Each year, seasonal Flu affects hundreds of thousands of people across the globe. In most cases the virus causes mild illness that doesn’t require medical attention or hospitalisation. For certain people in high-risk groups, however, catching the Flu can lead to life-threatening complications.
- NHS England: NHS flu and covid vaccine programmes brought forward due to risk of new covid variant | 30 August 2023
Contents
1. Introduction
Flu vaccination is important because although Flu is often unpleasant, it can also be dangerous. This is especially so for anyone with certain chronic health conditions, including ME/CFS. And, with Covid still around, a combination of Flu and Covid could be even more serious. To avoid becoming seriously ill, it’s advised that people in high-risk groups receive the Free NHS Flu vaccine before Flu season begins.
- NHS: Flu Vaccination for Adults | 09 August 2023
- Lloyds Pharmacy: Is it a cold or the Flu? | 30 March 2021
There is no simple yes/no answer as to whether everyone with ME/CFS should have a Flu vaccine. We have prepared the following information to help you decide if you want to have this protection and a template letter that can be used when speaking with a GP should you want to try and get a Free NHS Flu vaccine.
- In the UK, the Flu season runs from December to March (although outbreaks can occur from early autumn to late spring). Flu can lead to serious complications, such as bronchitis and pneumonia. It may also worsen pre-existing health conditions and lead to dangerous complications in pregnancy.
- The Flu virus exists year-round, but outbreaks are most common in the winter and early spring. It’s thought that the flu virus survives for longer in cold, dry air, and that it spreads more easily in the winter months as we spend more time inside in close contact with one another.
- Though December-March is the peak season for flu, outbreaks can occur as late as May. Flu viruses can also begin to spread in early autumn, usually from October onwards.
- It’s also worth noting that – although the Flu is far more common during the autumn and winter – you can contract the virus at any time of the year if you come into contact with someone who is infected.
2. Catching the Flu
- The Flu virus is primarily spread through the coughs and sneezes of those with the infection. When you cough or sneeze, droplets carrying the virus shoot from your mouth and nose and can travel around six feet. The droplets hang in the air before settling on surfaces.
- If someone with the Flu sneezes or coughs into their hands, they can contaminate surfaces when they touch them. That’s why you should wash your hands regularly and use tissues.
- If you’re standing close to someone when they sneeze or cough, there’s a high risk that you'll inhale some of these droplets and become infected. However, this is not the only way Flu can be transmitted.
3. Protecting against the Flu
- The Flu vaccine should provide a high degree of protection against all the Flu viruses that are predicted to be around in the coming months. This protection should persist for up to about a year. The vaccine takes about 2 weeks before it is fully effective.
- If you have any other chronic health conditions – especially affecting the heart or lungs – having this protection against the Flu could be even more important.
- Most healthy people do not experience any serious side-effects to Flu vaccines. Evidence collected by the ME Association over the years indicates that while many people with ME/CFS (possibly around half) don’t have any significant problems after having a Flu vaccination other people do and some of them experience more severe or prolonged adverse effects.
- If you have had a Flu vaccine in the past whilst having ME/CFS and have not suffered any adverse effects, it's reasonable (but not guaranteed as the vaccine composition changes each year) to assume that you should be OK this time.
4. Cautionary notes
- As with any vaccination it should be deferred if you are feeling unwell. If you are ill with Flu-like symptoms (i.e., a sore throat, enlarged glands, that are not normally associated with your ME/CFS) or a temperature or fever, you should wait until these symptoms subside before having the Flu vaccine.
- You should avoid having the vaccine if you have had a serious allergic reaction to a Flu vaccine in the past. You may be at risk of an allergic reaction if you have an egg allergy. This is because some Flu vaccines are made using eggs. If necessary, you can ask a GP or pharmacist for a low-egg or egg-free vaccine.
- We know from patient evidence collected over many years that some people with ME/CFS experience a significant exacerbation of symptoms, or even a prolonged relapse after having a Flu vaccination. This is probably because vaccines mimic the effect of infections on the body's immune system and infections are the commonest cause of symptom exacerbation or relapse in ME/CFS.
- Vaccinations can occasionally trigger ME/CFS and we are aware of occasional cases where this has happened following Flu or Swine Flu vaccination.
Fortunately, it's very rare for anyone to have a serious allergic reaction (anaphylaxis) to the Flu vaccine. If this does happen, it usually happens very quickly and within minutes. The person who vaccinates you will be trained in how to deal with allergic reactions and treat them immediately.
5. Who can have the Free NHS Flu vaccine?
If you have weighed up the pros and cons and decided to have a Flu vaccination this is given Free by the NHS to adults who meet any of the following criteria:
- are 65 and over (including those who will be 65 by 31 March 2024).
- have certain health conditions – including chronic neurological disease.
- are pregnant.
- are in long-stay residential care.
- receive a carer's allowance or are the main carer for an older or disabled person who may be at risk if you get sick.
