Fatigue Syndrome". Retrieved August 24, 2018.
  11. 11.0 11.1 Shepherd, Charles (October 4, 2017). "The Flu and M.E. – all you need to know about the 2017/18 flu vaccine | 04 October 2017". The ME Association. Retrieved August 24, 2018.