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Every fall, members of my fibromyalgia Facebook group begin asking the same questions:
“What do you guys think of flu shots? Do you think they’re safe for those of us with fibromyalgia?”
“Will getting the flu shot make me feel worse?”
“My doctor is recommending that I get the flu shot this year. Has anyone had a bad reaction?”
This year, I wanted to take the confusion out of this decision, so I reached out to 10 physicians who treat or research fibromyalgia to find out how they approach this issue with their patients.
Today I’m posting their responses. However, you’ll notice only four out of 10 physicians actually shared their opinion. The other six physicians I reached out to either declined to answer the question or didn’t respond at all.
It seems even some physicians are uncomfortable broaching the controversial topic of vaccines.
And the physicians who did respond are just as divided on the issue as fibro patients themselves.
Below, I’ve included the responses of the four physicians who were brave enough to respond.
You’ll notice there is a clear demarcation between physicians who practice mostly conventional or allopathic medicine versus those who are more integrative in their approach to treating fibromyalgia.
There’s also a difference in opinion among physicians who have actually been diagnosed with fibromyalgia themselves vs. physicians who treat fibro.
Even though I failed to get a conclusive answer on whether fibromyalgia patients should get flu shots, I do think there’s great value in reading these physicians’ differing opinions on the issue.
Following the physicians’ responses, I’ve included what the research says about fibromyalgia patients getting the flu shot as well as information from the Centers for Disease Control and Prevention and the results of an informal patient survey.
Hopefully, all of this information, when taken together, will help you to make an informed choice if you’ve been debating whether or not to get a flu shot this year.
Ask the doctors: Should fibromyalgia patients get the flu shot?
Dr. Ravindra Ganesh, Internal Medicine, Mayo Clinic
(Note: In 2019, the Mayo Clinic published a comprehensive guide to fibromyalgia, which provides a great overview of the condition – what it is, effective treatments and management strategies. It’s perfect for someone who is newly diagnosed or wants to expand their knowledge beyond drug therapy.)
“Patients with fibromyalgia (FM) suffer from a complex and debilitating disease characterized by chronic widespread pain, fatigue, cognitive impairment, unrefreshing sleep and exercise intolerance. In many cases, the onset of FM is preceded by a major emotional or physical stressor, including medical illnesses caused by infections.
“Recently, an association between vaccines and a newly described syndrome known as Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA) was proposed. There is, however, neither a biologically plausible mechanism nor a causal relationship established between immunization and the development of FM, according to a National Academy of Medicine report.
“As patients with fibromyalgia are more likely to experience significant malaise and a flare in their symptoms if they were to contract influenza, many patients suffering from FM are concerned about the possibility of developing worsening symptoms (flares) with immunizations.
“In a 2015 study, patients with fibromyalgia were shown to develop an immune response to the influenza vaccine without any significant increase in fibromyalgia symptom burden. Side effects may be more common in patients with FM, but these are expected to be short-lived. From my standpoint, it would be recommended that these patients receive the influenza vaccine.”
Watad, A., Quaresma, M., Bragazzi, N.L. et al. The autoimmune/inflammatory syndrome induced by adjuvants (ASIA)/Shoenfeld’s syndrome: descriptive analysis of 300 patients from the international ASIA syndrome registry. Clin Rheumatol 37, 483–493 (2018). https://doi.org/10.1007/s10067-017-3748-9
Institute of Medicine. In: Stratton K., Ford A., Rusch E., Clayton E.W., eds. Adverse Effects of Vaccines: Evidence and Causality. Washington (DC): National Academies Press (US); 2012.
Ablin J.N., Aloush V., Brill A., et al. Influenza vaccination is safe and effective in patients suffering from fibromyalgia syndrome. Reumatismo. 2015 Sep;67(2):57-61. DOI: 10.4081/reumatismo.2015.823.
Dr. Martin Rutherford, Doctor of Chiropractic and Certified Functional Medicine Practitioner, PowerHealthTalk.com
(Note: Dr. Rutherford lives with fibromyalgia himself and has an amazing YouTube channel where he periodically discusses issues related to fibro. I consider his video “Fibromyalgia Cutting through the B.S.” to be one of the best fibromyalgia videos online.
“I would suggest that anyone suffering with fibromyalgia, or any autoimmune condition for that matter, avoid taking the flu shot. There are many things that can trigger an exacerbation in a fibromyalgia case, and something as simple as a shot could be one, not to mention the potential triggers that could be caused by the ingredients in that shot.
“We have had multiple fibromyalgia and other autoimmune patients over the years have reactions to taking the flu shot from mild irritations to major flare ups that lasted months.
“My recommendation for all of my patients is to work on boosting up their immune system as much as possible through diet, hydration, exercise, sleep and supplementation as needed rather than relying on a flu shot that has been shown to be marginally effective at best.”
