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Chronic Fatigue Syndrome/ME
By By: Lisa Lorden •
October 13, 1999
It's that time of year again. As the leaves begin to change color and temperatures start to dip, there is another aspect of the autumn season that is on many people's minds—the flu. For those of us with Chronic Fatigue Syndrome, flu symptoms may be all too familiar and are often a part of our everyday lives. But an acute bout of Influenza can easily leave a CFS sufferer totally debilitated for weeks or months. So what can we do? Is a flu vaccination a good idea, or does it put CFS patients even more at risk for a relapse? Opinions vary widely among both doctors and patients; in order to make the best decision for yourself, it's important to evaluate the available information and discuss it with your own treatment provider. Following are some things for you to consider.
What is Influenza?
Influenza, commonly known as "the flu," is a virus that is highly contagious. The onset of symptoms is usually sudden and can include a fever of 100-104 degrees Fahrenheit, muscle aches, sore throat, a dry cough, headache, and extreme fatigue. Healthy people tend to recover within about 3-7 days, but for those with compromised health the effects can last much longer. The flu is the 5th leading cause of death among the elderly in the U.S., taking as many as 70,000 lives each year.
What is the Flu Vaccine?
Each year's flu vaccine contains three strains selected by the U.S. Public Health Service which are believed to be most likely to spread in the upcoming flu season. The vaccine is made up of purified viruses grown in egg cultures which have been made inactive and noninfectious. Injection of the vaccine, usually in the upper-arm, stimulates an immune reaction.
Although flu season typically runs from November through April, flu shots are ideally given between late September and mid-November. It takes about two weeks after receiving the shot for the vaccine to become effective. To be protected, you must be immunized every year.
According to the CDC, there are very few side effects of vaccination. Most common is soreness in the arm around the injection site; a few people report other mild side effects, such as low-grade fever or body aches, for a day or two following vaccination.
It is estimated that flu shots are about 70% effective in preventing the flu. Even for those who are vaccinated and do get the flu, the vaccine is said to reduce the severity of the infection.
Who Needs a Flu Shot?
Each year the U.S. Centers for Disease Control and Prevention (CDC) recommends the influenza vaccine for people who are at high risk of developing serious complications as a result of an influenza infection. These high-risk groups include:
People aged 65 years and older
People with diabetes
People with other underlying chronic conditions (i.e., renal dysfunction, pulmonary, or cardiovascular disorders)
Women who will be in the second or third trimester of pregnancy during the flu season
Residents of nursing homes and other chronic-care facilities.
Flu shots are also recommended for students living in dorms or other close quarters, international travelers visiting the tropics, those in daily contact with children such as teachers and day-care providers, and those with suppressed immune systems.
Since eggs are used in the production of the vaccine, the flu shot should not be taken by anyone with severe egg allergies.
Should People with CFS Get Flu Shots?
There is no conclusive evidence about the effect of the flu vaccine on people with CFS (PWCs). Many CFIDS specialists remain unsure about how to advise their patients. There are a number of issues involved which are likely to vary greatly among individuals. While the flu can be particularly debilitating for someone who is already severely depleted by chronic illness, many PWCs maintain that they have experienced relapses and symptom flares following a flu shot. As a result, many doctors are wary about recommending flu shots to certain patients, if the risks seem to outweigh the benefits.
Dr. Charles Lapp, a well-known CFIDS clinician and researcher, says that in most patients with CFS, "their immune systems are so up-regulated, they are so turned on, that any virus that gets in the system usually gets gobbled up anyway." In addition, Dr. Lapp cited studies done at Duke University in which CFS patients didn't "convert" the vaccine; in other words, the immune system didn't respond to the shot and, therefore, the shot has no benefit.
Dr. Paul Cheney, another CFIDS specialist in North Carolina, agrees that for PWCs with up-regulated immune systems, the immunization may not be necessary. More importantly, he expresses concern about the effect of injecting an antigen into a "fired-up" immune system. Both Lapp and Cheney cite patients who seem to have relapsed as a result of a flu shot.
But Dr. Stanley Schwartz, an infectious disease specialist in Tulsa, points out that while there is a great deal of accumulated scientific medical knowledge about the potential complications of influenza, there has been no scientific study of the effects of influenza vaccine in patients with CFS. He has rarely seen post-vaccination flare-ups with CFS patients in his practice. He states, "In medicine, it's always better to base decisions on what is known rather than what is not known." His rule of thumb is to recommend that people with CFS get vaccinated if they fall into any of the groups at increased risk for complications of influenza, as specified by the CDC. For example, CFS patients who are over age 65 or who have diabetes should receive the vaccine.
Dr. Cheney also emphasizes the importance of weighing the risks and benefits of a flu shot on a case-by-case basis. He says, "There is no way to generalize across the entire range. If these patients are working or marginally sick, exposed to the general population, I tend to immunize...If they are extremely sick, [with] very active immune systems [and] are not going into the public arena much, I think I tend to not immunize because of the fear I'm just going to make them worse."
In deciding whether or not to get a flu shot this year, be sure to discuss this with your doctor. By considering your health history along with your own personal profile of risks and benefits, you are more likely to make the decision that's right for you.
Influenza Fact Sheet
From the U.S. Centers for Disease Control (CDC), an overview of influenza statistics and flu shot information.
1999 Flu Vaccine
Information about influenza and this year's flu vaccine.
Dr. Cheney's Pros & Cons
Read his response to a question posed to him about flu shots during a lecture.
What do you think? Are you getting your flu shot this year? Take our poll, and/or share your comments in our discussion about flu shots on the Forum!
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