flu shot confusion...

[SonyaK]

Hi,
I really want to get a flu shot, but last year, after my flu shot, I had a mild flare up. At that time, my neuro said that happens sometimes? And if it does, it probably will happen again in the future after the flu shot. But she added that getting the flu would be MUCH worse, and still most likely be followed by a relapse.

So, this year, I want to get the flu shot again, but I'm scared. When I called her, she said since it triggered an 'event' last year, I best skip it unless I'm around a lot of people, in which case I should get it. But when I looked at the NMSS webpage, they said studies indicate that it doesn't trigger relapses.

So confused... Want the shot, but terrified it will trigger a horrible relapse or something. Do most PWMS get flu shots? Can the shot trigger a major relapse? Thanks!

[amandarianne28]

Not in most cases

I have gotten a flu shot every year for as long as I can remember. It has caused mild flu symptoms on several occasions and since my MS diagnosis and when we think it started I've noticed that all the symptoms seem amplified when it has occured. I dont think it causes flares, but I do think its side effects hit us more often than not given our immuno-response especially if you are on a DMD. Im currently on Tysabri and without a flare that required steroids for over a year now and I received my shot last month and have had no problems short of a sore arm the day of the shot

If you are likely to be in a situation where your risk of flu is greater like in a customer service position or you have school age children and are exposed to all the germs they carry (I have 3 in elementary school so we pass colds and such back and forth all year it seems like) I would think it is worth it. I am blessed with a good medical team around me, and if you are too maybe have a plan in place for quick steroid IV/oral medications should a flare occur so you are out of it as quickly as possible.

Good luck, and I hope you find whatever answers you are looking for.

[Redwings]

Hi Sonya:
This may not make your decision any easier, but it's something to consider. Since your flare after your last flu shot was only mild, it's possible that it wasn't a true flare, but was instead a pseudoexacerbation. It's normal for the body to have a mild immune reaction to a flu shot as it makes antibodies. That reaction can include a rise in temperature (a low-grade fever). The rise in temperature for a couple of days might have been mild, but might have been enough to cause a pseudoexacerbation.

According to the McDonald criteria, to be considered an MS "attack," the event must occur in the absence of fever or infection. After a flu shot, the body behaves as if it has an infection, and that can include a fever. So in the presence of a "pseudoinfection" with a resultant rise in body temperature, an increase in symptoms doesn't meet the definition of a true flare.

It's very common for the population in general to experience a mild fever and flu-like symptoms in response to a flu shot. To those folks, it's just expected side effects. But in someone with MS, those same symptoms can be interpreted as being a flare, especially when accompanied by an increase in their various MS symptoms.

The American Academy of Neurology's position is that flu shots are safe for most people with MS (although the study that led to that conclusion was small and subsequent supporting studies have also been small), and MS doctors do recommend flu shots for their patients with MS.

Regardless of study size, there are no reports in the literature of any significant number of people with MS having a true exacerbation after a vaccination. In a study from 1998, 5% of patients with RRMS had an exacerbation following a flu vaccination, whereas 33% of patients with RRMS had an exacerbation after getting the actual flu.

That 5% is a small risk compared to the risk of relapsing after getting the flu. Like so many things, guessing your risk is playing the odds without knowing all the variables. So there is a chance of having a true relapse if you get a flu shot, but that has to be weighed against your odds of getting the flu and having a relapse if you don't.

[rdmc]

I don't get vaccinations anymore but this is because I had an established pattern of exacerbation after them. Finally my neuro said to lay off the vaccinations, and I have.

As Redwings said, you might have had a pseudoexacerbation. You used the term mild, so maybe you can judge based on the time and severity of the event if it was a pseudoexacerbation.

My post vaccination reactions were long lasting flares, so yes they can trigger exacerbations in some people. But if you search titles and use the term "flu shot" you'll find that most people have no problem with them.

[BigA]

Very interesting. I've been wondering whether I should get my vaccination or not.

I had an exacerbation (a real one) after a flu vaccine, so although it may have been coincidence, I feel a little paranoid to get it, considering that getting the flu at my age and health is not high...

[SonyaK]

Thank you for the replies! Now I wonder if it was a pseudoexacerbation. Could that last for a week or so? I just felt some weakness in my right leg (a symptom I've had before). I don't work in customer service, but I'm out a lot and work out at the YMCA 3 times a week (there are a lot of people there). And I have a couple of high-schoolers at home. Anyway, thanks again!

[oso49]

For what it's worth, my neuro told me to avoid a "live virus" flu shot...

Anybody else???

[photomama]

I get psuedo-flares after just about every vaccination. Tetanus was the worst. I was in bed for a few days and was still feeling the after effects for a couple weeks. For me- I get a touch of a fever which will bring on the psuedo-flare.

But- I have asthma, so I get the flu shot every year. I just can't risk it (and with kids, etc...).

oso49 is right- no live virus vaccines- which means no nasal spray vaccines for the flu. Just the regular flu shot.

That said, this year's flu shot is supposed to be very similar (or the same) as last year's flu shot as the viruses going around are supposed to be similar. I DID NOT have a psuedo-flare at all. Just the regular soreness. So I was pleasantly surprised. Whether that was because it was the same vaccination or not, I can't say. Just something to be informed about.

Hope this helps you make a decision.

[techie]

No problems

I've never had a problem with any vaccination. But then my FORMER neoro said I don't have MS any more either
techie

[onlyairfare]

I get the flu shot every year, as I have asthma as well as MS, and influenza can be much worse in asthmatics. The flu shot is not a live virus vaccine so no problem, but the flu mist sprayed into the nose is a live virus - so asthmatics can't get that. I also work in health care, so it's really important for me to get the flu vaccine.

I've never had any MS symptoms worsen from any vaccine, but the two times I had actual influenza (the vaccine is not 100% effective), I was miserable with high fever, body aches, cough from the flu, then worsened weakness in my leg from pseudoexacerbation.

I have also had a number of "forbidden" live virus vaccines because sometimes I do volunteer work in the Third World, where I really could get yellow fever or some other bad disease. I've been lucky - no problem with live vaccines either, though I admit it's a calculated risk.

[pocoapoco]

Flu shot/Tysabri infusion

I got my flu shot the same day I got my 18th Tysabri infusion. No big deal! I felt crappy for 2 days. [/B][/B]But very mild. I had gotten my first flu shot last year. But I didn't get the flu, which made it worthwhile . So it's worth it.

[RedRose2]

My Neuro and GP recommended flu shots (no live virus). I had been getting the shots for years before my MS - no serious side effects - I am on Avonex - Sunday night Avonex, Monday a.m. flu shot - seemed to be OK - so it worked for me -

[Kraheera]

Also asthmatic... interesting that there are so many of us here. 0_0

Flu shot is mandatory with having young kids in this house too. I felt like crap for about 2 days, but I didn't start getting my flare up until almost a month after I got my shot, so I seriously doubt they are related.

[lukeduke]

This year I took the flu shot with no problems. Last year was a different story. Last year I had a psuedo-exacerbation. I was nauseous all day after the shot and skipped lunch because I did not feel like eating. I went to sleep on the couch for like 6 hours when I got home, and then when I got up to go to bed I had to crawl to the bathroom. I am thankful that I got the shot without the adverse reactions this year.

[gomer]

The LAST time I got a flu shot was in Oct. 2007... that gave me a mild case of flu Sx, but I had a hard time controlling my diabetes. So I have not had one since.

Gomer