|
Flu Vaccine
International
Vaccination Newsletter
Influenza
is a specific syndrome, provoked by a specific viral agent, the influenza
virus. The symptoms may be severe, or even lead to exitus in people with a
weakened general condition.
Two main families have
been detected, influenza A and B. But there are many strains of influenza
viruses, and, moreover, existing strains mutate all the time. It is,
therefore, an extremely difficult task to 'foresee' the causative agent of a
new influenza epidemic, and even more difficult to produce a corresponding
vaccine in time. The constant mutation of the viruses, and the
unpredictability of which virus will show up where and when, makes the whole
influenza vaccination business into a giant poker game.
The most intriguing
deception of the public, however, is the suggestion that the patient who gets
an influenza-vaccination will not get the flu. What is generally known to the
public as 'a flu' is an influenza-like syndrome, with symptoms like fever,
chills, muskel- or joint pains, a headache, a runny nose, and general
malaise. This disease, however, has got nothing to do with the real
influenza, neither can it in any way be prevented by an influenza
vaccination. Thus, if doctors guarantee their patients that they will not get
the flu after they came in to get their jab, this is an unethical
manipulation, the basis for which most probably is simply profit for both
those who produce the vaccine and those who administer it.
Apart from this
manipulation, questions have to be answered as to the efficacy and the safety
of the vaccine.
Efficacy
The lack of efficacy of
the vaccine is well illustrated in a Dutch article (1) about a home for elderly
people, where in spite of vaccination of two thirds of the population, a
severe flu struck 49% of them, with strong morbidity (bacterial infections,
pneumonia) and high mortality (10%). An important observation was that in the
vaccinated population, 50% got the disease, compared to 48% of
non-vaccinated. Also, complement binding antibodies for influenza A were
positive in 41% of vaccinated compared to 36% in non-vaccinated. This clearly
shows that the vaccination status did not have a protective influence at all.
Further laboratory investigation confirmed that antibody building against the
vaccine was normal, but the causative influenza A virus had not reacted to
the vaccine the patients had been given.
Comparison with a
similar situation in 1988 in a home for elderly people shows that in that
second case both morbidity and mortality were significantly lower, namely 37
and 3%, respectively. The main difference, however, was ... that in this
second home patients had not been vaccinated!
Induction of antibodies
in elderly people never is higher than 52-67% (2). Morris even declares the
efficiency is not more than about 20% (3). Mistakes in production, transport,
conservation and administration can be responsible for a further decrease of
efficacy (4).
Safety
Questions about the
safety of influenza vaccines are not new. As early as 1973, Rabin wrote that
between 1966 and 1970 almost all USA-made influenza vaccines were toxic (5).
I. Neurological complications
For many years,
neurological complications of influenza vaccination were simply denied. In
1966, Stuart-Harris wrote that "There is little direct evidence that any
of these neurological illnesses during or after influenza are specifically
caused by the influenza virus" (6). And in 1971, Wells still believed
that "There is at present no way of proving or of disproving the
aethiological relationship" (7).
Later on, USA studies
proved that there was indeed a relationship between both. Observations during
and after the A/New Jersey mass vaccination campaign in 1976 lead to
convincing statistics (see GBS). German authors calculated the frequency of
neurological complications at 1/0.7 million doses for influenza B vaccines
and at 1/1.3 million vaccinations for influenza A vaccines (4). It is clear
that for these figures, only documented cases have been taken into account,
whereas as a rule not all cases have been properly diagnosed and reported.
The real figures, thus, are likely to be higher. The first syndrome to be
clearly correlated with the influenza-vaccination was the Guillain-Barre
paralysis (1977). But only one year later, researchers discovered that
neurological complications were not at all restricted to this one syndrome;
on the contrary, they found a good number of neurological affections (8).
Hennessen et.al. call the spectrum of syndromes "remarquably wide"
and notice that in the course of a postvaccination disease process it is not
rare for them to mingle into many different mixtures.
Although the first
syndromes were detected after the A/New Jersey mass vaccination,
complications after influenza vaccination can in no way be attributed or
limited to this one vaccine. All 28 cases described by Hennessen et. al. e.g.
were vaccinated with vaccines that did not contain this A/New Jersey strain.
