Flu shot–evidence such as it is

June 27, 2009 at 10:37 pm

At the GBS-CIDP Symposium, there was quite a bit of discussion about flu shots and other immunizations–mostly flu shots. There were at least 10 neurologists that are very involved in GBS/CIDP there and many stated opinions. Almost everyone of these experts recommended the flu vaccine if you were in a higher risk group–including immunosuppression, unless you got GBS within 4-6 weeks after a flu vaccine and the feeling was that the GBS was at least possibly associated with the onset of the GBS. Also, the majority consensus seemed to be to not try to avoid giving any immunization within the first year after GBS/onset of CIDP. They specifically said that they did not recommend withholding the flu shot in anyone who did not get GBS/CIDP after a flu shot. This is also the recommendation of the CDC–that just anyone with GBS should not avoid the flu shot–only those with GBS after a previous flu shot. They also said that this was an area of considerable controversy and that most patients refuse the flu shot after having GBS –mainly as a reaction to incomplete understanding and fear although an understandable fear. Dr Parry was the one that lead the discussion and that workshop. He said that influenza is not one organism, but changes a lot each year and that the strongest scientific thinking about why it is NOT that great a risk another time to get a flu vaccine is that the vaccine is specific to (guessed) changes in the flu and different every year. Also that there are two important varients of influenza–A and B and that even if an individual immune reactivity were to do set to react to the A type, one should be “safe” from vaccines and infections with the B type. Of course, this last year was strange in that we saw influenze A and B types in addition to all the hoopla about HINI (swine flu).
Vaccinations of other diseases are different that that for the flu in that the wish for the flu is to protect you for THAT year and vaccination for measles, for example, is to protect you for life. The consensus is not to give a measles vaccine, for example, within 3 months of IVIG because there will be other people’s antibody to this same vaccine/illness in the immunoglobulin and it will not provide prolonged protection (since the immune response is attenuated by the presence of mature antibody). My understanding is that the vaccine will not hurt people with a normal immune system (definition subject to controversy) but if not advised because if may not help and may lead to a false sense of protection. My understanding is also that measles is a live vaccine and, thus, could possibly cause illness in some severely immunosuppressed people that could be serious. (severely immunocompromised is like the “bubble boy” with severe combined immunodeficiency–not just people on immunosuppression for autoimmune diseases–although there are ranges of immunosuppression). Thus, after immunoglulin, no benefit–risks in some groups–don’t do. Flu is different, from my understanding in that the vaccination is only supposed to work for a year, is a dead virus when given as a shot (safer for people with immune issues), so that there is a less risk, greater chance of benefit (since immunoglobulin in the pooled source is expected to be to flus of years past not the present one so one probably will get some immune protection, just maybe not as strong a one).
I do not say this to say that people should get the flu shot–but to state some of the facts of the case. I thought about all this and still declined to get the flu shots both years now after getting GBS. Each person needs to decide for themselves with their doctors help based on risks and benefits of the shots in their own situation. One of the tiny good things of the swine flu hoopla is that it. hopefully made it clearer that no flu is completely safe–tens of thousands of people die each year of flu and that there is a tremendous amount that medicine still does not know about influenza as illness or as vaccination.
WithHope for a cure of these diseases