Dr.Ian Gibson MP
House of Commons
LONDON SW1A 0AA
13th. December 2005
The Group on Scientific Research into M.E.
Dear Dr. Gibson,
I am enclosing two documents ("Is CFS Linked to Vaccinations?" and "Tetanus
Toxoid Vaccination") which I would like to be considered as part of the
inquiry by The Group on Scientific Research into M.E.
It was not until I gained access to my medical notes at the end of 2001
that I noticed that only days before I became ill (a case of "sudden
onset") in February 1993, I had received a routine tetanus booster.
I had become aware of the suggested link between M.E. and vaccinations in
the intervening years, but was shocked to see such an indication in my own
medical history: it naturally hadn't occurred to me at the time, not being
medically knowledegable, but I am surprised that my GP back then didn't
notice that my last visit to the surgery, only ten days prior to the
appointment I'd made as a result of collapsing, had been to receive this
vaccination, and that perhaps I had suffered an adverse reaction. Still,
that's history now.
However, I recently watched the BBC documentary, which you participated in,
"The Irresistible Rise of Tony's Crony", and was further shocked to realise
the extent to which vaccines used by the NHS can be harmful.
In the absence of any other obvious cause of my illness, I consider the
case for it being the result of receiving this tetanus booster to be
compelling. I received the vaccination, batch no. AH154A (or A4154A), on
25th. January 1993 at Reepham Surgery. Within six days I had experienced
two temporary episodes of suddenly feeling faint, disoriented and extremely
ill, and on the twelfth day (4th. February), collapsed completely, as I was
about to leave home for work.
I became increasingly worse over the next three days and was taken to
Reepham Surgery on Monday, 8th. February. I was so ill by then I had had to
write down my symptoms, as I was barely able to speak through a combination
of mental confusion, slurring, loss of strength in my voicebox and throat
muscles, and "lockjaw".
Reading "Tetanus Toxoid Vaccination" (I regret that I don't know where I
found this article on the internet), I immediately recognised the symptoms
described there of adverse reactions to tetanus vaccine. Unfortunately, the
piece of paper I gave my GP on 8th. February (amongst a couple of other
relevant documents) is now missing from my medical file.
I trust this information and the enclosed articles will be of use in the
Group's inquiry into the causes of M.E.
cc. Keith Simpson MP (Mid Norfolk)
Is CFS Linked to Vaccinations?
By Charles Shepherd, MD,
ME Association, United Kingdom
There is widespread agreement that a variety of infections are capable of
precipitating chronic fatigue syndrome (CFS) in susceptible individuals. In
l988, Lloyd et al reported that several of their patients had linked the
onset of CFS to receiving a vaccination in the absence of any coincidental
infection. [l] Since then, other anecdotal reports have also linked
vaccinations to the onset of CFS. [2,3]
The explanation for vaccine-induced CFS may be because the primary purpose
of any vaccine is to mimic the effects of infection on the immune system.
If an antigenic challenge by infection can precipitate CFS, then it is
conceivable that vaccines could act in a very similar manner.
This reasoning is further strengthened by the fact that immunologically
based illnesses, such as arthritis, can occur when a susceptible host and
an environmental trigger, such as an infection or vaccination, interact.
 It is also interesting to note that vaccinations have been suggested as
a possible precipitating factor in the development of Gulf War illness.
My research interest in this aspect of developing CFS is largely based on
clinical evidence from patients seen in my practice over the past 10 years.
As a result, I have gathered details on more than 200 patients with a
history of either developing CFS or experiencing a significant
relapse/exacerbation of CFS symptoms following a vaccination.
In addition, I have more than 150 reports referring to such a link from
members of myalgic encephalomyelitis (ME) or CFS self-help support groups
and/or their physicians throughout the world.
This data (although unpublished) suggests that tetanus, typhoid, influenza,
and hepatitis B are the most commonly implicated vaccines in cases of CFS.
I have reports of very few cases involving hepatitis A (using
immunoglobulin), polio, or rubella vaccine, or those predominantly given
during childhood - with the possible exception of Bacillus Calmette -
Guerin vaccine (three cases).
Almost all of my cases involve adults, and in a significant minority the
vaccine was administered when the person had not yet fully recovered from
an infective illness such as infectious mononucleosis (known as glandular
fever in the U.K.) or had already experienced an adverse reaction to a
previous dose of the same vaccine (as is sometimes the case with hepatitis
About one third of my cases involve vaccine-induced/exacerbated CFS
following receiving the hepatitis B vaccine (HBV). Most of these patients
are health care workers, particularly nurses. Most of the other patients
received HBV for occupational health purposes, often as a condition of
employment and without any information on side effects, such as severe
The prognosis in this group has been poor, with less than 10% of the
patients I have personally followed reporting any significant relief of CFS
Although chronic debilitating fatigue is the most frequently reported
symptom of CFS after vaccine administration in this group, around 20% also
complained of significant joint pain/arthralgia, a finding consistent with
several reports linking HBV to arthritis and other autoimmune disorders. 
Less than 5% of the patients also reported neurological complications/side
effects such as tremors or one-sided weakness, which appear to be separate
from their CFS symptoms.
For instance, one female patient developed an acute disseminated
inflammation of the brain and spinal cord (encephalo-myelitis) shortly
after the second dose of vaccine. This was followed by the gradual onset of
Hepatitis vaccines are highly immunogenic compounds, and a number of
possible explanations exist as to why they may be more likely to trigger
One explanation involves a preexisting genetic susceptibility, which after
antigenic stimulation with HBV, results in a pathological process (possibly
involving immune complex formation) leading to a clinical disease.
