Flu and the flu vaccination

It’s the start of the 2016/17 flu season and people with M.E. and carers may be eligible for the free vaccination at pharmacies and GP surgeries, so I have updated my original blog post with this year’s information.

Here are the facts about flu, along with information about the flu vaccination, who is eligible to have it free, and the evidence for whether it’s safe and effective for us. To skip straight to the information about the vaccine, click here.

N.B. Please note I will not be answering questions about whether you personally should have the vaccination or not. I have just presented the information so that you can make an informed decision. My blog post Making decisions about our health might also help. If you are unsure, please speak to your own pharmacist or GP.

About flu

Seasonal influenza, or flu, is a highly contagious viral winter illness. The symptoms of flu come on suddenly and include fever, sweating, aching muscles, sore throat, cough and feeling exhausted[1]. In most healthy people, flu is what we call self-limiting, meaning that the body’s immune system fights the virus and they get better after about a week, usually without treatment. Antibiotics don’t help fight flu because they only work to treat bacterial infections rather than viral ones. You can read more about this in my article on antibiotics.

Complications of flu

Even otherwise healthy people can become seriously ill because of the complications of flu but some people are at a much higher risk of needing to be hospitalised or even being fatally ill. The people at higher risk of complications are young children, pregnant women, the elderly and people with some long term conditions.

Complications include bacterial chest infections which can become serious and develop into life-threatening pneumonia. Other possible complications of flu include tonsillitis, ear infections, and sinusitis. It’s rare but flu can also cause febrile convulsions (fits during a fever or high temperature), meningitis and encephalitis[2]. Catching flu can cause a worsening, or an exacerbation, of the respiratory conditions asthma and COPD, which may lead to hospitalisation. People with type 1 and type 2 diabetes may need to monitor their blood sugar more closely[2].

Ways to prevent catching and spreading flu

Flu is spread by droplets of saliva in the air from sneezing, and is caught be either breathing in the droplets or touching the eyes or nose with the fingers after touching a contaminated surface such as door handles and surfaces[3]. Some simple measures should be used by everyone to reduce the spread of the flu virus:

• cough or sneeze into a tissue and throw it away as soon as possible
• wash your hands as soon as possible after coughing or sneezing
• have a flu vaccination every year

NHS Choices has a useful page looking at the evidence for vitamin C, zinc and echinacea, Preventing colds and flu, which concludes that none of these are helpful enough to prevent flu and colds[3].

It’s worth bearing in mind for people visiting you at home that most people are infectious from a day before symptoms start until five to six days after they start[4]. More information about how long people are contagious with viral infections can be found on the NHS Choices website.

The flu vaccine

The annual flu vaccine is an injection for adults and a nasal spray for children. The reason we need to have the vaccination each year is because the strains, or variations, of flu are constantly changing. The World Health Organisation predicts which strains are going to be the most common in the coming winter and the vaccine is made specifically against these strains. This winter, the vaccine protects against 3 strains, including swine flu[5]. If you opt to have the vaccination, it’s best to have it as early on in the flu season as possible, to get the best protection.

People who have had a serious life-threatening anaphylactic reaction to the flu jab in the past, for example if you are allergic to eggs used to make the vaccine, are advised to tell their GP so that an alternative vaccine can be given[1]. If you currently have a fever from a cold or other infection, it is advised that you wait until you no longer have a fever before having the vaccine.

After having the vaccination it’s normal to have a slight fever, aching muscles or a sore arm but this only lasts a day or two. It’s not possible to catch flu from the jab because it doesn’t contain the live virus and the nasal spray for children only contains a weakened form[1].

Eligibility for free vaccination

The following groups are eligible for the free flu vaccination in England[6]. If you live elsewhere in the UK this information can be found by clicking the following links: Scotland, Wales and Northern Ireland. If you live elsewhere in the world, try looking on your health service’s website or ask your doctor’s surgery if you are eligible. This list isn’t definitive and the conditions listed are just examples. I have contacted Public Health England to check the eligibility of people with M.E., and you may be eligible because of your M.E. or another condition on the list, but as with all other conditions, it’s always an issue of clinical judgement. If there are any doubts, discuss it with your GP.

