Flu Vaccination

Oct 01, 2015

We are entering flu season. I anticipate getting many questions as to my recommendations regarding whether people with ME/CFS should get the flu vaccine or not. Health Canada recommends that everyone over 6 months of age including pregnant women receive an annual flu vaccine at the start of the season. For optimal results as many people as possible need to be vaccinated to decrease the prevalence of the flu in the population in general (referred to as the herd effect). For individuals the vaccine decreased the probability of catching the flu and dying as a result.

I advise my patients to consider the pros and cons as one would with any medical decision. In this case one has to weigh the risks of getting a severe flu with the risks of the vaccine and the risks to the population if many people remain unvaccinated. For most individuals the risk of the vaccine is far less than the risk of getting the flu.

There are no published contraindications for people with Fibromyalgia getting the flu vaccine apart from the risks anyone faces of.

ME/CFS is associated with abnormal immune function. This means that some people with ME/CFS become more severely ill with the flu than “healthy” individuals and that their immune system may not react in the usual way to the vaccine. The IACFS/ME Primer (pg 30) states that there are case reports of patients who have become ill or whose condition has worsened after an immunization. There are no large scale studies of this.

A recent study Ekua Brenu and colleagues at Griffith University in Australia shows that while influenza vaccination may protect CFS/ME patients against influenza, it has the ability to increase cytotoxic activity and pro-inflammatory reactions post vaccination. They conclude that “the benefits of influenza vaccine still likely outweigh the risks ME/CFS patients experience following vaccination”. The same group conducted a second study to understand how increased inflammation occurs post vaccine. This study specifically assessed the impact of the trivalent influenza vaccine (a flu vaccine containing three antigens). Most vaccines available in Canada contain three or four flu virus antigens. They found that this vaccine may increase the expression of genes in ME/CFS and this may contribute to the increase in cytotoxic activity observed in these patients post vaccination.

Brenu, E. W. et al (2013). Enhanced gene expression following vaccination in chronic fatigue syndrome/myalgic encephalomyelitis. International Journal of Clinical Medicine, 4, 165-170. Retrieved from http://dx.doi.org/10.4236/ijcm.2013.43029

Brenu, E. W et al (2012). The effects of influenza vaccination on immune function in patients with chronic fatigue syndrome/myalgic encephalomyelitis. International Journal of Clinical Medicine, 3, 1-8.

Author: Eleanor (Ellie) Stein MD FRCP(C)

I am a psychiatrist with a small private practice in Calgary and am an assistant clinical professor in the faculty of medicine at the University of Calgary. Since 2000, I have worked with over 1000 patients, all with ME/CFS, FM and ES. My passion for this field comes from my own struggle with these diseases, my desire to improve my health and then pass on what I learn. My goal is for every patient in Canada to have access to respectful, effective health care within the publicly funded system. 


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