Update on 2021 Flu Vaccine and 3rd COVID-19 ‘booster’ Vaccine for people with ME/CFS

September 22, 2021

Once the situation on booster vaccines for COVID-19 is absolutely clear, we will be updating the current (2020/21) MEA information leaflet on flu vaccine and pneumococcal vaccine to also include information on the COVID-19 booster jabs.

In the meantime, almost all of the information in the current MEA leaflet on flu vaccine, which is available as a free download from the MEA website, applies to this year’s flu vaccine.

The only important addition to the eligibility criteria list is that everyone over the age of 50 can now have a free NHS flu vaccination. The MEA information leaflet contains detailed information on how to weigh up the risks and benefits of having a flu vaccine if you have ME/CFS.

As in previous years, the type of flu vaccine given will largely depend on your age:

  • The over 65s will be offered an adjuvated quadrivalent influenza vaccine (aQIV)
  • Those aged 18 – 64 will be offered QIVc (cell cultured vaccine)
  • Children aged 2 – 15 will be offered a live attenuated influenza vaccine (LAIV) unless this is contraindicated

The quadrivalent flu vaccines offer a fairly high degre of protection against the 4 strains of flu (two A strains and 2 B strains) that are most likely to be present this coming winter.

Questions and Answers on flu vaccine and COVID-19 booster:

1 Are people with ME/CFS entitled to have a free NHS flu vaccine if they choose to do so?

The simple answer here should be yes. This is because one of the at risk health conditions for having an NHS flu vaccine is having a chronic neurological disease.

Confirmation that ME/CFS is classified as a ME/CFS neurological disease:

  • ME/CFS is classified by the World Health Organisation as a neurological disease in section G93:3 of ICD10
  • NHS England classifies ME as a long term neurological condition
  • The SNOMED disease classification system, which is used by the NHS, classifies CFS as a chronic disorder of the nervous system
  • And a letter from a previous Chief Medical Officer confirms that people with ME/CFS should be able to have an NHS flu jab – an extract friomt this CMO letter is included in the MEA information leaflet.

If you are still being refused an NHS flu jab by your GP surgery it’s worth going to a pharmacy that is administering NHS flu jabs. This is because feedback to the MEA in previous years indicates that pharmacists are normally quite happy to accept that ME/CFS is a chronic neurological disease.

2 Is it safe to have a flu vaccine and COVID-19 booster vaccine together?

To make the process more efficient it looks as though many people are going to be offered both vaccines together – where they are entitled to have both. But we know that people with ME/CFS do sometimes react badly to vaccinations, including flu vaccine and COVID-19 vaccines.

So it’s possible that having both vaccines together may increase this risk still further. On the other hand, attending two vaccination sessions on separate occasions, and possibly having to deal with two separate adverse reactions, could also carry a risk.

As we just don’t know the answer to this question at the moment, people will have to make an individual judgement. On a personal basis, having not had any significant problems with either flu or the first two doses of COVID-19 vaccination, I will probably have them together if offered.

3 Will people with ME/CFS be automatically offered a COVID-19 booster jab?

The JCVI have now recommended that everyone on priority groups 1 – 9 should receive a COVID-19 booster jab. So this will include everyone in JCVI group 6 (which should include people with ME/CFS) and everyone over the age of 50 in (Group 9).

However, as the same descending JCVI priority list that was used for first and second doses is applied to booster doses, we may see people with ME/CFS who are below the age of 50 having to once again prove that they have a medical condition that is likely to be made worse by COVID-19.

If so, we will be updating the MEA letter which explains why people with ME/CFS under the age of 50 should be regarded as having a vulnerable medical condition in relation to COVID-19.

In theory, if your doctor agreed that you should be in JCVI group 6 for the first and second doses, the same reasoning should automatically apply to a booster dose. Unfortunately, anyone who was refused a first or second dose of vaccine on the basis that they did not meet JCVI group 6 criteria may have to battle with the medical authorities all over again.

4 Should I have a COVID-19 booster if I had a bad reaction to the first or second dose?

This is another difficult question with no easy answer. On the one hand, COVID-19 is going to be with us for the foreseeable future and there is evidence that vaccine-induced immunity starts to progressively decline from around 6 months after the second dose. On the other, we just don’t know if having a bad adverse reaction to a first or second dose of COVID vaccine means that you will probably have a bad reaction to a booster. Intuition suggests that this could well be the case….

One important point to note here is that booster jabs will be with either the Pfizer or (half dose) Moderna vaccine – regardless of which vaccine was used to start with. These vaccines have been shown to produce a strong booster response. AstraZeneca vaccine is only being used for booster jabs in exceptional circumstances.

5 Can I get a booster jab at home if I cannot get to the surgery or vaccination hub?

There are likely to be problems here in that the Pfizer vaccine has to be stored at very low temperatures – so this isn’t a good choice for home vaccinations. If you are being told that you cannot be vaccinated at home you will need to ask about having the (half dose) Moderna vaccine.

Dr Charles Shepherd, Hon. Medical Adviser, ME Association

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