(Note: Dr. Teitelbaum was diagnosed with fibromyalgia during medical school, so like Dr. Rutherford, he has a unique understanding of what it’s like to live with fibro. “The Fatigue and Fibromyalgia Solution” was the first book I read after my own fibromyalgia diagnosis, and I still consider it to be one of the best fibro books available today. I will be reviewing the newly updated version of his book “From Fatigued to Fantastic” soon here on FedUpwithFatigue.com.)
“Although it is okay to get the flu vaccine, in general I don’t recommend it. Overall, people seem to have about as much trouble from the vaccine as they do from the flu. But if somebody feels like getting it, especially if they have not had problems with the flu vaccine in the past, it is not unreasonable.
“More important? Optimizing nutritional support with vitamin D, zinc and vitamin C along with taking measures to improve sleep and hydration. I discuss this in more length in my just-released fourth edition of ‘From Fatigued to Fantastic.’
“Personally, I am not planning to get the flu vaccine myself. Once we have more information on the safety and efficacy of any upcoming COVID-19 vaccines, I would be happy to give my opinion on that as well.”
Dr. Fred Wolfe, clinical professor of medicine, University of Kansas School of Medicine, and researcher with Forward – The National Databank for Rheumatic Diseases
(Note: Dr. Wolfe has been researching fibromyalgia for decades! He’s a true pioneer and actually helped develop the diagnostic criteria that physicians use to diagnose fibromyalgia. He’s retired from active clinical practice, but still continues his work as a teacher and researcher.)
“Everyone should get a flu immunization. Flu shots do not affect anyone with fibromyalgia differently from those without fibromyalgia, nor are side effects increased.”
What does the science say?
I was only able to find one study on PubMed that addressed fibromyalgia and flu shots. This small Israeli study involving 19 patients found the “influenza vaccination was both safe and effective in [fibromyalgia] patients. Neither severe adverse reactions nor significant worsening of [fibromyalgia] symptoms were recorded following vaccination and serological evidence of sero-conversion was observed, similar to healthy controls. In view of these results, [fibromyalgia] patients should be encouraged to undergo influenza vaccination according to standard [World Health Organization] recommendations.”
There is also some limited research pertaining to chronic fatigue syndrome (CFS), the sister condition to fibromyalgia.
A small Canadian study involving 40 CFS patients found “influenza immunization is safe, not associated with any excess early reactions and stimulates an immunizing response comparable with that of healthy volunteers.”
A Netherlands study concluded “the humoral and cellular immune responses upon influenza vaccination were comparable in CFS patients and healthy controls. Putative aberrations in immune responses in CFS patients were not evident for immunity towards influenza. Standard seasonal influenza vaccination is thus justified and, when indicated, should be recommended for patients suffering from CFS.”
What does the CDC say?
The Centers for Disease Control & Prevention recommends an annual flu shot for anyone ages 6 months old and older especially those who fall into the following high-risk groups:
- Adults ages 65 and older
- Adults with chronic health conditions such as asthma, heart disease/stroke, diabetes, HIV/AIDS, cancer and chronic kidney disease
- Pregnant women
- Young children ages 5 and under
- Children with neurologic conditions
The CDC has published additional information this year related to getting a flu shot amid the COVID-19 pandemic.
The best months to get a flu shot are September and October, according to the CDC.
What do patients say?
As I was working on this article, I decided to poll the members of my Facebook group about their experiences with the flu shot. Obviously, this is not a scientific study but it does give some idea about how other fibromyalgia patients are handling this issue.
Out of 549 fibromyalgia patients who responded:
- 55% have gotten the flu shot and did not experience any increase in their fibromyalgia symptoms.
- 34% do not get the flu shot.
- 11% have gotten the flu shot and experienced an increase in their fibromyalgia symptoms.
Limiting exposure to mercury
If you ask someone why they don’t get the flu shot, sometimes they’ll say they avoid it because of the mercury that’s used as a preservative in the vaccine.
According to the CDC, “thimerosal is an ethyl mercury-based preservative used in [flu vaccine] vials that contain more than one dose of a vaccine to prevent germs, bacteria and/or fungi from contaminating the vaccine.”
The CDC maintains, “Thimerosal use in vaccines and other medical products has a record of being very safe. Data from many studies show no evidence of harm caused by the low doses of thimerosal in vaccines.”
For those who are concerned, there is a way to get flu shot without being exposed to mercury.
“Most single-dose vials and pre-filled syringes of flu shot and the nasal spray flu vaccine do not contain a preservative because they are intended to be used once,” reads the CDC website.
How well does the flu shot work?
The effectiveness of the flu shot varies from year to year. The CDC has not posted effectiveness rates for the current season, but rates from previous years provide a guide for how well flu vaccines work.
Now it’s your turn: If you have fibromyalgia, do you plan to get a flu shot this year? The flu shot does not prevent COVID-19. That being said, are you more likely to get a flu shot this year due to the ongoing pandemic? Sound off in the comments below!