• all people aged 65 years and over (including those becoming age 65 years by 31 March 2017);
• people aged from 18 to less than 65 years of age with one or more of the following medical conditions:
  • chronic respiratory disease, such as severe asthma, chronic obstructive pulmonary disease (COPD) or bronchitis;
  • chronic heart disease, such as heart failure;
  • chronic kidney disease at stage three, four or five;
  • chronic liver disease;
  • chronic neurological disease, such as Parkinson’s disease or motor neurone disease, or learning disability;
  • diabetes;
  • a weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment); or
  • splenic dysfunction
• pregnant women aged 18 or over (including those women who become pregnant during the flu season);
• people aged 18 or over living in long-stay residential care homes or other long-stay care facilities;
• carers aged 18 or over; or
• household contacts of immunocompromised individuals who are aged 18 or over.

Children aged two, three and four plus children in school years one, two and three, and children with a long-term health condition are recommended to have the vaccination. These may be offered at school or at your GP surgery but the pharmacy service doesn’t include children.

Carers may be eligible for the free vaccination, whether the person with M.E. they care for has the vaccine yourself or not, if the person with M.E.’s care will be affected if the carer becomes ill[1]. The criteria define a carer as “someone who is in receipt of a carer’s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill”. You can read more information about the flu jab for carers on the Carers UK website.

Where to have your vaccination

You can have your vaccination at GP surgeries and registered pharmacies. The free flu vaccination pharmacy service launched last flu season in England for everyone eligible for a free flu vaccine, with the exception of children[6], who can receive the nasal spray at a GP surgery. Some pharmacies also offer private flu vaccinations costing around £15. You or your carer could have the flu jab at your pharmacy when picking up medication, or just go along without an appointment. Your GP will be informed for you, so that this can be added to your medical records.

Many GP surgeries have special flu vaccination days when you can go along and have your vaccination. If you are housebound, the surgery may provide vaccinations at home but pharmacists can’t. Contact your surgery to find out what arrangements they have in place.

Is the flu vaccine safe and effective for people with M.E.?

Last year I heard from people who didn’t want to have the vaccine because they were worried it might make them relapse. I heard from others who said catching flu itself made them relapse and that they were having the jab to prevent this happening again. Understandably, some may be worried, so I looked at the evidence about having the flu vaccination with M.E.

It’s worth noting that in surveys of M.E. patients, many more patients who had never been vaccinated against flu reported fears of a relapse than those who had[7]. If you’ve had the vaccine before and had nothing more than the common mild side effects yourself, you are highly unlikely to have a bad reaction to this year’s vaccine.

Several studies have examined the immune response by CFS patients (CDC criteria) compared with healthy controls following flu vaccination. The blood tests of the CFS patients showed a slightly heightened immune response to the vaccine compared with the healthy controls but this did not translate into self-reported worsened side effects, or a relapse[8,9,10,11]. The vaccine successfully achieved the desired antibody response in the CFS patients, so it would be as effective against flu as in the healthy controls. In one study, both the placebo and the active jab groups self-reported quadruple the number of side effects than healthy controls and on analysis, these were actually CFS symptoms which were reported as side effects[9].

This could also explain the results of an ME Association poll from 2009, where roughly half said they felt either the same, or even slightly better following the vaccination, and around half said they felt slightly worse or much worse. It’s worth bearing in mind that this wasn’t a scientific, controlled study and is open to bias. We all have different circumstances and react to things like vaccines differently. This is worth bearing in mind if others with M.E. tell you their experience too.

Though there isn’t much research and the studies are small, all of the scientific research papers conclude that the advantages of having the flu vaccination in protecting against flu, the complications, and a flu-related relapse, still outweighed the risk in people who have M.E.[7,8,9,10,11].

