Or why you get sick after getting a flu shot.
I have an unusually robust immune system for a seventy year old American woman, or so I infer from rarely falling prey to contagious diseases or developing lingering infections following injury. People describe me as “disgustingly healthy.” Likewise, I have no symptoms of something that would be characterized as an autoimmune disorder, although testing at a level that was not routine even thirty years ago might identify early stages, or a risk, of something like diabetes or rheumatoid arthritis and trigger aggressive treatment.
This is in contrast to most of my contemporaries. I was recently talking to a fellow member of the South Eugene High School class of 1966 who bemoaned the high cost of shingles vaccine. Like me and most baby boomers she had chicken pox as a child and at 71 is liable to an attack of shingles if her immune system becomes compromised. To forestall this, the medical community is now recommending that every oldster, whether or not there is any evidence that they are immunocompromised, be vaccinated to raise the antigen level vis-à-vis this particular pathogen which our systems harbor.
I doubt I need this vaccine, or would benefit from it, since I seem to have the immune system of a much younger person. Aside from advancing age, many of the factors known to undermine the immune system emanate from medical procedures, including cancer therapy, steroid drugs, and xenotransplantation. I found myself wondering whether the vaccine itself might undermine the immune response and actually make a person more vulnerable to shingles.
The prevalence of shingles, a disagreeable and sometimes debilitating but seldom dangerous condition, rose by 39% between 1992 and 2010. It has since leveled off, but it is too early to tell whether vaccination is effective on a population level. The rise has sometimes been attributed to adoption of a childhood vaccine against chicken pox, but the correlation is weak, and most people over 60 (the vulnerable population) had the actual disease as children. This is a relatively new vaccine. It is touted, based on experimental data and limited trial studies, as being 95% effective, but the in-use effectiveness in the general population is not known, and if experience is any guide, once use becomes general there will be great resistance to scrutinizing whether any net benefit derives from treating the general population with a drug or procedure developed for a much more restricted group.
The history of influenza vaccination may prove instructive here. When first marketed it was touted as being 95% effective. The effectiveness against the commonest H1N1 strain is now around 50% at the population level and declines in an individual with successive immunizations. When novel strains emerge, as occurred in 2009, the vaccinated population is vulnerable, and the often quoted assertion, that vaccinated individuals suffer less serious illness, is based only on patients who were hospitalized. Unvaccinated people like myself who stayed home and dosed themselves with over the counter medications don’t figure in the statistics.
It is frequently observed that people come down with flu-like illnesses shortly after receiving an immunization. People will say that they “got the flu from the flu shot”, which is not the case. However, while it is true that you cannot get actual flu from a killed virus vaccine, a lot of people do get sick, and there is a definite correlation between receiving the vaccine and falling ill with an unrelated respiratory or intestinal virus shortly afterward.
This brings us to the phenomenon of immunological paralysis. When a person is seriously ill and his or her immune system summons all its forces to combat the pathogen, there is a window of time during recovery when the immune system is less functional and the patient is vulnerable to secondary infections. The mechanisms behind immunological paralysis are known. It has been most extensively studied in hospital settings and life-threatening illnesses like pneumonia and sepsis, but it has also been observed outside hospitals and is one reason why knowledgeable physicians recommend staying home and staying relatively isolated after a serious illness even after one feels well enough to return to work or school.
Could vaccinations trigger immunological paralysis? Vaccinations fool the immune system into thinking you are suffering from a serious bacterial or viral illness, although your body does not become acutely ill. Getting sick soon after receiving a flu vaccination suggests this is possible. It would also explain why friends of mine who work in public schools and health care, who are required to have the whole gamut of available vaccines, complain of being frequently sick, whereas other friends who work in high public contact jobs that do not require vaccinations, like bus drivers and retail clerks, do not.
What concerns me here is not vaccination per se, which is a powerful tool against life-threatening diseases actually present in the environment; rather, it is the possibility that the frequency and variety of vaccinations given to people to whom the disease itself is not a threat (either because they are very unlikely to be exposed to it or because it is not dangerous to an otherwise healthy individual) may be undermining the immunological status of the population at large and ultimately having a net negative impact on health in general.
Photo is from CDC and is public domain
Feature image – H1N1 Influenza Virus Particles – by NIAID on flickr – some rights reserved