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ME associated with flu, but not vaccine

Snow Leopard

Hibernating
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5,902
Location
South Australia
The potential interest in this paper is not just the study of the vaccine effects, but other epidemological measures. I kind of wish the study reported the results of other infections, eg EBV and their association with a later diagnosis of ME/CFS within the surveillance period.
 

Snow Leopard

Hibernating
Messages
5,902
Location
South Australia
Also: http://www.ncbi.nlm.nih.gov/pubmed/26008750

Eur J Epidemiol. 2015 May 26. [Epub ahead of print]
Risk of Guillain-Barré syndrome after exposure to pandemic influenza A(H1N1)pdm09 vaccination or infection: a Norwegian population-based cohort study.
Ghaderi S1, Gunnes N, Bakken IJ, Magnus P, Trogstad L, Håberg SE.
Author information
Abstract

Vaccinations and infections are possible triggers of Guillain-Barré syndrome (GBS). However, studies on GBS after vaccinations during the influenza A(H1N1)pmd09 pandemic in 2009, show inconsistent results. Only few studies have addressed the role of influenza infection. We used information from national health data-bases with information on the total Norwegian population (N = 4,832,211). Cox regression analyses with time-varying covariates and self-controlled case series was applied. The risk of being hospitalized with GBS during the pandemic period, within 42 days after an influenza diagnosis or pandemic vaccination was estimated. There were 490 GBS cases during 2009-2012 of which 410 cases occurred after October 1, 2009 of which 46 new cases occurred during the peak period of the influenza pandemic. An influenza diagnosis was registered for 2.47 % of the population and the vaccination coverage was 39.25 %. The incidence rate ratio of GBS during the pandemic peak relative to other periods was 1.46 [95 % confidence interval (CI) 1.08-1.98]. The adjusted hazard ratio (HR) of GBS within 42 days after a diagnosis of pandemic influenza was 4.89 (95 % CI 1.17-20.36). After pandemic vaccination the adjusted HR was 1.11 (95 % CI 0.51-2.43). Our results indicated that there was a significantly increased risk of GBS during the pandemic season and after pandemic influenza infection. However, vaccination did not increase the risk of GBS. The small number of GBS cases in this study warrants caution in the interpretation of the findings.

The Incidence rate ratio for GBS after vaccination was 1.31 (8 cases) and 8.45 after influenza diagnosis (2 cases). In both cases the numbers were not significant.
So it seems GBS after influenza vaccination or influenza infection is rare.

Important note:
One weakness in this study is the under-reporting of influenza infections. It has been estimated that around 30 % of the Norwegian population had clinical influenza during the pandemic [23], while less than 3 % of the population were diagnosed with influenza by a primary care physician. The low number of consultations can be explained by public recommendations during pandemic peak. Due to high demands on health clinics during the pandemic peak, people were advised not to seek medical help for influenza symptoms if they were not in need of urgent care or were at high risk of complications. Consequently, many people with influenza were regarded as unexposed which may have led to an underestimation of the association between influenza infection and GBS.
 
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Hip

Senior Member
Messages
17,824
Thinking about this study a bit more:

The authors found a twofold increase in the risk of developing ME/CFS in those who were diagnosed with H1N1 swine flu. I assume this increase in risk is relative to the general population (who were not diagnosed with H1N1 influenza).

But note that the number of people who caught the H1N1 virus will be higher than the number of people actually diagnosed with having H1N1 influenza (because the majority of people catching the virus would have only had minor symptoms, or have been asymptomatic, so were not diagnosed).

Studies show that just after the 2009 pandemic, around 24% of the general population, and 50% of school-age children were seropositive for H1N1, meaning they had caught the virus at some point.

So, people actually diagnosed with H1N1 influenza in general must have been hit much harder by the H1N1 virus, because presumably these were the people whose symptoms were so bad on contracting H1N1 that they had to go to their doctor.

Thus what this study may be measuring is how severely someone's body or immune system may be reacting to the H1N1 virus. By focusing on those who were actually diagnosed with H1N1 influenza, rather than focusing on the larger set of people those who are seropositive for H1N1, this study may merely be selecting people whose immune system reacts more strongly to a H1N1 viral infection.

