Should People with Autoimmune Diseases get the Flu Shot?

Should People with Autoimmune Diseases get the Flu Shot?

I get asked this question A LOT. But before I go on to tell you my thoughts about the flu shot, I want to be clear that I am NOT against vaccinations. I support vaccinations when they are necessary, especially when they provide herd immunity that can eradicate or greatly reduce the chances of people getting a deadly virus (such as polio, MMR, hepatitis…etc). But I also support people being educated around what they are putting in their body, and how that can affect them, as well as the community around them.

But before we get into it, let’s learn a little bit about the flu shot, or more specifically, why vaccines help prevent infection.

How Vaccines Work

Vaccines were designed to help our immune system be able to recognize bugs faster. When our bodies are exposed to foreign bugs, it is the responsibility of our immune system to 1) recognize that the bug is bad and needs to be dealt with and 2) deal with it. When the immune system initially recognizes something that is bad it’s slow to respond. But the more times that the immune system responds to a bug, the faster it gets because it remembers it. Vaccinations work by helping the immune system create memory to different bugs. It does this by showing the immune system pieces of the bug, so the immune system can remember it later. The next time the immune system comes into contact with that bug in the wild, it will respond in a rate fast enough to kill it before it causes problems in the body and spread.

Over time, if not exposed to the bug, our immune system may “forget” what it looks like and lose response time. This is why we sometimes need booster shots – to help boost our immune system’s response to the bug. If a bug can’t use a body to reproduce because the immune system has killed it first, then it greatly reduces the likelihood of that bug being able to survive.

How the Flu Virus Works

In order for vaccines to be effective, they need to be able to train the immune system to react to a SINGLE virus. But the flu virus is tricky. Every year, the type of flu virus that causes people to have the flu changes, so it isn’t the same every year. Every year, researchers have to study what type of virus was big last year, and try to make an educated guess on what virus might be more common THIS year. We don’t actually know how effective a flu vaccine is until AFTER the flu season is over and we can look back and see how many people were able to prevent the flu by getting the shot. And then the next year, we do it all over again. The flu vaccine does NOT provide herd immunity – meaning that it does not help to eradicate the virus completely.

How Effective is the Flu Shot?

Every year, the CDC puts out a statement of how effective the flu vaccine was for the previous year. While I hear a lot of people talk about the importance of the flu vaccine, I rarely ever hear people talking about how effective it is. For example, for last year’s 2018-2019 flu season, the overall efficacy for people of all ages was 29%, meaning that the flu shot only prevented the flu in 29% of those that got the flu shot (that’s less than 1/3). If you break it down by age, children ages 6mo to 8 years were the most benefited (49% effective), while young adults 9 – 17 were least benefited (6% effective). The flu vaccine was only effective in 12% of those older than 65.

Efficacy rates for other years are similar, but they can go up and down yearly. If you compare this to other vaccines, say the vaccine against measles (MMR), this vaccine is estimated to be 97% effective if both vaccines are administered. So you only need 2 vaccines in your LIFETIME to prevent measles 97% of the time. In comparison, you have to get the flu vaccine EVERY YEAR and there is still a 70% chance you will get sick with the flu.

So Should People With Autoimmune Diseases get the Flu Shot?

So back to the original question – should people with autoimmune diseases get the flu shot? Well the answer (that no one really wants to hear) is, it depends. Flu shots have been known to aggravate autoimmune diseases. I mean, you are in fact giving your immune system something to react to when you get a flu shot. But on the other hand, viruses can also cause autoimmune flares, so you want to prevent that also.

Essentially what I tell people is this: Getting the flu shot will only slightly reduce your risk of getting the flu. Small children, those who have weak immune systems, pregnant women and older populations are more likely to have complications from the flu. Even that small amount of prevention can mean a lot in trying to avoid flu related death. But for those that are relatively healthy and have autoimmune diseases, then you may want to think hard about whether the flu shot is right for you. I definitely do not recommend that those with autoimmune diseases in an active flare get a flu shot. But waiting until the flare is over may be a good option. Sometimes the best options is getting your body healthy enough to help fight the flu when it comes around.

It’s all about weighing out the risks vs benefits

And ideally, this is a conversation you should be having with your doctor who is familiar with your health and personal history. Naturopathic doctors are great advocates for patient choice when it comes to the flu vaccine. So if you are looking for a doctor that can help you look at all aspects of your health, they would be the best option. If you have specific questions about how this flu system would affect your autoimmune disease, you can call our office and schedule a free consult with one of our knowledgeable physicians.

Looking for more information on autoimmune diseases? Get our FREE ebook The 5 Foundations of Autoimmune Diseases, register for one of our FREE online webinars, or check out our blog for additional articles.

24 Responses to Should People with Autoimmune Diseases get the Flu Shot?

  1. I have ulcerative colitis, plus I no longer have a gall bladder, and I have osteoporosis, and osteoarthritis, and peripheral neuropathy. Should I get the flu shot with all this happening
    to my body?

    My husband is a diabetic, and has severe rhuematoid arthritis, and has had Quadruple by pass surgery in 2005. Should he get the flu shot?

