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Caught between Scylla and Charybdis

BY KEITH ROACH, M.D.

DEAR DR. ROACH: I am asking for a restatement/clarification of your position on flu shots for those who have had autoimmune disorders.

I am a 69-year-old male who suffered an attack of Guillain-Barre syndrome in 1973. I have residual neurological and muscular damage, but otherwise I am in excellent health. I have declined the flu shot up to this point, based on the recommendation of my doctor and the advice given at sites where flu shots are offered. I have always questioned this advice. Caught between the Scylla of risking a recurrence of Guillain-Barre and the Charybdis of dying of the flu, it seems to me that Scylla is the better bet. — P.B.

ANSWER: Guillain-Barre syndrome is an immune-mediated neurological disease causing paralysis, usually as a result of an infection. It’s thought that the infection tricks the body into thinking that part of your body is an invader that needs to be destroyed. In the case of GBS, it’s the nerve cell — or the myelin, a protein that protects and insulates the cells — that is the target of the immune system.

Although people have developed GBS after vaccination, the risk is very low (unlikely to be more than 2 per million), and some studies have suggested that there is no increase in risk following vaccination. However, many experts recommend against influenza vaccination in those people who developed GBS within six weeks of getting the vaccine.

Odysseus tried to sail exactly between Scylla (a six-headed monster) and Charybdis (a whirlpool), but you can’t go between — you must choose whether or not to get the vaccine. Here’s what studies have shown:

Among 107 people who chose to get the vaccine after having had GBS, none had a recurrence of GBS. Another study with 279 patients also showed zero episodes of recurrent GBS. This does not mean there is no risk, but the risk probably is very low. Getting the flu vaccine (partially) protects you from dying of the flu, but the absolute reduction in death rate is small. In older people, perhaps a single vaccinated person is saved per 200-300; other estimates are not that high.

It’s very difficult to make a decision about competing low-risk events. You probably will be fine either way. Given a more likely benefit of vaccination against only a lesser possibility of harm from GBS would argue for getting the vaccine; however, this remains controversial.

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