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Vaccinations for Flu and COVID – your questions answered 

Vaccines in current use are thoroughly tested and are considered amongst the safest medicines available. Unless you know for a fact that your GBS/CIDP was triggered by a vaccination (which studies repeatedly show to be extremely rare) the advice for people who have had GBS or are living with a chronic variant such as CIDP is the same as for anyone else as you are no more or less likely to have unwanted side effects from a vaccination.

As far as the COVID-19 vaccine is concerned, it is vital that as many people as possible get vaccinated as this is the only way to achieve ‘herd immunity’ and protect the most vulnerable amongst us.

Please see a copy of the Facebook post copied below on the seasonal flu vaccine for further information, and follow this link to the NHS website for advice on vaccinations in general; https://www.nhs.uk/conditions/vaccinations/why-vaccination-is-safe-and-important/

 

Seasonal flu & COVID19 vaccine – Facebook post Sometimes people are advised by their doctor not to have a vaccination within 12 months of having had Guillain-Barré syndrome, as a precaution, so if your diagnosis was very recent, your doctor might advise you to give it a miss this year, unless you are in a group considered to be at high risk from flu.

Otherwise, the advice for people who have had GBS is the same as for anyone else regarding vaccinations. GBS is a single event acute condition that is very unlikely to recur; it doesn’t ‘relapse’ and someone who has had GBS is unlikely to get it again (recurrence rate is believed to be around 2-5%). The only caveat to this would be if you developed GBS within 6 weeks following a vaccination, in which case it would be wise to avoid that particular vaccine in the future (please note that the seasonal flu vaccine changes each year, depending on which strains are predicted by the WHO to be most prevalent: https://www.who.int/influenza/vaccines/virus/recommendations/en/).

The flu vaccine is also considered safe and is recommended for people with CIDP, or another of the chronic variants. If you are being treated with immunoglobulins via IVIg or SubCut, you may be less likely to get viral infections, but the best protection is still to have the vaccination. If you’re being treated with corticosteroids, or other immuno-suppressant medication, you may be more prone to viral infections, and a serious case of flu could put you at considerable risk, so it would make sense to protect yourself from flu by having a vaccination.

The risk of the seasonal flu jab triggering GBS or CIDP is far lower than the risk from flu itself. Under normal circumstances, most people don’t need a flu jab, because for them, flu is inconvenient but not life-threatening. However, if you are in an at-risk group, or you live or work closely with people for whom flu can cause severe and even life-threatening complications, then the advice is to be vaccinated, as this is the most effective way to protect yourself against getting flu, and passing it on to others. This year, things are a bit different, because in the absence of a COVID-19 vaccine, anyone getting flu and COVID-19 concurrently is potentially at a heightened risk. The flu vaccination programme for 2020/21 is being extended beyond those traditionally considered to be at risk, to minimise the spread and to protect as many people as possible from the associated danger, so it’s worthwhile asking your GP or pharmacist about getting vaccinated, even if you wouldn’t normally be considered at risk.

In the document The national influenza immunisation programme 2020 to 2021 Public Health England states that ‘Previous GBS is not a contraindication to influenza vaccination. A UK study found that there was no association between GBS and influenza vaccines although there was a strong association between GBS and influenza-like illness. A causal relationship between immunisation with influenza vaccine and GBS has not been established.’

This is further supported by the Medicines & Healthcare products Regulatory Agency (MHRA) which states; ‘The balance of epidemiological evidence is not sufficient to confirm that currently used influenza vaccines are causally associated with the development of GBS. As GBS also occurs naturally in the vaccinated population, and particularly because flu-like illness is a known risk factor for GBS, a number of cases are reported each year in temporal association with vaccination. This does not mean the vaccine was the cause.

Recent data supports the findings made in previous studies that an influenza vaccination may trigger GBS in fewer than 1 in 1,000,000 people vaccinated. There were approximately 14,000,000 people vaccinated in the UK during 2019/20 and there were 11 reports submitted through the yellow card scheme for the same period. It should be understood that these may be true side-effects, or they may be due to concurrent diagnosed or undiagnosed illness, other medicines or they may be purely co-incidental events that would have occurred anyway in the absence of therapy. Based on current evidence, the MHRA findings are that these reports do not indicate a causal relationship between influenza vaccine and GBS.’

