Add the Flu to the List of Chronic Fatigue Syndrome Triggers

[Cort]

Pandemic influenza A (H1N1) infection was associated with a more than two-fold increased risk of CFS/ME​

It's now official. Thanks to yet another Norwegian study (they are so organized over there!) getting the flu doubles ones risk of getting ME/CFS. There was no evidence though that getting a flu vaccine did...

• http://www.ncbi.nlm.nih.gov/pubmed/26475444

Vaccine. 2015 Oct 16. pii: S0264-410X(15)01433-4. doi: 10.1016/j.vaccine.2015.10.018. [Epub ahead of print] Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine.
Magnus P1, Gunnes N2, Tveito K3, Bakken IJ2, Ghaderi S2, Stoltenberg C2, Hornig M4, Lipkin WI4, Trogstad L2, Håberg SE2.Author information

Abstract

BACKGROUND:

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated to infections and it has been suggested that vaccination can trigger the disease. However, little is known about the specific association between clinically manifest influenza/influenza vaccine and CFS/ME. As part of a registry surveillance of adverse effects after mass vaccination in Norway during the 2009 influenza A (H1N1) pandemic, we had the opportunity to estimate and contrast the risk of CFS/ME after infection and vaccination.
METHODS:

Using the unique personal identification number assigned to everybody who is registered as resident in Norway, we followed the complete Norwegian population as of October 1, 2009, through national registries of vaccination, communicable diseases, primary health, and specialist health care until December 31, 2012. Hazard ratios (HRs) of CFS/ME, as diagnosed in the specialist health care services (diagnostic code G93.3 in the International Classification of Diseases, Version 10), after influenza infection and/or vaccination were estimated using Cox proportional-hazards regression.
RESULTS:

The incidence rate of CFS/ME was 2.08 per 100,000 person-months at risk. The adjusted HR of CFS/ME after pandemic vaccination was 0.97 (95% confidence interval [CI]: 0.91-1.04), while it was 2.04 (95% CI: 1.78-2.33) after being diagnosed with influenza infection during the peak pandemic period.
CONCLUSIONS:

Pandemic influenza A (H1N1) infection was associated with a more than two-fold increased risk of CFS/ME. We found no indication of increased risk of CFS/ME after vaccination. Our findings are consistent with a model whereby symptomatic infection, rather than antigenic stimulation may trigger CFS/ME.
Copyright © 2015 Elsevier Ltd. All rights reserved.

 

[weyland]

If I understand correctly there was no temporal correlation between the flu diagnosis and ME diagnosis meaning you can't conclude that influenza triggered their ME.

 

[AnneVA]

Here is yet another similarity between CFS/ME and POTS/dysautonomia. Viruses and concussions are strongly suspected as triggers for some with POTS. But I've read that there is most likely an underlying but as of yet unexpressed problem in the body and that the trigger sets it into motion. Any thoughts on that?

 

[Cort]

If I understand correctly there was no temporal correlation between the flu diagnosis and ME diagnosis meaning you can't conclude that influenza triggered their ME.

I didn't know that. So people didn't come down with ME/CFS immediately after the flu but getting the flu was associated with at some point doubling their risk for ME?

 

[Cort]

Here is yet another similarity between CFS/ME and POTS/dysautonomia. Viruses and concussions are strongly suspected as triggers for some with POTS. But I've read that there is most likely an underlying but as of yet unexpressed problem in the body and that the trigger sets it into motion. Any thoughts on that?

It's also true for fibromyalgia - infection is a common trigger. Of course it's also true for autoimmune disease...I don't know that anyone knows what the unexpressed problem is...However the Dubbo studies have shown that people who come with ME/CFS tend to have genetic variations of immune factors that make them react more strongly to an infection. That over-reaction somehow triggers some sort of system reset but I don't think anyone knows how it does that. It could sensitize the microglia....

 

[weyland]

I didn't know that. So people didn't come down with ME/CFS immediately after the flu but getting the flu was associated with at some point doubling their risk for ME?

I don't have access to the full text but in the abstract they just say that they looked at medical records for people that had a diagnosis of G93.3 and influenza infection in the time period of 2009-2012. Unless they limited this somehow I have to imagine that this could include for example someone that had influenza in 2009 and then developed ME two years later.

 

[Cort]

I don't have access to the full text but in the abstract they just say that they looked at medical records for people that had a diagnosis of G93.3 and influenza infection in the time period of 2009-2012. Unless they limited this somehow I have to imagine that this could include for example someone that had influenza in 2009 and then developed ME two years later.

Got it - thanks weyland.