More epidemiological
data were gathered by Hennessen et al. The incidence of affections was
significantly higher in autumn (September-November), four times more common
in males than in females, in all age groups (16-73 years old) with an average
age of 38,9 years. The interval between vaccination and first symptoms varied
between 24 hours and 4 weeks, with an average of 11.3 days (8).
A. Paralysis
1) Guillain-Barre
Syndrome (GBS)
The relationship between influenza-vaccination and GBS was proven after the
1976 A/New Jersey mass vaccination in the USA. In eleven states, comparable
samples of vaccinated and non-vaccinated proved that in those vaccinated GBS
occured in 1,55/million, compared to 0,17 in non-vaccinated (9,11 times more
frequent in those vaccinated). (Hennessen quotes different figures:
8,0/million in vaccinated compared to 1,8/million in non-vaccinated 8). 31%
of cases were over 60 years old. Only 12% occured within 7 days after
vaccination, 74% between 8 and 28 days, and 14% even after one month 9. Most
cases were diagnosed between 2 and 4 weeks after vaccination. Single cases
occured up to 9 weeks after vaccination. Ehrengut & Allerdist mention
that, within 3 weeks after vaccination, the frequency already is up to 3,12
cases per million vaccinees 4, which would raise the risk factor for
vaccinees to 18,35.
Ehrengut and Allerdist
describe a case which progressed from paralysis of the extremities to
affection of the intercostal muscles and facial paralysis (4). This
complication may occur in normal, healthy individuals without any preliminary
disease.
More cases were
described during an IABS Symposium in Geneva, 1977 (10).
2) Facialis paralysis
This symptom generally occurs as part of a Guillain-Barre Syndrome (4, 8). 3)
Paralysis of the extremities
Paralysis of both upper limbs occured in a 40 year old man, with severe pain,
atrophy of deltoideus muskles and hypoesthesia of the right arm after
inoculation in the left upper arm (4).
Paresis of both lower
limbs in a 58 year old man (4).
Wells describes two
cases of myelitis transversa (7).
4) Landry syndrome (8)
5) Hypoglossus nerve paralysis (11)
B. Polyneuritis
Polyneuritis may occur in hands and feet, eventually accompanied of paralytic
symptoms (4). Cases of polyradiculitis, polyradiculomyelitis and
polyganglioradiculitis are documented.
1) Hypoesthesia
2) Paresthesia (formication and numbness) have been noticed (4, 8).
3) Neuralgia
a) Trigeminus neuralgia (8)
b) Ischialgia (right sided) (8)
c) Intercostal neuralgia (chestpain) (8)
d) Sensory brachial plexus neuropathy (Parsonage-Turner Syndrome) (8, 12,
13).
C. Meningitis
Meningeal infection and a stiff neck with positive lumbar punction can exist
separately, or as part of a GBS syndrome (4).
D. Encephalitis
Encephalomyelitis and encephalopathy after influenza vaccination have been
documented. A case was described by Ehrengut & Allerdist with loss of
sight, then complete loss of consciousness and paralysis (4). Case 10
described by Hennessen had encephalitis with central disturbance of the N.
Vestibularis (8). Also case 13 in the same study had encephalitis. Case 20
& 21 were diagnosed as meningoencephalomyelitis. Woods describes a case
of encephalitis in a healthy seven year old girl in 1963 (14), Warren in 1956
(15), and another two cases were documented in 1962 (16).
E. Multiple Sclerosis
Some authors described a "recurrent encephalomyelitic syndrome"
after vaccination (17, 18). Hennessen et al saw a similar case, where they
were able to make the certain diagnosis of MS (8).
An exacerbation of
symptoms was noticed in 1 out of 93 MS-patients vaccinated against influenza
19, 20.
F. Ataxia
Difficulties in walking in a 34 year old man were noticed, nine months after
his influenza vaccination. The sensitive polyneuritis which also started
shortly after vaccination had not subsided by that time. Right sided ataxia
of lower limbs (8).
G. Headache
A strong headache (8) occuring within hours after vaccination is suggestive
for meningeal or brain irriatation and deserves immediate further
investigation.
