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Should a person with Chronic Fatigue Syndrome get a flu shot?
This question was posed to Dr. Paul Cheney on Sunday, September 28, 1997. Dr Cheney, M.D., Ph.D, is the director of The Cheney Clinic in Charlotte, North Carolina. The clinic is dedicated exclusively to Chronic Fatigue Syndrome (CFS) patients from around the world. The clinic has served over 3,000 CFS patients from 48 states and 15 foreign countries. Dr. Cheney is an international authority on CFS and was a founding Director of the American Association of Chronic Fatigue Syndrome (AACFS), a professional association of scientists and clinicians from around the United States interested in or doing research on CFS.
What follows is his response.
The reason you give a flu shot is to inject an antigen to invoke an immune response against catching the flu. CFIDS patients are already immune activated. Especially involving an anti-viral pathway. Many have said to us that since I've had this disease I don't get the flu. They seem to have a resistence to colds and flu, that wasn't seen previous to the disease and we suspect they're so immune activated, and this anti-viral system is so turned on they actually have a relative resistence to at least initial infection of common agents. This not always true but we see it. We have a little feeling that maybe it's less necessary to get immunized, cause in effect your immune system is already really cranked-up. The more worrysome thing though is that injecting an antigen into a fired-up immune system may actually make people go into a relapse and we have seen that. So we think we have to weigh the benefits, on one hand, against the risks on the other. The benefits are marginalized because they are already immune activated. The risks are increased because they are immune activated and you are about to inject an antigen into them. So I have misgivings in immunizing this patient population. But I try to do it on a case by case basis. 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. Because the risk-benefit weighs in favor, I think, of immunization. If they are extremely sick, very active immune sytems 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. It's sort of a risk-benefit analysis. It's not an easy decision to come to. It depends on the patient and I try to make it on an individual basis.
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