A Vaccination Link?
a vaccination precipitate Myalgic Encephalomyelitis [CFIDS in the U.S.]? When
I became ill the day after a flu jab 2 1/2 years ago, I thought at first I had
flu. However, the flu-like symptoms persisted for 3 months, and I was told I had
"post viral syndrome." After a brief remission a viral infection precipitated
a relapse into chronic ME.
wondered whether my own experience was unusual. I advertised in Interaction
14 for others who felt their ME, or a relapse, had been precipitated by
a vaccination to contact me.
had 14 replies; in some cases the onset of symptoms was within days, or even hours
of a vaccination.
a home help from Falmouth, became ill the day after having a flu jab in 1988.
Until then, she had led a very active life, and enjoyed sports.
next day I felt terrible, as if I'd got flu," she says. About three months
later Rosalie was diagnosed as having ME by her GP. Blood tests were positive
for both Coxsackie B and Epstein Barr virus.
carried on working for about a year, trying to ignore it. "That's the sort
of person I am," she says. "I found I was doing things for people of
about 80, and they could do it better than I could. I was determined I wasn't
going to be off sick. In the end, I could hardly walk, and when it got so bad
I couldn't lift my head off the pillow one morning, I realised that perhaps I
needed a week off. That was 5 years ago. I still feel just as ill as I did at
the beginning, with mostly flu-like symptoms." Rosalie believes she has become
more sensitive to certain drugs. "At a recent visit to the dentist, I was
given a local anaesthetic to have a tooth out. I immediately started shaking,
freezing and sweating. This wore off after a few minutes."
from Bristol was advised to have various vaccinations as a trainee nurse, and
in August 1990 had a polio booster and the first hepatitis B vaccination (of a
course of 3).
about 10 minutes I blacked out, and was unwell for 5 weeks," she remembers.
"I had ME-like symptoms -- exhaustion, muscle fatigue, aches and pains, co-ordination
and balance problems, and memory loss, but they were complicated by the fact that
when I blacked out I banged my head and suffered concussion. My employers were
re-starting her course 2 months later, Hazel was encouraged to complete the course
of hepatitis B vaccinations. "I was told that if I suffered any reaction
to the second one they would let me off the third. I took advice from a GP, and
was eventually persuaded to have it. I didn't pass out, but started feeling light-headed
after a few hours. After 24 hours I developed balance problems, and soon all the
symptoms I'd experienced after the first injection returned."
has since had the diagnosis of ME confirmed, but after more than 3 years is still
unable to do any work, and reports no overall improvement.
problem faced by health workers who have had hepatitis B vaccinations was raised
by other respondents.
now, it has been voluntary for health care workers to have a course of hepatitis
B vaccinations, although it is recommended that they do so for their own safety.
some workers this could change with the introduction of new health service guidelines,
"Protecting Health Care Workers and Patients from Hepatitis B", which
come into force for most health care workers in 1995.
state that all health care workers who perform "exposure prone procedures"
should be immunised against hepatitis B, and their response to the vaccine subsequently
purpose is both to protect health care workers who may be at risk of acquiring
hepatitis B from a patient, and to protect patients against the risk of acquiring
hepatitis B from an infected health worker.
interpreted, it should not be compulsory for most GPs and nurses to be vaccinated,
but under the guidelines, non-immunised staff would not be permitted to do certain
"exposure prone procedures." These are defined as where there is a risk
that injury to the worker may result in the exposure of the patient's open tissues
to the blood of the worker. As it is impossible to predict when some of these
procedures may need to be carried out, it is possible that staff may be requested
to have a course o It remains to be seen how these guidelines will be implemented
by the individual Health Authorities, Trusts and FHSAs, and those workers concerned
about the implications for themselves could initially consult their Occupational
Health Department or FHSA.
guidelines have caused concern to a West Midlands GP, who prefers not to be identified.
He initially developed ME, which lasted 2 years, after an attack of hepatitis.
the ME, I waited until I had been 100% fit for about a year before starting the
hepatitis B course, as in my job I am at risk," he says. "Four days
after the first injection all the symptoms returned. The vaccination appeared
to bring about a complete relapse. I didn't have any time off to begin with, and
struggled on for about 18 months, but in the end I had to take a month off, and
after that things began to improve."
years after the vaccination, the GP believes that he has almost recovered from
ME, but is concerned that he may be requested to complete a course of hepatitis
B vaccinations by next year.
says "I have no intention of having a further hepatitis B vaccination and
going through another 3 years of that. I've had it twice already."
believes that the risk of a GP giving hepatitis B to a patient is very remote,
and is prepared to run the risk, which he believes is small, of acquiring it from
Charles Shepherd, medical adviser to the ME Association, is convinced of the connection
between vaccinations and ME. "I consider that in a small minority of cases
a vaccination can be a triggering factor, as can viral infections and possibly
some neurotoxins," he says. He believes a vaccination alone can precipitate
the illness. "A vaccination mimics the effects of a viral infection, so it
is not surprising that it can have the same effect. It is stress on the immune
personal experience with patients, he believes tetanus, typhoid and possibly hepatitis
B are particularly implicated. "There may be a particular problem with
hepatitis B. Many health workers are under enormous pressure to have it. Although
anyone who has contact with blood products would be foolish not to have it, I
would advise people with ME, or who have recently recovered, to be extremely cautious
about having hepatitis B."
