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Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine.
Vaccine. 2015 Oct 13. pii: S0264-410X(15)01433-4. doi: 10.1016/j.vaccine.2015.10.018. [Epub ahead of print]
Magnus P1, Gunnes N2, Tveito K3, Bakken IJ2, Ghaderi S2, Stoltenberg C2, Hornig M4, Lipkin WI4, Trogstad L2, Håberg SE2.
Author information
Abstract
BACKGROUND:
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated to infections and it has been suggested that vaccination can trigger the disease.
However, little is known about the specific association between clinically manifest influenza/influenza vaccine and CFS/ME.
As part of a registry surveillance of adverse effects after mass vaccination in Norway during the 2009 influenza A (H1N1) pandemic, we had the opportunity to estimate and contrast the risk of CFS/ME after infection and vaccination.
METHODS:
Using the unique personal identification number assigned to everybody who is registered as resident in Norway, we followed the complete Norwegian population as of October 1, 2009, through national registries of vaccination, communicable diseases, primary health, and specialist health care until December 31, 2012.
Hazard ratios (HRs) of CFS/ME, as diagnosed in the specialist health care services (diagnostic code G93.3 in the International Classification of Diseases, Version 10), after influenza infection and/or vaccination were estimated using Cox proportional-hazards regression.
RESULTS:
The incidence rate of CFS/ME was 2.08 per 100,000 person-months at risk.
The adjusted HR of CFS/ME after pandemic vaccination was 0.97 (95% confidence interval [CI]: 0.91-1.04), while it was 2.04 (95% CI: 1.78-2.33) after being diagnosed with influenza infection during the peak pandemic period.
CONCLUSIONS:
Pandemic influenza A (H1N1) infection was associated with a more than two-fold increased risk of CFS/ME.
We found no indication of increased risk of CFS/ME after vaccination.
Our findings are consistent with a model whereby symptomatic infection, rather than antigenic stimulation may trigger CFS/ME.
Copyright © 2015. Published by Elsevier Ltd.
KEYWORDS:
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME); Cohort; Influenza vaccine; Pandemic influenza
PMID:
26475444
[PubMed - as supplied by publisher]
J Clin Pathol. 2010 Feb;63(2):184-5. doi: 10.1136/jcp.2009.071944. Epub 2009 Oct 26.
A case of chronic fatigue syndrome triggered by influenza H1N1 (swine influenza).
Vallings R1.
Author information
Abstract
This case report describes an adolescent boy who was diagnosed as suffering from chronic fatigue syndrome 5 months after infection with H1N1 influenza.
PMID: 19858526
[PubMed - indexed for MEDLINE]
It was, but only marginal. It depends how this was done though. We need to read the paper.Could be significant. Good to see this being looked at.
"We found no indication of increased risk of CFS/ME after vaccination."
But if flu is associated with increased risk then shouldn't it follow that vaccination should demonstrate lowered risk?
The key here is the "per 100,000 person-months," which I think means they counted how often CFS/ME onset within a month of influenza diagnosis or vaccine shot.
It takes time for the muscular damage of vaccines to snowball and eventually lead to CFS/ME, usually much longer than 1 month, up to years.
Yeah I know it means that. I was wondering why they did, because I'm trying to figure out how they did their analysis. It says "The adjusted HR of CFS/ME after pandemic vaccination was 0.97." "after pandemic vaccination" sounds like they used a time period, during/after a "pandemic." And how did they "adjust" it? Did they count the number of vaccines used? Basically, there are lots of ways their analysis could be faulty, but I have no idea what they might be if I don't know their exact methodology.It does not mean that.
They state that they followed the population for 39 months (1 Oct 2009 to 31 Dec 2012). During this period they found that the overall incidence of ME/CFS was approximately 2 cases per 100,000 person-months.
So this means, for example, if you tracked 1000 people for 100 months (= around 8 years), you would expect 2 people out of the 1000 on average to come down with ME/CFS during that time.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4246686/Never heard such a thing.
We assume that the majority of subjects with influenza-like symptoms who received an R80 code in the period October–December 2009 were infected with the H1N1 influenza virus rather than another respiratory pathogen. No other influenza virus was known to be circulating in the population at this time.
But if flu is associated with increased risk then shouldn't it follow that vaccination should demonstrate lowered risk?
Magnus et al. said:Table 3.
Incidence rates and hazards ratios (HRs) of CFS/ME, with associated 95% confidence intervals (CIs), according to exposure to pandemic vaccination and influenza infection. Follow-up time from October 1, 2009, through December 31, 2012, for 4822,377 residents of Norway born 1899–2009.
Vaccinated - Infected - No. of person-months at risk - No. of cases - Incidence rate* - Adjusted (HR 95% CI)**
No No 107,475,182 2165 2.01 1.0
Yes No 67,985,240 1345 1.98 0.98 0.91–1.05
No Yes 3032,843 164 5.41 2.08 1.78–2.44
Yes Yes 1,389,917 63 4.53 1.88 1.46–2.42
* Number of new cases per 100,000 person-months at risk.
** Stratified Cox analysis with separate baseline hazards functions for each year-of-birth category and adjusted for sex.
The incidence rate of CFS/ME was 2.08 per 100,000 person-months at risk.
Thanks Snow Leopard, I was just about to ask how they they knew that the patients had the flu. Do you mean that there was some confirmatory testing for H1N1 for those who subsequently developed ME?
Magnus et al. said:Information on infection with the H1N1 influenza virus was obtained from two different sources. One source was from consultations in primary health care and emergency outpatient clinics, where all consultations must be reported to obtain reimbursement. Diagnoses are reported with codes from the International Classification of Primary Care, Second Edition (ICPC-2). The code for influenza-like illness (R80) was taken as a measure of H1N1 infection when the diagnosis was made during the pandemic peak period (October 1 through December 31, 2009). We considered R80 codes outside this period as insufficiently specific to be used as evidence for exposure to H1N1, as other infections may have caused similar symptoms. The other source of information on influenza infection was registrations in the Norwegian Surveillance System for Communicable Diseases of a confirmed antigenic test for H1N1 as reported from microbiology laboratories. The majority of these infections were reported during the peak period. However, due to the high specificity of these tests, reports from outside the peak period were included.