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Lupus and the Flu Vaccine

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By A. G. Moore 12/13/2013

Just about every responsible medical professional recommends that most people with chronic illnesses receive a vaccination against seasonal flu. Until two years ago, I followed this recommendation. Then I had what was apparently a reaction to the shot. Of course, there is no way to prove that what I experienced was precipitated by vaccination. The possibility exists that I was about to get sick anyway and the flu shot merely coincided with the onset of illness. Complicating my assessment of this situation is the fact that it is often impossible to separate the symptoms of a flare from the symptoms of an illness.

According to the Australian government website, Better Health Channel, if someone has lupus, “It can be difficult to diagnose an infection…symptoms may closely mimic those of lupus”. And so, as I ached, became feverish and generally felt unwell, I found myself wondering: how much of this is due to the flu shot and how much is due to my body simply objecting to the stress of going to the doctor’s, being jabbed and having a foreign substance injected into my body?

This is a body that can react strongly to sunscreen or body lotion. The Lupus Society of Alberta includes in its list of possible lupus antagonists a number of fairly common offenders: sunlight, stress, fatigue, medications, physical trauma (including accidents and surgery), infections and certain immunizations.

Last year, with the memory of my reaction fresh in my mind, I was not tempted at all to subject myself to risk by being vaccinated again. This year I have thought more about getting a shot but still came down on declining. A number of factors fed into my decision:

For one thing, as “safe” as the flu vaccine is, it has never been entirely cleared of the charge that there may be an association between the vaccine and the subsequent development of a rheumatological disease. An article in Lancet is clear on this. The article recommends the following in future development of vaccine protocols: “… identify genetic markers of populations at high risk for after-vaccination autoimmune events and…develop more effective, safe, and personalized vaccines“.

Another factor that figures in my decision is the apparently reduced efficacy of the vaccine in people with SLE. A report that came out of the ACR’s annual meeting this year contained the following statement: “Several studies suggest that the efficacy of influenza vaccination may be decreased in systemic lupus erythematosus“. An analysis of this finding showed that it held true whether or not a patient was on immune suppressive therapy–which can depress the effectiveness of vaccination. It turns out that the decline in immunogenicity (immune response) held true for SLE patients who were not on immune suppressive therapy.

There’s another factor that figures into my thinking, something called immunesenescence. The older we get, the less vigorous our immune systems are. This means that when we are vaccinated, our response to the vaccination is less than it would be in a younger person. Once again, immunogenicity is reduced. I am not a young woman. I’m reaching the stage in life where immunesenescence is likely a factor.

In addition to the three considerations addressed so far, there’s one more that has rather general application: the flu cocktail chosen to protect against flu in any year may not contain any of the virus circulating that season. Which means the shot is largely ineffective. While there is the chance that carryover immunity may be conferred by one strain of virus to another, this is at best a weak response. In the words of the CDC “…antibodies made in response to vaccination with one flu virus can sometimes provide protection against different but related viruses.” Sometimes.

I’d like to be clear on one point as I describe my thought process in forgoing the flu vaccine: I believe, generally, in the efficacy and wisdom of vaccines. If I hadn’t had a reaction two years ago, I would likely be going for my shot this year. But I did have a reaction and I have done some research on this issue. From this research I have discovered that there are suspicions that the flu vaccine may cause a flare–the Alliance for Lupus Research states on its website: “There is… some evidence suggesting that the vaccine can stimulate new or increased, autoantibody production, possibly triggering disease activity“. I’ve also discovered that I am likely to get less protection from this vaccine than many people might–both because I have SLE and because I am not young.

So I weigh my options.

Flu would likely be a very serious event for me. Knowing this, I intend to decrease my exposure as much as possible. If I do come down with something that seems to be the flu, I will run, not walk, to the doctor for antivirals. These are likely my best protections against an unpleasant outcome.

As I write this I think of my responsibility to those who read my blog. I certainly do not intend to discourage anyone from getting the flu vaccine. However, I operate on the principle that we are all entitled to as much information about our bodies and our treatment options as the physician who treats us has. We, the patients, run the risks of treatment or lack of treatment. And since that risk is ours, we should be reasonably clear about what consequences might be attached to the decisions we make

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