H. Disorientation
about places (8)
I. Unconsciousness
Multiple drop attacks occured in a case described by Stör & Mayer (21).
J. Trembling of upper
limbs (21)
K. Automatic motions
of fingers and toes (21)
L. Aphasia (loss of
speech) (8)
II. Respiratory Infections
A. Bronchitis
A strong bronchitis with fever was noticed in a 29-year old man who also
developed GBS later on (4).
B. Bronchopneumonia
This occured in a 41 year old man, where symptoms started with paresthesia of
fingertips, and ended up with death, 4 weeks after vaccination. Pneumonia 14
days after vaccination (8).
III. Gastro-intestinal problems
A. Vomiting
This happened to a man
13 days after vaccination; paralytic symptoms were noticed later on (4).
B. Nausea (8)
C. Rectal incontinence
(8)
IV. Urinary symptoms
Dysuria or paralysis of
the bladder
Difficulties with
urination bothered a man 13 days after vaccination; a distention of the
bladder was diagnosed. Complete paralysis of the bladder with necessity of
catheterisation followed. Paralytic symptoms of the extremities were noticed
later on (4).
V. Sexual problems
Impotence
Lessening of sexual
potency lasted for over 3 months in a patient who suffered GBS (4). Sexual
impotence (4).
VI. ORL
A. Vertigo
Vertigo with tendency to fall to the right side, 5 days after vaccination,
accompanied an encephalitis in an eighteen year old male 4. Vertigo with
nystagmus, within minutes after vaccination, so strong that the 13 year old,
healthy boy could not even stand up or sit anymore (4). Affection of the N.
Vestibularis in combination with encephalitis (8).
B. Noises in the ears
(8)
C. Impeded hearing (8)
VII. Eyes
A. Prooptosis (8)
B. Oedema of the retina (8)
C. Diminished vision; blurred vision (8)
D. Diplopia (8)
E. Nystagmus (8)
F. Paralysis of eye muscles (cranial nerves VII & IX) (8)
VIII. Circulatory problems
A. Collapse (8)
B. Transient livid discoloration of the hands (8).
C. Allergic thrombocytopenia in a 58 years old man 7 days after vaccination.
D. Disturbed blood pressure (both increased of decreased) (8).
E. Angor pectoris (8).
F. Collapse (8)
Hennessen et al describe some cases, both in elderly men with either hyper-
or hypotonic crises, but also in a young man with ophistotonus, and
tonic-clonic fits within minutes after vaccination.
IX. General symptoms
A. Fever
Fever occurs together with other syndromes, e.g. meningitis or GBS.
B. Somnolence
This may also be part of a larger neurological syndrome, such as GBS (4),
(8).
C. Fatigue
Fatigue can be part of a general decrease of functional capacities (21).
Chronic fatigue is known
to last for years after the infection subsided (4).
D. Anaphylactic
reactions
Typical for anaphylactic reactions is the short incubation time.
Ehrengut & Allerdist
describe such a reaction in an allergic person 1/2 h after vaccination (4).
Warren describes a case where the reaction followed 4 to 5 hours after vaccination
with fever, coryza and bronchospasms (15).
X. Mental problems
A. Difficulty in
thinking (21)
B. Loss of initiative (21)
C. Confusion (14)
D. Hallucinations (14)
XI. Emotional problems
Sadness (21)
XII. Death
A 41 year old man died 4
weeks after vaccination, after progressive polyneuropathy and
bronchopneumonia had developed (4). Death within 4 days (7).
Age Distribution
The many case
descriptions available in medical literature prove that all age groups are
susceptible to side effects.
Particularly important
is the frequency of patients with serious side effects after the vaccine had
been given for several years without any problem. This means that a lack of
side effects after a vaccination is not a guarantee of safety of
administration of the same vaccine in that patient later on.
From those who suffered
GBS after vaccination, 11% were under 30 years of age, 58% were between 30
and 59, and 31% were 60 and more.
