Immunisation and ME

By Dr E G Dowsett MB ChB Dip Bact

QUESTION: I have been slowly recovering from ME, but suffered a bad relapse after a recent tetanus injection – what should I do in future?

ANSWER: Most sufferers can recount stories like this because their immune systems are already fully engaged in a long term battle with persistent infection and any additional insult (in terms of a vaccine injection) can prove counterproductive. If the patient is very debilitated the vaccine may not “take” anyway and sufferers would do well to think carefully and take advice on this subject.

There are two types of immunisation:

1. PASSIVE IMMUNISATION

in which antibodies made by another individual are transferred temporarily to the sufferer by injection (e.g. the gamma globulin given to prevent Hepatitis A in travellers). Their activity lasts about 6 weeks and there are usually no ill effects in ME. Even so, it is well to remember that this is “foreign” material and can cause side effects even in normal people.

2. ACTIVE IMMUNISATION:

a. by injection of live or dead microbial products, sometimes combined with aluminium salts or other insoluble material for greater effect (e.g. Diphtheria, tetanus, Typhoid) these cause the most problems in ME; there are relatively fewer side effects with BCG.

b. By oral administration of specially altered or weakened microbes (e.g. polio vaccination). These vaccines are not noticeably associated with relapse in ME for they act locally to boost immunity in the bowel and keep out more harmful viruses. In any case the ME sufferer will be exposed to polio viruses circulating in the family and local community. As these occasionally revert to virulence it is wiser for the whole family to receive a harmless vaccine strain simultaneously.

The best general advice that can be given on immunisation and ME is as follows:

1. If the vaccination procedure is potentially life saving, and essential for work or for foreign travel, then ME takes a lower priority.
2. Many immunisation procedures already received in childhood may well provide sufficient protection in adult life.
3. Strict attention to hygiene may be greater benefit than vaccination (e.g. in the case of cholera) or may considerably reduce the risk( e.g. in the case of Hepatitis B, where people are not employed in a very high risk situation)
4. Always take advice before immunisation (e.g. from your occupational health department). It may be wiser to alter a holiday destination or move to a lower risk job than to subject oneself to repeated immunisations.