GAIN would also add that this is supported by independent research showing colds and flu-like illnesses to be known triggers for GBS. Because vaccines stimulate the immune system, theoretically this might exacerbate or lead to the appearance of an autoimmune disease, but it is not possible to identify those for whom a vaccine might act as a trigger, or why. The seasonal flu vaccination is considered to be a very low risk trigger, with approximately 1 case of GBS triggered per 1,000,000 vaccinations as opposed to 1 case of GBS per 60,000 cases of flu.

It is difficult to comment on the many COVID-19 vaccines that are currently under development, as they are still in various stages of being tried and tested, but it would seem feasible that similar advice would follow. In this case, however, we know that unlike flu, only around 20% of people who test positive for COVID-19 actually show symptoms, and that as well as amongst high risk groups, COVID-19 can be fatal in younger people and people without co-morbidities who would not normally be considered at risk. The advice, once a proven vaccine is available, will probably be for everyone to have it, to limit the spread amongst the population as a whole, so protecting the most vulnerable.

On vaccinations in general, our Medical Advisory Board would offer the following advice:

DON’T have a vaccine that was temporally associated with your onset of GBS (i.e. within about 6 weeks) DON’T have unnecessary vaccines for travel but DO have all travel vaccines that are recommended for the particular area you are travelling to DO have all vaccines that are ‘necessary’. This includes the flu vaccine (if you are in an at risk group), MMR, DTP, pneumovax, HIF etc., and will include COVID-19 vaccine when it becomes available. There is no population link to causation in any of these – there are monitoring programmes going on so a link would be picked up if it occurred; no links have been detected since the 1970s Vaccines currently in use are amongst the safest medicines available. However, as with many things in life, there is no simple ‘yes or no’ answer, and each person must weigh up the risks associated with not having a vaccination, against the very small risk that might be associated with having it. Hopefully, this information will help you reach an informed decision.

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COVID-19 (coronavirus)

Posted on 04/03/2020 | Updated: 25/08/2020

We have been asked whether people who have been affected by Guillain-Barré syndrome, CIDP or one of the associated inflammatory neuropathies are more at risk from coronavirus COVID-19. The following information is a general guideline only. If you have other health conditions to take into consideration, please seek medical guidance.

GBS / acute variants

The advice for people who have had GBS is the same as for anyone else. A common misconception is that people who have had GBS have a weakened or damaged immune system – this isn’t the case, and you are no more or less likely to contract the coronavirus or to be adversely affected by it, unless you have other underlying health conditions, or are considered more vulnerable due to your age, etc.

CIDP / chronic variants

For those of you living with CIDP, or another of the chronic variants, you may have a suppressed immune system, depending on your treatment. Receiving immunoglobulin, either intravenously or subcutaneously, does not suppress your immune system, nor does plasmapheresis (aka plasma exchange or plex). However, if you take steroids, or other immunosuppressant drugs, then you are considered to be more vulnerable. If you are unsure, ask your GP or neurologist

Further information online

For up to date information on current guidelines where you live, please visit the relevant government website:
England
https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance
Scotland
https://www.gov.scot/coronavirus-covid-19/
Wales
https://gov.wales/coronavirus
Northern Ireland
https://www.nidirect.gov.uk/campaigns/coronavirus-covid-19
Republic of Ireland
https://www.gov.ie/en/campaigns/c36c85-covid-19-coronavirus/

Check if you have coronavirus symptoms

https://111.nhs.uk/covid-19

Book a test online if you have coronavirus symptoms

https://www.nhs.uk/conditions/coronavirus-covid-19/testing-and-tracing/get-a-test-to-check-if-you-have-coronavirus/

Local restrictions: areas with an outbreak of coronavirus/COVID-19

https://www.gov.uk/government/collections/local-restrictions-areas-with-an-outbreak-of-coronavirus-covid-19

Advice from the NHS, including how the most vulnerable should continue to protect themselves

https://www.nhs.uk/conditions/coronavirus-covid-19/

BBC News online

https://www.bbc.co.uk/news/coronavirus

Coronavirus (COVID-19) UK data

https://coronavirus.data.gov.uk/

World Health Organisation map showing location and numbers of cases globally

https://covid19.who.int/

World Health Organisation questions and answers

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses

Advice from MIND regarding mental health and wellbeing during the pandemic

https://www.mind.org.uk/information-support/coronavirus/