This blog post looks at the evidence for safety of the flu vaccine in people who already have M.E. but there is also a study comparing flu itself and the vaccine for causing the onset of M.E. The study used data from the entire population of Norway after a flu vaccine campaign. It concludes that catching flu increased the risk of onset of M.E. and that the vaccine had no effect on risk of M.E.[12]

Whether you have the flu vaccination is entirely your decision. If you’re unsure, it’s about weighing up the risk of flu complications compared with the side effects, if any, that you get. This might be different for everyone, depending on your circumstances, your own experiences, and if you have other health conditions which make you at risk of complications. My blog post Making health decisions might help. If you are still unsure, talk it over with your GP or pharmacist.

Useful information from the NHS

• Flu vaccination 2016/17 booklet
• Coping with colds and flu
• Winter health
• 10 myths about flu and the flu vaccine
• How the flu jab works
• How vaccines work
• Vaccination ingredients – how safe are they?
• Are vaccine additives safe?

Please note I will not be answering questions about whether you personally should have the vaccination or not, so the comments section is not available on this blog post. If you have any queries, please speak to your own pharmacist or GP. 

References
1 NHS England. Flu and the flu vaccine. NHS Choices. 2015. http://www.nhs.uk/Livewell/winterhealth/Pages/Fluandthefluvaccine.aspx (accessed 23 Sept 2016).
2 NHS England. Flu – Complications. NHS Choices. 2015. http://www.nhs.uk/Conditions/Flu/Pages/Complications.aspx (accessed 23 Sept 2016).
3 NHS England. Preventing colds and flu. NHS Choices. 2015. http://www.nhs.uk/Livewell/coldsandflu/Pages/Preventionandcure.aspx (accessed 23 Sept 2016).
4 NHS England. How long is someone infectious after a viral infection? NHS Choices. 2015. http://www.nhs.uk/chq/Pages/1068.aspx?CategoryID=87&SubCategoryID=876 (accessed 23 Sept 2016).
5 NHS England. Flu vaccine for adults. NHS Choices. 2015. http://www.nhs.uk/Conditions/vaccinations/Pages/flu-influenza-vaccine.aspx (accessed 23 Sept 2016).
6 PSNC. Flu Vaccination – eligible patient groups. PSNC. 2016. http://psnc.org.uk/services-commissioning/advanced-services/flu-vaccination-service/flu-vaccination-eligible-patient-groups/ (accessed 23 Sept 2016).
7 Sleigh K, Marra F, Stiver H. Influenza vaccination: is it appropriate in chronic fatigue syndrome? NCBI. 2015. http://www.ncbi.nlm.nih.gov/pubmed/14720070 (accessed 23 Sept 2016).
8 Sleigh K, Danforth D, Hall R et al. Double-blind, randomized study of the effects of influenza vaccination on the specific antibody response and clinical course of patients with chronic fatigue syndrome. The Canadian Journal of Infectious Diseases 2000;11:267. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094778/ (accessed 23 Sept 2016).
9 Ortega-Hernandez O, Shoenfeld Y. Infection, Vaccination, and Autoantibodies in Chronic Fatigue Syndrome, Cause or Coincidence?. Annals of the New York Academy of Sciences 2009;1173:600-609. http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.2009.04799.x/abstract (accessed 23 Sept 2016).
10 Brenu E, van Driel M, Staines D et al. The Effects of Influenza Vaccination on Immune Function in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. International Journal of Clinical Medicine 2012;03:544-551. http://file.scirp.org/Html/17-2100362_24744.htm (accessed 23 Sept 2016).
11 Prinsen H, de Vries I, Torensma R et al. Humoral and cellular immune responses after influenza vaccination in patients with chronic fatigue syndrome. BMC Immunol 2012;13:71. http://www.biomedcentral.com/1471-2172/13/71 (accessed 23 Sept 2016).
12 Magnus P, Gunnes N, Tveito K et al. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine. Vaccine 2015;33:46. http://www.ncbi.nlm.nih.gov/pubmed/26475444 (accessed 23 Sept 2016).