Statement  

Vaccination is a valuable and generally safe tool to reduce the risk of numerous communicable diseases [1]. People with ME/CFS are generally able to receive routine vaccines according to the National Immunisation Programme Schedule (NIP), although there is a caution around receiving live vaccines from some ME/CFS expert clinicians[2]. As with any medication, there are rare instances where “adverse events following an immunisation” (AEFI) occur[1], which may or may not be directly related to the vaccine received. Currently, there is not sufficient research to establish if people with ME/CFS are at higher risk of an AEFI. Emerge Australia will continue to monitor the research and update this statement accordingly.  

People with ME/CFS should discuss vaccination eligibility and spacing of vaccines and boosters with their treating doctor, who knows their individual medical history.  

Please refer to the COVID-19 vaccination position statement for specific coverage of that topic. 

Background / What is the issue? 

Vaccination decisions can be complex for individuals with ME/CFS. There is often considerable uncertainty surrounding whether to receive a specific vaccine, the immune system status of people living with ME/CFS, and its impact on developing protective immunity, as well as how immunisation might impact ME/CFS symptoms. The topic of vaccination has become more controversial in recent years, with misinformation adding to the difficulty for people with ME/CFS wanting to make informed decisions about the best ways to protect their health.  

Evidence / What does the evidence say? 

Are people with ME/CFS immunocompromised?  

People with ME/CFS are not generally considered immunocompromised in the same manner as individuals undergoing immunosuppressive chemotherapy[​3]​. However, there is evidence that ME/CFS causes immune dysfunction or dysregulation[3], but it is unclear how this affects vaccination risk and how effective vaccinations can be at providing protective immunity for any individual with ME/CFS. Some small studies suggest that vaccines do provide disease protection in people with ME/CFS, despite some differences in immune response to vaccines in people with ME/CFS compared with healthy people[​4,5]​.  

While ME/CFS is known to involve immune dysfunction or dysregulation, this varies between and within individuals, and may include both an overactive immune system (such as elevated IgE levels), and underactive immune function (such as lower IgG or natural killer cell function). This immune dysfunction may increase the risk of either contracting or recovering from infections or experiencing a poor response to vaccination; though there is not enough evidence to confirm this​[3​]. People with ME/CFS often have comorbidities that may impact how their immune system operates and people should seek individual advice for their situation.  

Can vaccines cause ME/CFS? 

While a post-infectious onset is most common, non-infectious triggers for ME/CFS have been noted, including vaccination​[3,6–8​]. However, the evidence is very limited and largely anecdotal, so should be interpreted with caution.  

Hepatitis B vaccination has received attention as a potential initiating trigger for ME/CFS, but there is conflicting evidence, and medical opinion​[7,9​]. There is some evidence that there may be a causal relationship between hepatitis B vaccination and the risk of developing multiple sclerosis[​10]​, though this is contested​[11​]. It may be possible to draw parallels between increased risks associated with autoimmune diseases like multiple sclerosis following hepatitis B vaccination and a similar risk of developing ME/CFS following this vaccination. However again, the evidence is very limited.  

In contrast, one large study found that certain vaccines may help reduce the risk of developing ME/CFS by reducing the risk of infection, which is the most common trigger for ME/CFS​[12​]. Further, a large population study also found that there was no increased risk of developing ME/CFS after HPV vaccination​[13]​.  

Please refer to Emerge Australia’s COVID-19 Vaccination Position Statement for a detailed discussion regarding COVID-19 vaccines and emerging research.  

Is vaccination safe for people with ME/CFS? 

All medications, including vaccines, come with risks. While vaccination is generally considered safe, there is a small risk of AEFI’s, from mild to serious side effects. This is the case for any vaccine and for any member of the population[1].   

At this stage, there is limited published research examining if people with ME/CFS are at increased risk of an AEFI compared to the rest of the population, with small studies showing conflicting results​[5,14,15]​.  Some ME/CFS experts caution against live vaccinations​1​ though the research is both very limited and unclear​[4​].  

However, the process of receiving a vaccination may pose some additional stressors for people with ME/CFS. For example, it may take someone with ME/CFS longer to recover from the immune response triggered by the vaccine than it does a healthy person​[14]​. 