Etiology
Different mechanisms can
play a role in the development of a post-vaccination neuropathy.
a) Hypersensitivity
reactions of the nervous system (serogenetic) are responible in a good number
of cases. Poser and Fowler describe similarities between GBS and serum
disease.
b) Toxic reactions may occur soon after inoculation of the patient in the
absense of specific allergies.
c) Viral infection of the brain by vaccinal viruses (4) or by reactivation of
latent germs (21).
d) Activation of latent auto-immune diseases (21).
The fact that different
vaccines from different manufacturers lead to similar complications, suggests
that these are not the consequence of the impurity of a certain vaccine, but
a risk inherent in any influenza vaccine.
Contra-Indications
Any impairment of the
immune system should be considered a contra-indication.
1. Allergies, especially
to any substance of the vaccines; allergy to proteins, cowsmilk etc.; hay
fever... Allergic constitutions often lead to hypersensitive reactions (8).
2. Akute infections with or without fever must be a reason to postpone or
abandon vaccination.
3. Chronic impairment of the immune system (auto-immune diseases) imply an
increased risk in case of vaccination.
References
1. Beyer, W.E.P.; et.
al. Influenza-epidemie in een verpleeghuis door een virus dat niet in het
vaccin was opgenomen. Ned Tijdschr Geneeskd, 1993; 137/39:1973-7
2. Palache, A.M.; Influenza subunit vaccine - ten years experience. Eur J
Clin Res, 1992; 3:117-38
3. Coulter, H.L.; Fisher, B.L. DPT, a shot in the dark, p 275. Harcourt Brace
Jovanovich
4. Ehrengut, W.; Allerdist, H.; Über neurologische Komplikationen nach der
Influenzaschutzimpfung. Münch. med. Wschr., 1977; 119/705-710 5. Rabin, J.;
JAMA, 1973; 225:63
6. Stuart-Harris, C.H.; BMJ, 1966; 149:1(1966)217
7. Wells, C.E.C.; BMJ, 1971/2:755
8. Hennessen, W.; Jacob, H.; Quast, U.; Neurologische Affektionen nach
Influenza - Impfung. Der Nervenarzt, 1978; 49/90-96
9. Morb. a. Mort.; Wkly Rep. 25 (1977) 430; 26 (1977) 7; 26 (1977) 52
10. Bryan, J.; Noble, G.R.; Guillain-Barré Syndrome after administration of
killed vaccines. Genf: Ref: IABS Symposium on Influenza Immunization
1.6-4.6.1977
11. Felix, J.K.; Schwartz, R.H.; Myers, G.J.; Isolated Hypoglossal Nerve
Paralysis Following Influenza Vaccination. Amer. J. Dis. Child., 1976;
130/1:82-3
12. Furlow, T.W.; Neuropathy after Influenza Vaccination. Lancet, 1977; i:
253
13. Schumm, F.; Neurologische Komplikationen nach Grippe-Impfung. Fragen aus
der Praxis. Dtsch med Wschr, 1976; 101/18:720-21
14. Woods, C.A.; Ellison, G.W.; Encephalopathy following Influenza
Immunization. J. Pediat., 1964; 65,5:745-8
15. Warren, W.R.; Encephalopathy due to Influenza Vaccine. A.M.A. Archives of
Internal Medicine, 1956; 97:803
16. JAMA, 1962;181:70
17. Miller, H.; Cendrowski, W.; Schapira, K.; Multiple Sclerosis and
Vaccinations. BMJ 1967;April 22: 210-3
18. Yahr, M.D.; Lobo-Antunes, J.; Relapsing Encephalomyelitis Following the
Use of Influenza Vaccine. Arch Neurol, 1972; 27:182-3
Hennessen et al
19. Sibley, W.; Foley, J.; Infection and Immunization in Multiple Sclerosis.
Ann Ac Sci fenn , 1965; A 122:457-68
20. Sibley, W.; Bamford, C.R.; Laguna, J.F.; Influenza vaccination in
Patients with Multiple Sclerosis. JAMA, 1976; 236, 17:1965-66
21. Stöhr, M.; Mayer, K.; Neurologische Erkrankungen nach
Grippeschutzimpfung. Med. Welt, 1976; 27/912-14
 Email this
to a friend  Printer
friendly version
|