- live with someone who is more likely to get a severe infection due to a weakened immune system, such as someone living with HIV, someone who has had a transplant, or is having certain treatments for cancer, lupus, or rheumatoid arthritis.
In relation to pre-existing long-term health conditions, several specific diseases are covered. These include:
- Respiratory conditions, such as asthma (needing a steroid inhaler or tablets), COPD, emphysema, and bronchitis.
- Diabetes.
- Heart conditions, such as coronary heart disease or heart failure.
- Being very overweight – having a body mass index of 40 or above.
- Chronic kidney disease.
- Liver disease, such as cirrhosis or hepatitis.
- Neurological conditions, such as Parkinson's disease, Motor Neurone Disease, Multiple Sclerosis, or Cerebral Palsy.
- A learning disability.
- Problems with your spleen like Sickle Cell disease, or if you've had your spleen removed.
- A weakened immune system because of conditions such as HIV and AIDS or taking medicines such as steroid tablets or chemotherapy.
6. Can I have the Free NHS Flu vaccine if I have ME/CFS?
Although the neurological conditions shown above do not include ME/CFS as a specific example, the accompanying NHS guidance states that you can, “talk to your doctor if you have a long-term health condition that is not in one of these groups. They should offer you a Flu vaccine if they think you're at risk of serious health problems if you get Flu.”
This means that if you live in England, Wales, Scotland, and Northern Ireland you should be able to have a Free NHS Flu vaccination if you choose to do so because ME/CFS is classified as a neurological disease in the SNOMED CT electronic classification system (which is used by the NHS) and by the World Health Organisation in the International Classification of Diseases (ICD10; G93.3).
- We have produced a Template letter that you can use when speaking with a GP if you have ME/CFS and decide to try and get a Free Flu vaccine on the NHS.
Please note that feedback from previous years indicates that pharmacies are normally very willing to provide a free NHS Flu vaccine to people with ME/CFS.
7. Possible vaccine side-effects
For healthy people Flu vaccines are usually very safe. All adult Flu vaccines are given by injection into the muscle of the upper arm. Side-effects – if indeed there are any – are usually mild and only last for a day or so. These can include:
- a slightly raised temperature.
- muscle aches.
- sore arm at the point of injection.
Less common side-effects, some of which are symptoms of ME/CFS, include fatigue, shivering, sweating, headache, joint pain, nerve pain, paraesthesiae (‘pins and needles’ sensations) and skin reactions (itching, urticaria).
Serious side-effects are fortunately very rare. These include convulsions, thrombocytopenia (lowered level of platelets), encephalomyelitis, vasculitis (blood vessel inflammation), Guillain Barre syndrome.
8. When to get the Flu vaccine
If you choose to have a Flu vaccination the best time to have it is in the autumn or early winter before Flu starts spreading. Most people who are eligible for a Free NHS Flu vaccine will be able to get it from 7 October 2023. Some people will be able to get it from 2 October 2023. This includes people who live or work in a care home.
9. Where to get the Flu vaccine
You can have the Free NHS Flu vaccine at:
- your GP surgery.
- a pharmacy offering the service – if you're aged 18 or over.
- some maternity services if you're pregnant.
- at a hospital appointment.
If you are having difficulty obtaining a Free NHS Flu vaccine you can pay to have one at a pharmacy. Boots charge £19.95, for example.
10. Can I have the Free NHS Flu vaccine and Autumn Covid Booster together?
You may be offered a Flu vaccine and the Autumn Covid Booster at the same appointment. We have very little feedback from people who have had both together. Whilst having both at the same time reduces the number of surgery visits, having two vaccinations on the same day may increase immune system activation and the risk of an adverse reaction.
- Please refer to the website blog: Covid Autumn Booster Vaccination | 06 September 2023
11. Pneumonia and Shingles vaccinations
If you are elderly, you may also be offered a Free pneumococcal (pneumonia) vaccine (for 65+) or a shingles vaccine (for 70+). Both vaccines are covered in the ME Association Medical Matters Question and Answer archive on the website.
12. Feedback
As always, please let us know if you have had any problems obtaining a Free NHS Flu vaccine and if you do have one whether you have had any adverse reactions. Email: feedback@meassociation.org.uk and title your email ‘Flu Vaccination’.
We will be creating a website survey so that you can share your decisions and experiences of the Flu vaccine. This should be available in the next few days and will seek Covid Booster feedback as well. We will keep the survey open until the New Year.
Medical disclaimer
The information provided by the ME Association and Dr Shepherd and should not be construed as medical advice. We recommend that any information you deem relevant is discussed with your GP as soon as possible. It is important to obtain advice from a GP who is in charge of your clinical care and who knows you well. Seek personalised medical advice should you have ME/CFS and decide to have the Flu vaccination, especially if you experience any new or worsened symptoms afterwards. Don't assume they are simply the result of having ME/CFS.