Groundhog Day: the Flu Vaccine and Narcolepsy

Winter, with its wonderful festivals and awful weather is the time of year we are often physically closest to our fellow men, women andchildren. For much of the day we are indoors breathing the same few cubic metres of air as those around us and one by one most of us will succumb to some kind of infection or another, most likely a cold or, for the more unlucky, the flu.

Fortunately, each year, when the season’s particular strain is identified, production of flu vaccine goes into overdrive. The panic caused by the 2009 outbreak of the H1N1 strain of swine flu, put a huge strain on health services around the world. Thankfully, it did not become a global tragedy thanks, in no small part, to vaccination. This year’s flu season has, according to the CDC, brought with it at least 18 fatalities in the USA so far. Nevertheless, the fear mongering over the 'flu vaccine continues in the usual quarters. It, once again, focusses on a supposed link between vaccine receipt and narcolepsy; therare and debilitating condition the most obvious symptom of which is excessive sleepiness. Narcolepsy can be accompanied by a host of other problems such as cataplexy where one suddenly loses muscle tone as in sleep but while still awake, hallucinations and hypnagogia �" dreaming while between sleep and wakefulness.

Just as the panic merchants have done in regurgitating this old story, I have to admit to recycling much of this piece from one I wrote for my Autismum blog around about this time last year bemoaning that year's the resurrection of these fears.

The World Health Organisation (WHO), has confirmed that more than a dozen countries reported cases of narcolepsy following the administration of one brand of flu vaccine.In 2009, the vaccine in question, Pandemrix, produced by Glaxo Smith-Kline, was used in 47 countries world wide. More than 30 million shots were administered in Europe alone with six million of those going to UK recipients. The reported cases of narcolepsy following the administration of Pandemrix include 52 in Finland, fourteen in the Republic of Ireland and four as yet unconfirmed cases in the UK. “Further investigation [is] warranted,” says the WHO.

In February 2012, the Finns published their preliminary data. What they found certainly suggested a link between the vaccine and narcolepsy. The incidence of diagnosis in children aged five to nineteen had increased significantly compared to previous years’ data. Of those new cases, 90% were vaccinated with Pandemrix compared to a 70% vaccination coverage for that age group in general. Comparing one group with the other, the risk of narcolepsy is seen, in this study, to be nine times higher in those who received the vaccine than those who did not. In essence, the study showed there to be a probable link.

…But that’s not the end of the story.

The WHO’s Global Advisory Committee on Vaccine Safety (GACVS) stated in response to the Finnish study,

“it does not appear that narcolepsy following vaccination against pandemic influenza is a general worldwide phenomenon and this complicates interpretation of the findings in Finland.”

Indeed, there is no global pattern as one would expect if a vaccine so widely distributed were at fault. There has been no increase in the reports of numbers of people falling ill with narcolepsy in, for example, Canada, Germany or even Finland’s neighbour, Sweden. The four cases reported in the UK were flagged up only because of a temporal association to the vaccine being administered and onset of symptoms. In fact, the number lies well within expectations. To complicate the matter further, there has been observed a rise in cases of narcolepsy across both vaccinated and unvaccinated populations in Scandinavia.

So, could the vaccine have caused narcolepsy? The answer is an unsatisfying maybe. All of those who developed the condition post vaccine and have been tested, have been found to be of the (HLA) DQB1*0602 genotype. That narcolepsy is familial is not a matter of controversy. However, of those who fall within this group, only around 40% become symptomatic so it seems there must be an environmental trigger for an individual genotypically narcoleptic to become phenotypically narcoleptic. Among the candidates for that trigger are smoking, stress and infections including influenza.

Naturally, there has been an outcry from anti-vaccine groups - the one now repeated annually. The flu vaccine does not rely for its action on live virus and is one of vanishingly few vaccines routinely administered that contain the anti-microbial agent thimerosal. This chemical, which prevents microbial growth in vaccines, contains ethylmercury which, it has been proposed, can cause autism. This myth is still in wide circulation despite numerous studies that have proved it false and by the fact that the incidence of autism continues to rise years after thimerosal’s removal from most vaccines.

There are, of course, other reasons people choose not to get the flu vaccine �" even those who really should, like pregnant women and health care workers. Some believe it just is not effective, citing either themselves or a friend who got the shot and then got flu, too. No vaccine offers 100% protection but significantly more for most people than relying on their immune system alone. Protection afforded by the vaccine can take weeks to fully develop and that’s one of the reasons some vaccinated individuals will still get the infection against which they are vaccinated. Perhaps the silliest excuse for not getting the shot is believing the vaccine can give you the flu. This is impossible. You may experience mild flu-like symptoms afterwards, but getting the infection from the jab won’t happen as it contains no live virus.What is so often lacking, amid the hysteria surrounding vaccines, is reporting of the very real and far more frequent complications of the infections which they prevent. In the case of influenza, this can include a consequence far more serious than narcolepsy: death.