Now people who naturally mount a strong inflammatory response to viral infection might conceivably be much more likely to develop ME/CFS, given that ME/CFS is often viewed as a chronic inflammatory condition driven by viral infection. So this might explain why people from the group diagnosed with H1N1 influenza were found to be at higher risk for later developing ME/CFS.



Thus I can see two ways we can interpret the results of this study:

(1) The first interpretation is that H1N1 influenza virus does not trigger ME/CFS, but those who get major influenza symptoms on catching from H1N1 may simply be more immunologically disposed to developing ME/CFS (but only when they catch the usual ME/CFS-triggering viruses like enterovirus or EBV).

(2) The second interpretation is that H1N1 influenza virus does sometimes trigger ME/CFS.



Possibly one way to work out when the first or second interpretation might be correct is to look at the timing of the onset of ME/CFS after coming down with H1N1 influenza. We know with the usual ME/CFS-triggering viruses, you tend to get either rapid-onset ME/CFS (the disease appearing within days of contracting the triggering virus), or you get gradual-onset ME/CFS (the disease appearing within a few months of contracting the triggering virus).

So if we looked at the average time of onset of ME/CFS during the 39 months that the cohort was tracked, if there are a lot of cases of ME/CFS appearing withins days of coming down with their H1N1 influenza, or within a few months of their H1N1 influenza, then that suggests the H1N1 virus is actually triggering ME/CFS.

But if the typical onset time of ME/CFS is found at random times during the 39 month observation period, that suggests the H1N1 virus is not triggering ME/CFS.

Perhaps we will find some info on the onset time of ME/CFS in the full paper.



There is also a third possibility:

(3) The third interpretation is that H1N1 influenza virus does not trigger ME/CFS as such, but after coming down with a major case of H1N1 influenza, the body becomes more vulnerable to later developing ME/CFS (when catching one of the usual ME/CFS triggering viruses like enterovirus or EBV).
 
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halcyon

Senior Member
Messages
2,482
(1) The first interpretation is that H1N1 influenza virus does not trigger ME/CFS, but those who get major influenza symptoms on catching from H1N1 may simply be more immunologically disposed to developing ME/CFS (but only when they catch the usual ME/CFS-triggering viruses like enterovirus or EBV).
I think this is the most likely answer.
 

Hip

Senior Member
Messages
17,824
I think this is the most likely answer.

So do I.

If influenzavirus were capable of triggering ME/CFS, we'd already know about. Even in the absence of formal studies, doctors and patients alike are quite capable of amassing anecdotal observations, so at the very least we would have gathered some anecdotal data suggesting that influenzavirus can trigger ME/CFS. But I have never seen such data.

I did find this single case of ME/CFS apparently appearing after H1N1:

A case of chronic fatigue syndrome triggered by influenza H1N1 (swine influenza)

But that's hardly much evidence.
 
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Hip

Senior Member
Messages
17,824

The aluminum hydroxide vaccine adjuvant-associated disease you are referring to is macrophagic myofasciitis. This has very similar symptoms to ME/CFS, but would appear to be a distinct disease.

Does make you think, though, that when patients say their ME/CFS suddenly appeared after a vaccination (which Dr Chia finds occurs in 1.5% ME/CFS patients), these patients might potentially have macrophagic myofasciitis rather than ME/CFS. Though macrophagic myofasciitis is a rare disease.
 

msf

Senior Member
Messages
3,650
Or, 4. That these patients didn´t actually have H1N1 (the non-lab ones).

Or 5. That these patients (the lab ones) didn´t actually have ME.
 

Vic

Messages
137
I just found in an article on the CDC it stated, "In fact, no adjuvanted influenza vaccines are licensed in the United States, and no adjuvanted influenza vaccines were used in the United States during the influenza pandemic or in any other influenza season."

So actually this study may be spot on after all... A reminder I need to be careful of my pre-conceived opinions and look at each situation objectively.
 

acer2000

Senior Member
Messages
818
I wonder if the preparation of the vaccine makes a difference. I think "inactive" ingredients vary. I wonder if the flu mist would produce different results?

Also, isn't the Heb B vaccine the most complained about vaccine for triggering ME/CFS? Perhaps they should look at this.

I got a very bad migraine after taking the flu vaccine about 4 months before coming down with ME/CFS. It was the first migraine I have ever experienced, and I have gotten them since. Since then I have avoided flu shots. Its not clear thats what caused my migraines, but I don't really want to take another chance. Two years ago I got the flu and it was pretty bad.
 
