Flu, it’s not too late to be vaccinated

F

Barts-MS rose-tinted-odometer  ★★★

Not walking my talk. Having not taken up the NHS offer of the seasonal flu vaccine and having just spent the last 3 days bed-bound with severe flu I found the following research paper very timely. 

Using the Norwegian registries these investigators show that pwMS are much more susceptible to the complications of influenza, i.e. pwMS are much more likely to require emergency hospital admission as a result of influenza infection. Reasons for this are three-fold. Firstly, people with advanced MS may not have as strong gag and cough reflexes with a higher chance of aspiration of their secretions with secondary pneumonia. They may also have weakened respiratory muscles that increase their chances of getting a segmental collapse of their lungs and secondary pneumonia. Secondly, many pwMS are on immunosuppressive medications which blunt their immune response to the influenza virus making the virus more virulent and likely to affect multiple organ systems. Finally, on average pwMS have reduced resilience to infections independent of being on immunosuppressive medication, this probably relates to deconditioning, temperature-related conduction-block in response to fever and the fact that many pwMS are disabled. In summary, pwMS handled infections less well than the general population and are more likely to get complications. 

Disappointing is the observation that pandemic vaccination did not influence the risk of hospitalization in this study. I suspect this was because the pandemic vaccine used in this study epoch was not effective. 

Even if you don’t need hospitalisation having influenzae is very unpleasant and make your MS symptoms much worse. There have been some studies that have shown that not all patients recover back to their baseline when they get worsening of their MS symptoms in response to an infection. The latter observation would imply that the infection triggered an MS relapse. Avoiding infections is, therefore, one of our aims as part of the holistic management of MS.

As I sit here and type this blog post I am still incredibly tired with brain fog and many persistent symptoms that will take a week or more to clear. The physical symptoms are one thing, what about the social impact? I just spent the three days of the festive season in bed ignoring my family and social commitments. The bottom line is if you can avoid having flu, why wouldn’t you? It is not too late to be vaccinated. 

Ghaderi et al. Hospitalization following influenza infection and pandemic vaccination in multiple sclerosis patients: a nationwide population-based registry study from Norway. Eur J Epidemiol. 2019 Dec 23. doi: 10.1007/s10654-019-00595-2.

Patients with multiple sclerosis (MS) are at increased risk of infections and related worsening of neurological function. Influenza infection has been associated with increased risk of various neurological complications. We conducted a population-based registry study to investigate the risk of acute hospitalization of MS patients in relation to influenza infection or pandemic vaccination in Norway. The entire Norwegian population in the years 2008-2014 was defined as our study population (N = 5,219,296). Information on MS diagnosis, influenza infection and vaccination were provided by Norwegian national registries. The self-controlled case series method was used to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CI) in defined risk periods. 6755 MS patients were identified during the study period. Average age at first registration of an MS diagnosis was 51.8 years among men and 49.9 years among females (66.9%). The IRR for emergency hospitalization among MS patients the first week after an influenza diagnosis was 3.4 (95% CI 2.4-4.8). The IRR was 5.6 (95% CI 2.7-11.3) after pandemic influenza, and 4.8 (95% CI 3.1-7.4) after seasonal influenza. Pandemic vaccination did not influence risk of hospitalization [IRR within the first week: 0.7 (95% CI 0.5-1.0)]. Among MS patients, influenza infection was associated with increased risk for acute hospitalization while no increased risk was observed after pandemic vaccination. Influenza vaccination could prevent worsening of MS-related symptoms as well as risk of hospitalization.

CoI: multiple

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

12 comments

  • As someone who teaches student health professionals about vaccination and in particular influenza vaccination, it really annoys me when health professionals don’t get the flu vaccination, especially if their employer is offering it on site for free!!!
    That being said, I am really sorry that you had the flu over the holiday period and missed Christmas with your family. I hope you feel much better soon, but next flu season please remember how crap you feel now, an’d make sure you get you flu vaccine.
    And for everyone else, pwms and others, it is definitely not too late to get it, so if you haven’t had it yet, put it at the top of you list.

  • The real question is why you weren’t vaccinated? In a clinical facing role why wouldn’t you? Time? Lack of planning? …,,,,,,

    • I was actually asking myself the same question – shouldn’t front line medical staff be vaccinated against everything imaginable? It is a high risk profession in that sense after all….

  • Sorry that life, no doubt, got in the way and you’ve paid the price for missing the flu jab, Prof G. Hope you feel completely well again asap.
    I’m on to day eleven of being unwell with a cold, having not left the house since 16th Dec and spending most of Xmas Day and Boxing Day home alone. Yet I had the flu jab at the end of Sept. Just goes to show that viruses can still have a significant impact and I’m fingers crossed this isn’t becoming a chest infection.
    Our GP surgery is now offering the flu vaccination to all its patients and I’d recommend that family members of PwMS have it too, especially as I reckon I contracted the cold from my husband.

  • Sorry to hear that you had the flu over Christmas,. No doubt you had a temperature as well as feeling very grotty. Its worth mentioning that a lot of pwMS suffer from Uhthoff’s phenomenon, me included. If my body temperature rises over 1/2 degree above normal Uhthoff’s strikes and makes walking very difficult. One degree and I am bed bound, legs don’t support me. I also get other problems like cog fog and anxiety. Another unfortunate consequence of MS and the heat problem is its getting worse over time. The only solution is to stay healthy and out of the sun. So far the flu jab has been successful for me over the last few years, Instead I just have bad doses of man flu.

    Pleased that you are on the mend. I hope the New Year is kind to you

  • As they say in Vermont, “JJBA” (Jesus Jumpin´ Bubble Ass) That is a term of exasperation. I´m sorry you feel/felt like cr@p. I am stunned that someone who treats folks with weakened immune systems would be so brazen as to not get the boola-hoola vaccine. Would you have expressed this as, “Crikey, why didn´t you get the bloody shot.”? Well, bless your heart.

  • The flu vaccine may not have been the same strain of flu that Prof G has. As the flu can mutate. Just something to bear in mind.

    • The other issue is had have not had a molecular diagnosis and hence my syndromic diagnosis of flu could be due to another virus. For example, I could have been infected with adenovirus.

      • Adeno would not cause the high fever, chills that keeps you in bed as influenza. You probably had the flu. No rapid flu tests in your hospital?

  • Doesn’t getting vaccinated help to stop spreading the virus around???

    A relative of mine who works in mental health is obligated to receive the vaccine, also to help protect patients.

    • Yep. Just didn’t get around to the vaccination clinic. When I went to the drop in clinic the queue was too long and I couldn’t wait. I am the fool for not going back. Good thing I was at home on holiday when I got ill; self quarantine.

      • And at least your honesty owning up will get others (like me) thinking 🤔 So well done for being human and hopefully by now flu free

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