Weird Medicine Healthcare for the Rest of Us

Desiree Jennings developed severe side effects from the flu shot she received seven weeks ago, according to the Loudon Times-Mirror.

“You realize your life is never going to come back the way it was,” Jennings told the Times-Mirror. “My goal in life was to one day be a CEO. Now, I don’t know if I can ever return back to work.”

This one is really scary…and is being used by some to advocate against receiving the influenza vaccine. Some people are quoting the CDC as saying this is a “one in a million” event…a severe neurological reaction to having a flu shot. Well, if we have 300 million people in this country, are we looking at 300 events like this a year? Probably not. I suspect (and the data is sketchy, so it’s just a suspicion) that the probability of this happening has been overstated; I’ve been in medicine for over 20 years and in that time 100s of millions of people have had flu vaccine and this is the first case like this I’ve seen in the media. I could find no data in the literature linking dystonia to influenza vaccine, but that doesn’t mean it didn’t happen.

Vaccines stimulate the immune system to make antibodies against the proteins that are injected. Sometimes those same antibodies “recognize” normal human tissue and attack it. This arises from the natural variation humans have in their immune-protection systems, and occasionally someone will have a natural protein in their body that is similar enough to a viral protein to be attacked by the same antibody.

A classic condition thought to be caused this way is Guillain-Barre’ syndrome (GBS). Since the pathway in Desiree Jennings’ case is thought to be similar, I think an in-depth look at GBS is worth the time.

From the CDC:

Guillain-Barré syndrome (GBS) is a rare disorder in which a person’s own immune system damages the nerve cells, causing muscle weakness and sometimes paralysis. GBS can cause symptoms that last for a few weeks or several months. Most people recover fully from GBS, but some people have permanent nerve damage. In rare cases, people have died of GBS, usually from difficulty with breathing. In the United States, for example, an estimated 3,000 to 6,000 people develop GBS each year on average, whether or not they received a vaccination. This is about 1 to 2 cases of GBS per 100,000 people.

What causes GBS?
Scientists do not fully understand what causes GBS, but it is believed that stimulation of the body’s immune system may play a role in its development. Here’s what scientists know for sure: About two-thirds of people who develop GBS symptoms do so several days or weeks after they have been sick with a diarrheal or respiratory illness. Infection with the bacterium Campylobacter jejuni is one of the most common risk factors for GBS. People can also develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks following receiving a vaccination.

Who is at risk for developing GBS?
Anyone can develop GBS, but it is more common among adults than children. The incidence of GBS increases with age, and people over age 50 are at greatest risk for developing GBS. Each year, on average, about 3,000 to 6,000 people in the United States develop GBS whether or not they received a vaccination – that’s 1 to 2 people out of every 100,000 people.

Do vaccines cause GBS?
It is not fully understood why some people develop GBS, but it is believed that the nerve cells are damaged by a person’s own immune system. Many types of infections, and in very rare cases vaccines, may activate the immune system to cause damage to the nerve cells.

How common is GBS, and how common is it after people are vaccinated for seasonal influenza?
GBS is rare. Each year, about 3,000 to 6,000 people in the United States develop GBS whether or not they received a vaccination – that’s 1 to 2 people out of every 100,000 people. This is referred to as the background rate.

In 1976, there was a small risk of GBS following influenza (swine flu) vaccination (approximately 1 additional case per 100,000 people who received the swine flu vaccine). That number of GBS cases was slightly higher than the background rate for GBS. Since then, numerous studies have been done to evaluate if other flu vaccines were associated with GBS. In most studies, no association was found, but two studies suggested that approximately 1 additional person out of 1 million vaccinated people may be at risk for GBS associated with the seasonal influenza vaccine. It is important to keep in mind that severe illness and possible death can be associated with influenza, and vaccination is the best way to prevent influenza infection and its complications.

What happened in 1976 with GBS and the swine flu vaccine?
Scientists first reported a suspected link between GBS and vaccinations in 1976, during a national campaign to vaccinate people against a swine flu virus. The investigation found that vaccine recipients had a higher risk for GBS than those who were not vaccinated (about 1 additional case occurred per 100,000 people vaccinated). Given this association, and the fact that the swine flu disease was limited, the vaccination program was stopped.
Since then, numerous studies have been done to evaluate if other flu vaccines were associated with GBS. In most studies, no association was found, but two studies suggested that approximately 1 additional person out of 1 million vaccinated people may be at risk for GBS associated with the seasonal influenza vaccine.

Why did some people develop GBS after they received the 1976 swine flu vaccine?
The Institute of Medicine (IOM) conducted a thorough scientific review in 2003 and concluded that people who received the 1976 swine influenza vaccine had a slight increased risk for developing GBS. Scientists have multiple theories on why this increased risk may have occurred, but the exact reason for this association remains unknown.

Note that GBS is relatively common compared to dystonia…6000 cases/year compared to 300 or less (or even less if the “1 in a million” is off by a factor of 10 or 100 which I suspect that it is). Also note, though that people are much more commonly affected after getting a virus than from being vaccinated for said virus.

Now I’m just theorizing here, but it’s based on some science…if it’s the antibodies to the vaccine that cause the disorder, then the antibodies to the virus itself would have caused the same disorder. There may be people out there who are simply fated to get an autoimmune adverse reaction because of their native proteins; they would get it if they took the vaccine or if they contracted the virus since the immune response is very similar, if not identical. The only way they could prevent the syndrome would be to not take the vaccine and not get the virus, something that’s difficult to control. In addition, there’s no way to know ahead of time that you’re the person who is going to have this problem.

Statistically (and that’s the only way we can look at large populations), the flu vaccine saves lives. In 1918, the flu pandemic affected 1/3 of the world’s population and 1/10 of those people died. In real numbers, the world had 1.5 billion people then–500 million got the virus and 50,000,000 died. If there had been a vaccine back then, those numbers would have been slashed dramatically.

So you weigh the “good of the many versus the good of the few…or the one”. Influenza vaccine will save a ton of young adults and children from dying this year. There will be tragic calamities caused by the vaccine in a much smaller number of people. Unfortunately we live in a grossly imperfect world. Someday in the future if we can keep from blowing ourselves up or doing something equally stupid, we may be able to harness the immune system in such a precise way that no one ever need die from a viral infection again.

Then of course we’ll figure out we need the viruses to live somehow, but then it’ll be too late (fatalist that I am).

More later

your pal,

Dr Steve