Messages
2,087
I wonder if the preparation of the vaccine makes a difference. I think "inactive" ingredients vary. I wonder if the flu mist would produce different results?

Also, isn't the Heb B vaccine the most complained about vaccine for triggering ME/CFS? Perhaps they should look at this.

I got a very bad migraine after taking the flu vaccine about 4 months before coming down with ME/CFS. It was the first migraine I have ever experienced, and I have gotten them since. Since then I have avoided flu shots. Its not clear thats what caused my migraines, but I don't really want to take another chance. Two years ago I got the flu and it was pretty bad.

Just wondering - do you associate your me/cfs Onset with the flu shot ?
 

Hip

Senior Member
Messages
17,824
"In fact, no adjuvanted influenza vaccines are licensed in the United States, and no adjuvanted influenza vaccines were used in the United States during the influenza pandemic or in any other influenza season."

I found this study which mentions the use of the Pandemrix H1N1 vaccine on 470,000 children and adolescents in Norway from October 2009 to January 2010. It was found this vaccine is linked to significantly increased risk for narcolepsy with cataplexy.

Pandemrix contains the adjuvant AS03 which consists of vitamin E, squalene and polysorbate 80.

Though I am not sure if Pandemrix was the only H1N1 vaccine used in the mass vaccination in Norway during the 2009 H1N1 pandemic.

But if it was, then I think can conclude that the AS03 adjuvant is not linked to triggering ME/CFS.
 

SOC

Senior Member
Messages
7,849
Don't some US Flu Shots still contain Thimerosal? IIRC they are some of the only vaccines that still do...

http://www.cdc.gov/flu/protect/vaccine/thimerosal.htm
Maybe. Perhaps this is why my ME/CFS specialist recommends I get a preservative-free, killed-virus (the shot, not the mist, which is live-virus) flu vaccine. Since I have always gotten the flu when I don't get the vaccine, I'm not afraid of the the vaccine. For me, the actual flu is much worse than the preservative-free vaccine.
 

Hip

Senior Member
Messages
17,824
Don't some US Flu Shots still contain Thimerosal? IIRC they are some of the only vaccines that still do...

As far as I am aware, thimerosal has not been linked to any diseases or health conditions. If it was, then eating a can of tuna fish would probably trigger the same diseases, since a calculation I did elsewhere showed you will get more mercury lodged in your brain after consuming a can of tuna fish than you will from a mercury-containing vaccine.

An accumulation of mercury in the body may increase the risk of autoimmune conditions, but high body burdens of mercury are going to come from regularly eating fish with high mercury content (such as tuna, or even worse, restaurant sushi), not really from vaccines.
 

searcher

Senior Member
Messages
567
Location
SF Bay Area
I'm confused about this statement about no anecdotal statements linking the flu and ME/CFS. Don't a lot of patients say that they got the flu and it never went away (and then a lot of other symptoms get added on)? I had some symptoms beforehand after catching a bug in India and major mold exposures, but I developed full-blown ME/CFS after getting the flu (theorized to be H1N1) in October '09. My roommate got ME/CFS after getting the flu. Not many patients were tested for the flu at the time because you usually don't go to the doctor with flu symptoms if you are seemingly otherwise healthy.

So do I.

If influenzavirus were capable of triggering ME/CFS, we'd already know about. Even in the absence of formal studies, doctors and patients alike are quite capable of amassing anecdotal observations, so at the very least we would have gathered some anecdotal data suggesting that influenzavirus can trigger ME/CFS. But I have never seen such data.

I did find this single case of ME/CFS apparently appearing after H1N1:

A case of chronic fatigue syndrome triggered by influenza H1N1 (swine influenza)

But that's hardly much evidence.
 

Hip

Senior Member
Messages
17,824
Don't a lot of patients say that they got the flu and it never went away

They sometimes say they developed ME/CFS after a "flu-like illness". But that's not necessarily the flu. Even HIV can cause a flu-like illness when you first contract it.
 

searcher

Senior Member
Messages
567
Location
SF Bay Area
No, but he didn't go to a doctor until after a month. It looked like the flu-- runny nose, sneezing, fever, etc.
Do people with enteroviral triggers usually get tested early?