FLU SHOTS: WEIGH THE RISKS

Thankyou to Emerge Magazine - ME/Chronic Fatigue Syndrome Society of Vic. Inc

Physicians who treat patients with Chronic Fatigue Syndrome (CFS/ME) must balance the benefits of an annual influenza vaccination against the concerns that the inoculation will exacerbate CFS/ME symptoms.

Here are two physicians' views on the use of flu vaccines in CFS/ME patients

Charles Shepherd, MD

On the plus side, the vaccine should provide a fairly high degree of protection against the particular strains of the flu virus that seem likely to occur over the coming months. This is important because a bout of the flu will almost certainly cause a relapse or marked worsening of symptoms in people with CFS/ME. In addition, influenza can trigger life- threatening complications in patients with underlying conditions such as diabetes or heart, lung or kidney disease.

However, physicians must be aware of concerns that the vaccine can cause problems in CFS/ME  patients. There are a number of anecdotal reports (but not firm evidence published in the scientific literature) of people with CFS/ME  experiencing a relapse in symptoms following the use of the vaccines.

In a survey i carried out a few years ago, a total of 21 people with CFS/ME  responded to a request for information about what happened following flu vaccinations. Seven had no problems at all whereas 13 reported an exacerbation of symptoms that ranged from mild (3 of 13) to moderate (7of 13) to severe (3 of 13). There also was an interesting report involving a teenager who noticed a considerable degree of improvement in symptoms following a vaccination. There results are very similar to the general feedback I continue to receive on this subject.

It is impossible to predict who is more likely to suffer an adverse reaction or relapse following use of the influenza vaccine. However, anecdotal reports suggest that this may be more likely to occur in people who have ongoing infective-type symptoms (sore throats, enlarged glands, problems with temperature control, etc). In this situation I would personally advise against having a flu vaccine unless there are very good reasons for doing so.

I would also advise against flu vaccinations if a patient is in the very early stages of CFS/ME, particularly when it obviously follows an infective episode. In addition, I would avoid administering the vaccine if the patient has previously experienced an adverse reaction to flu shots. Patients who have not shown adverse reactions to the influenza vaccines in previous years without any real problems, even though the preparation varies annually.

Charles Shepherd, MD, is a medical director of the Myalgic Encephalopathy Association (MEA) in the United Kingdom.
 

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