Additionally, anyone receiving a vaccine may potentially experience a reaction to a specific component[​1]​. Although there is little published research, people with ME/CFS are often sensitive to medications​[3​]. 

Vaccination in Australia occurs in strictly regulated environments with emergency equipment and staff training, to safely manage an acute reaction to a vaccination​[1]​. However, anyone receiving a vaccination is encouraged to check vaccine components for known allergens prior to injection.  

Emerge Australia’s Position 

You should adhere to the National Immunisation Programme Schedule, if you are in Australia, or consult your corresponding country’s vaccination schedule, in coordination with your healthcare practitioner.  

The current state of published evidence makes it difficult to make any definitive statement about how immune system dysfunction in ME/CFS impacts the safety and efficacy of any specific vaccine, or vaccination in general.  

Each individual with ME/CFS has a unique symptom profile, including reactions to medications and vaccines. It’s important to carefully consider potential risks and benefits. The decision to receive a vaccination is made more difficult by the lack of research on its effects in well-defined cohorts of people with ME/CFS. Emerge Australia welcomes increasing research in this field.  

Emerge Australia recommends that individuals work with their treating doctor/s or immunisation provider if they have concerns about vaccine safety or the effects that vaccination may have on their health. 

References

  1. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. , , Australian Government Department of Health and Aged Care, Canberra. https://immunisationhandbook.health.gov.au (2022).
  2. ​International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME). ME/CFS: Primer for clinical practitioners. 2014 edition. https://www.massmecfs.org/images/pdf/Primer_2014.pdf (2014).
  3. Bateman, L. et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management. Mayo Clinic Proceedings vol. 96 Preprint at https://doi.org/10.1016/j.mayocp.2021.07.004 (2021).
  4. Vedhara, K. et al. Consequences of live poliovirus vaccine administration in chronic fatigue syndrome. J Neuroimmunol 75, 183–195 (1997).
  5. Sleigh, K. M., Danforth, D. G., Hall, R. T., Fleming, J. A. & Stiver, H. G. Double-Blind, Randomized Study of the Effects of Influenza Vaccination on the Specific Antibody Response and Clinical Course of Patients with Chronic Fatigue Syndrome. Canadian Journal of Infectious Diseases 11, 267–273 (2000).
  6. Becker, P. De, McGregor, N. & Meirleirxy, K. De. Possible Triggers and Mode of Onset of Chronic Fatigue Syndrome. J Chronic Fatigue Syndr 10, 3–18 (2002).
  7. Agmon-Levin, N. et al. Chronic fatigue syndrome and fibromyalgia following immunization with the hepatitis B vaccine: another angle of the ‘autoimmune (auto-inflammatory) syndrome induced by adjuvants’ (ASIA). Immunol Res 60, 376–383 (2014).
  8. Tschopp, R., König, R. S., Rejmer, P. & Paris, D. H. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): A preliminary survey among patients in Switzerland. Heliyon 9, e15595 (2023).
  9. Report of the working group on the possible relationship between hepatitis B vaccination and the chronic fatigue syndrome. CMAJ 149, 314–9 (1993).
  10. Le Houézec, D. Evolution of multiple sclerosis in France since the beginning of hepatitis B vaccination. Immunol Res 60, 219–225 (2014).
  11. Langer-Gould, A. et al. Vaccines and the Risk of Multiple Sclerosis and Other Central Nervous System Demyelinating Diseases. JAMA Neurol 71, 1506 (2014).
  12. Magnus, P. et al. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine. Vaccine 33, (2015).
  13. Feiring, B. et al. HPV vaccination and risk of chronic fatigue syndrome/myalgic encephalomyelitis: A nationwide register-based study from Norway. Vaccine 35, 4203–4212 (2017).
  14. Brenu, E. W. et al. The Effects of Influenza Vaccination on Immune Function in Patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. Int J Clin Med 03, 544–551 (2012).
  15. Magnus, P. et al. Vaccination as teenagers against meningococcal disease and the risk of the chronic fatigue syndrome. Vaccine 27, 23–27 (2009).