By Paul Cheney, M.D., Ph.D.

Every year we have a number of PWCs asking about flu shots. This question was posed to Dr. Paul Cheney, the Director of The Cheney Clinic, which has served over 3,000 PWCs from 48 states and 15 foreign countries. This international authority of CFIDS gave the following reply:

"The reason you give a flu shot is to inject an antigen to invoke an immune response against catching the flu. CFIDS patients are already immune activated, especially involving an antiviral pathway. Many have said to us that since I've had this disease I don't get the flu. They seem to have a resistance to colds and flu that wasn't seen previous to the disease and we suspect they're so immune activated, and this antiviral system is so turned on, they actually have a relative resistance to at least initial infection of common agents. This is not always true, but we see it. We have a little feeling that maybe it's less necessary to get immunized because, in effect, the immune system is already really cranked-up. The more worrisome thing, though, is that injecting an antigen into a fired-up immune system may actually make people go into a relapse, and we have seen that. So we think we have to weigh the benefits, on one hand, against the risks on the other. The benefits are marginalized because they (PWCs) are immune activated and you are about to inject an antigen into them. So I have misgivings in immunizing this patient population. But I try to do it on a case-by-case basis. There is no way to generalize across the entire range. If these patients are working or marginally sick, exposed to the general population, I tend to immunize. Because the risk-benefit weighs in favor, I think, of immunization. If they are extremely sick, very active immune systems are not going into the public arena much, I think I tend to not immunize because of the fear I'm just going to make them worse. It's sort of a risk-benefit analysis. It's not an easy decision to come to. It depends on the patient, and I try to make it on an individual basis." 4 

(Dr. Cheney is the Director of The Cheney Clinic in Bald Head Island, North Carolina.)

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