Flu shots and neuropathy

Somewhere around the world, it will be approaching flu season and the annual question as to whether it's advisable to have the shot. HIV patients are used to reading articles which cast doubt on the yearly vaccine and you will come across internet articles which advise against for neuropathy patients too. This article from Neuropathy News seems to clear the way for most people to safely have the flu jab and whatever flu is currently making the headlines in any given year, is probably a worse alternative.

Influenza Vaccinations in Patients with Neuropathy:
Should You Get a Flu Shot?
BY KENNETH C. GORSON, M.D.

The perennial question of whether or not to get a flu shot arises every fall with the reemergence of the influenza virus in the general population. Many neuropathy patients are uncertain whether they should receive a vaccination. For the vast majority of patients with peripheral neuropathy, the answer is yes.

In an average year, the influenza virus is responsible for more than
200,000 hospitalizations and 36,000 deaths. There is no evidence that the influenza vaccination aggravates neuropathy symptoms in patients with neuropathy resulting from diabetes mellitus, nutritional deficiencies, kidney,liver or thyroid disease, celiac disease, various connective tissue disorders,HIV infection, or exposure to toxins. In fact, the Center for Disease Control (CDC) urges these patients to receive an annual flu vaccination because they are at high risk of developing serious complications from infection with the influenza virus. Similarly, there are no neuropathic complications of vaccination for those with an inherited neuropathy or neuropathy of an unknown cause (“idiopathic” neuropathy).

There is, however, some controversy around the administration of the flu vaccine to patients with immune neuropathies—patients with a history of Guillain-Barré Syndrome (GBS) or chronic inflammatory demyelinating polyneuropathy (CIDP). The flu vaccination effectively prevents influenza infection by stimulating the patient’s immune system to generate antibodies directed against the virus. In patients with immune neuropathy, there is a theoretical concern that this immune stimulation may actually trigger GBS in a healthy individual or cause a relapse in patients with a history of GBS or CIDP.

In 1976, there was a highly publicized relationship between the Swine flu vaccine and an excess number of GBS cases within weeks of the vaccination. This observation seems restricted to that specific vaccine, as another large population study demonstrated that the vaccine administered during the 1993-1994 flu season was associated with only one excess case of GBS (i.e., greater than the background frequency of GBS in non-vaccinated individuals in the general population) per million people vaccinated. This extraordinarily low risk of influenza vaccine associated GBS also was
confirmed in a recent study in the United Kingdom. Furthermore, because up to two-thirds of patients with GBS have reported a preceding viral illness in the weeks before the onset of the neuropathy, the flu vaccination theoretically might reduce the risk of contracting GBS. Therefore, healthy individuals without neuropathy should have little concern about developing
GBS after a flu vaccination.

The CDC recommends that those rare patients who developed GBS after a flu vaccination should not be vaccinated. Many neuromuscular experts also recommend that GBS patients should not be vaccinated for at least one year after recovery, but this is an arbitrary time interval. Similarly, those with active CIDP may wish to avoid vaccination, but this decision needs to be balanced with the risks of infection associated with advanced age, other chronic medical conditions, and the potential for triggering a relapse as a consequence of infection with the influenza virus. Relapses after vaccination are usually mild and respond to standard therapies for CIDP.

Below are the current CDC recommendations for influenza vaccination
(also available on the CDC website). People who should get vaccinated each year include:

Children aged six months until their 19th birthday
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions (chronic
lung, heart, liver of kidney diseases, blood disorders, diabetes mellitus)
People who live in nursing homes and other long term care facilities
People who live with or care for those at high risk for complications
from the flu, including:
— healthcare workers
— household contacts of persons at high risk for complications from
the flu, and
— household contacts and out-of-home caregivers of children less than
six months of age (these children are too young to be vaccinated).


Ultimately, the decision to receive the flu vaccine needs to be individualized in consultation with your neurologist who is familiar with these issues.

Kenneth C. Gorson, M.D. is Professor of Neurology at Tufts University
School of Medicine. Dr. Gorson also serves on the Association’s Medical
Advisory Committee.