Another explanation is that a hypersensitivity reaction occurs to a
component of HBV, such as the preservative thimerosal. 
Researchers in Canada, who made similar observations of a link between HBV
and CFS, hypothesized that this may involve an autoimmune reaction with a
microscopic form of demyelination not visible on magnetic resonance
Despite growing anecdotal evidence from other experienced physicians who
also believe that HBV can precipitate CFS,  vaccine manufacturers do not
acknowledge any causal link. In fact, a report by an independent working
group in Canada that dismissed any such causal link is frequently quoted as
a reason for dismissing these claims, even though it contained some very
questionable assumptions to support the conclusions. 
For example, the report inaccurately states that chronic carriers of
hepatitis B infection without signs of ongoing liver damage do not complain
of tiredness. The report also uses results from a one-week follow-up study
of 700 health care students, which found excessive short-term tiredness in
about 14% after vaccination with HBV to refute any link with chronic
Health care providers caring for CFS patients who require vaccinations
clearly must weigh the pros (i.e., how effective? how necessary?) and cons
(i.e., risks of adverse effects and exacerbation of CFS symptoms) for each
individual vaccine. I would advise against having routine nonessential
vaccinations if a patient is:
a. In the very early stages of CFS, particularly when it obviously follows
an infective episode;
b. Continuing to experience flulike symptoms, including sore throat,
enlarged glands, fevers, and joint pains; or
c. Has previously experienced an adverse reaction to that particular vaccine.
If the vaccination is potentially lifesaving, then considerations relating
to CFS must take a lower priority. As for some of the more commonly
required vaccines, my advice on their use is as follows:
Hepatitis A. Short-lived protection using immuno-globulin does not seem to
cause any problems in CFS patients. I have not received any adverse
feedback from CFS patients who have used hepatitis A vaccine.
Hepatitis B. If a patient requires HBV for occupational health purposes,
clinicians should weigh the pros and cons as previously discussed and then
discuss with the patient.
Influenza. If a patient has any medical condition that could be severely
affected by an attack of the flu, such as heart disease, asthma, or
bronchitis, influenza vaccine should certainly be considered.
My own data indicates approximately 60% of CFS patients experience some
form of exacerbation in their fatigue and flulike symptoms (sometimes
quite marked) following an influenza vaccine.
Meningitis C. My feedback from approximately 30 children and adolescents
with CFS who have been given the meningitis C vaccine in the U.K. is that
there were no serious side effects or exacerbations of CFS symptoms. The
only adverse effects reported have been minor exacerbations of fatigue and
Polio and diphtheria. One research study showed evidence that people with
CFS do not experience adverse reactions to polio vaccination.  This is
also my own impression from feedback received from patients I have advised
receive polio boosters in relation to foreign travel.
Polio vaccinations or boosters should clearly be given to patients
traveling to countries where polio still occurs. The same advice applies to
diphtheria, which is becoming increasingly common in parts of Eastern
Tetanus. Maintaining up-to-date protection is vital for individuals whose
employment (e.g., working on a farm) or leisure activity (e.g., gardening)
places them at risk of contracting tetanus.
However, tetanus vaccine can produce side effects in healthy people and may
well cause CFS patients to relapse. The pros and cons need to be carefully
considered as tetanus vaccine has been reported to precipitate CFS. [1,2]
Typhoid. The typhoid vaccine can cause side effects in healthy people. The
feedback I received from my CFS patients, however, indicates that the oral
form of typhoid vaccine was generally well tolerated.
Whenever vaccinations are considered necessary, they should be given when
CFS patients are feeling reasonably well and not under any undue stress. It
is also wise to make sure that all travel vaccinations are completed at
least two weeks before departure in the event a patient experiences
exacerbated symptoms or a relapse.
Not surprisingly, patients with possible vaccine-induced CFS often face
considerable difficulty in obtaining disability benefits on the grounds of
permanent ill health. However, some of my patients in the U.K. have
successfully argued their cases and been awarded injury payments on the
grounds that HBV given for occupational health reasons caused their CFS. I
am also involved in a number of cases where the debate is likely to be
settled in court.
1. Lloyd A et al. What is myalgic encephalomyelitis? Lancet. l988; l: 1286-7.
2. Weir W. The post-viral fatigue syndrome. Current Medical Literature:
Infect Dis. l992; 6: 3-8.
3. CIBA Foundation. Chronic Fatigue Syndrome. Eds. Bock GR et al. J Wiley;
l993; symposium 173.
4. Symmons DPM et al. Can immunisation trigger rheumatoid arthritis? Ann
Rheum Dis. l993; 52: 843-844.
5. Gross K et al. Arthritis after hepatitis B vaccination. Scand J Rheum.
l995; 24: 50-2.
6. Grotto I et al. Major adverse reactions to yeast-derived hepatitis B
vaccines-a review. Vaccine. l998; 16: 329-34.
7. Hyde B. The clinical investigation of acute onset ME/CFS and MS
following recombinant hepatitis B immunisation. Second World Congress on
CFS and Related Disorders, Brussels. 1999; September 9-12.
8. Report of the working group on the possible relationship between
hepatitis B vaccination and the chronic fatigue syndrome. Canad Med Assoc
J. l993; 149: 314-9.
9. Vedhara K et al. Consequences of live poliovirus vaccine administration
in chronic fatigue syndrome. J Neuroimmun. l997; 75: 183-95.
Dr. Charles Shepherd is in private practice in the United Kingdom (U.K.)
and is a member of the Chief Medical Officer's Working Group on CFS/ME at
the U.K. Department of Health.
© CFIDS Association of America