Shepherd has been concerned by cases where people have been given hepatitis B
soon after having glandular fever. "Vaccinations shouldn't be given when
people are recovering from an infective episode."
Shepherd stresses that he is not anti-vaccination. "However, there appears
to be a small but significant link, which needs to be looked at."
is also concerned that adverse reactions are not being reported to the Committee
on Safety of Medicines. "These sort of reactions should be going down
on yellow cards and being sent in by GPs, and this is not happening."
Elizabeth Dowsett, Honorary Consultant Microbiologist to the Basildon and Thurrock
NHS Health Trust, and President of the ME Association, agrees that an immunisation
can precipitate a relapse.
first attack can be after a vaccine, but it's not the vaccine that causes it.
You have got to have the causal agent of ME in you, an enterovirus. In my experience,
any type of vaccine can cause this problem; anything that knocks or disturbs your
immune system even temporarily can cause a relapse; any trauma such as an infection
or immunisation, an accident or certain drugs. Also physical or mental over-exertion;
cold or malnutrition, or any chemical substance active in the brain, such as alcohol."
Dr. Dowsett advises extreme caution to ME sufferers who may be considering
an immunisation for any reason. "Any immunisation has to be considered very
carefully in ME. In fact, I would advise no immunisations at all unless it is
absolutely necessary and you are in the best possible health. However, I would
make an exception for polio if you are in contact with young children who have
recently been immunised against polio, because of the small risk of contracting
paralytic polio after exposure."
Dowsett says people with ME should take advice before any immunisation. "For
some people it may be safer to alter a holiday destination or change job rather
than have repeated immunisations."
is particularly concerned about the position of health workers and the hepatitis
B vaccine. "Many health care workers have ME, it is one of the highest categories,"
she says. "We are already discussing the matter with the Occupational Health
Service, and it should be taken up with the Dept of Health."
of all it may be possible to postpone it - although you never know at what point
it would be safe. Secondly, many health workers may not actually need it. For
example, GPs have been pressurised to have the hepatitis B vaccine, but don't
actually need it."
Dowsett believes the relatively high rate of ME among teachers is primarily explained
by their greater exposure to childhood infections, particularly strains of enterovirus.
"These can be spread by the respiratory route - coughing and sneezing - and
younger, primary school children tend to be more infectious. Immunisation of teachers
may be a secondary factor."
Dr. Dowsett also included a general
anaesthetic as one of many possible causes of a relapse.
Jones has conducted a study of ME for her MSc thesis at the University of East
London. Her research suggests that a vaccination can trigger the illness, or precipitate
13% of 225 subjects had been vaccinated in the month before ME onset,"
she says. She found certain types of vaccine more frequently associated with ME
onset, particularly tetanus, and, in younger people, BCG.
a prior viral or bacterial infection was normally involved, other factors, or
combinations of factors, were often implicated. These included the frequent use
of antibiotics for recurring infections, stress, and exposure to toxic chemical
or environmental pollutants.
agrees that being vaccinated before fully recovering from a viral or other infection
may increase the risk of developing a post viral illness or ME. "My research
suggests that there could be an interaction between a viral or other infection
and a vaccination. This can occur if someone is vaccinated when they either have
a subclinical infection, or are incubating an infection they are not aware of."
it is possible that a vaccination alone can precipitate ME, but it depends on
a number of things. Also, certain people may be more at risk of having an adverse
reaction, including those who have had a previous reaction to a vaccine, and people
with allergies or a suppressed immune system."
conclusion, the evidence suggests that any vaccine may precipitate ME or a relapse,
particularly if other factors are present, such as a viral infection, around the
time of the vaccination.
who have ME, or have recently recovered, should be cautious about having any vaccine
because of the possibility of a relapse.
workers face a particular problem, because they are encouraged to have hepatitis
B jabs for their own safety, and the new guidelines will mean certain categories
of workers may be required to complete a course of vaccinations.
vaccine is only one of many factors which may contribute to the development ME,
and it would be difficult to prove in any particular case how great a role a vaccination
played, if any. However, there is sufficient evidence to suggest that the issue
deserves more publicity and research, and it is hoped that this article may give
rise to further debate on the subject.
If your CFIDS or ME started after receiving a flu shot or vaccination of some
other sort, please contact Jane Affleck at 101521.3515@compuServe.com
and share your experience. We can't count on the medical establishment to make
this possible vaccination/CFIDS link, so we need to track down the information
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