    My daughter has Celiacs disease . Should she get the flu shot?

    • Hi Janice,

      This is a great question for your primary care doctor. If you are on immune suppressants or other anti-inflammatories for the above conditions, then it’s unlikely that you may have a flare with the flu shot. But if not, there is always the possibility that you might, so taking your individual needs into consideration here is important.

      As for your husband – if he is on immune suppressing medications, then yes, it will likely be beneficial for him to get the flu shot to minimize reactions from the flu if he were to get it.

      For your daughter, if she is successfully avoiding gluten, then it’s unlikely that her celiac symptoms will flare with a flu shot.

  2. Flu shot caused Viral Meningitis Nov 2919 autoimmune system resulted in Polymyalgia, should I have the flu shot in 2020?

    • This is a great question for your primary care doctor. If you have had previous flu shots before 2019 and they haven’t caused any issues than getting one this year may not be as concerning. If you have not had other flu shots before, then it may be likely that you have a flare of the PMR with this vaccination. If you are on steroids though for the PMR that will decrease your risk of a flare from the flu shot, so you could get the benefit of the shot without the flare from it.

  3. I am debating whether to have the flu shot this year. I have Sarcoid, and have had it for the past 13 years. It is under control because I take a hydroxychloroquine pill daily, and give myself a shot of Methatrexate once per week. The last time I had the flu shot I was sick for almost 3 weeks. The past couple of years I did not have the shot and did not get the flu. What I did was drink “Emergen-C” almost every day for the vitamin C. Because of Covid-19 this year, I do not know if it is wise to get the flu shot. What I know about Sarcoid is my immune system does not recognize good cells from bad cells, therefore attacks both.

    • Hi Teresa,

      This would be a great question for your primary care doctor. The risks and benefits of the flu shot will depend on your individual needs and your condition. Being on hydroxychloroquine can suppress your immune system, so a flu shot may benefit you given your immunosuppression. Though if you are concerned about the flu shot aggravating your sarcoidosis then talking to your doctor about this would be important.

  4. Two years ago I did get a Flu shot, because it’s mandated for our Nursing Home facility, and I am a nurse. I have been a nurse in gerontology for 36 years, and only started getting the vaccine about 10 years ago when my current employer pressured staff to get it, for the sake of the older population that we serve on this retirement campus. After getting the vaccine in 2018, I developed a severe case of lichen planus, had a course of steroids, topical applications of Triamcinolone, and struggled with the severe skin rash for about 6 months. I decided not to get the vaccine in 2019, because I believe the autoimmune disorder that flared & disappeared with treatment, could have been a reaction to the vaccine. Is this supposition realistic? Thank you for your input… I’m otherwise healthy, no allergies, no chronic meds or diagnoses.

    • It’s always possible that proteins from the vaccine or the immune stimulation itself as a result of the vaccination, in combination with other immune triggers, could have aggravated this flare. If you haven’t had other flares of the lichen planus before, then I would recommend caution with other things that may stimulate the immune system in the future.

  5. I have an autoimmune disease, mitral & tricuspid regurgitation (mild) pulmonary hypertension (mild). Age 79, mild egg allergy, I occasionally eat an egg. I have always got a flu shot but didn’t have autoimmune problem, always thought I had mitral valve prolapse. Things change with age. My Dr told me to get the Flu shot, I have had cold symptoms for at least a week now

  6. I am worried about getting the flu vaccine, I haven’t taken one in several years. I have recently had a heart attack and bypass surgery, am a type 2 diabetic, on medications for diabetes and heart and I am isolating due to the coronovirus also have autoimmune disease Sjogren with major dental issues which have and still am addressing and decreased salivation. I am 78 years old and have had three back surgeries and spinal neuropathy and use a wheeled walker if I have to walk more than a few yards (my legs give out). Thank you for your advise. I have a new great primary care doctor and he listens to me regarding my issues but he is young and I worry he may just want me to take it and see how my body handles it….

    • This is a good question for your primary care doctor. If you feel like he does a good job at listening to you, then just express your concerns about getting the flu shot. He will be able to give you the best information given your history and risk factors.

  7. I have ms never ever had a flu shot in my life I swear I had mild case of covid twice an twice dr gave me z pac I was fine thank god my ms is under control I work stand I’m a fighter I take vit c everyday pill form 500 mg an cal mag n zinc I’m really afraid to get flu shot with all this going on in the world is it ok to just keep taking what I am

  8. The only time I ever got a flu shot was in 1994 and I’ve never been sicker in my life. I could barely move for two full weeks. I never got another flu shot and haven’t had the flu since. I’m not an anti-vaccer, but I don’t see any reason for me to risk getting horrifically ill again, so I don’t get flu shots. For those in health care, please don’t shame or guilt people if they tell you they have chosen not to get the flu shot—that’s something I have to deal with every year. For some of us, we have good reason to abstain!

    • Great advise! People who have had adverse reactions to previous vaccinations should not be shamed for that. And being against a flu vaccine doesn’t mean that you are an anti-vaxxer. I’m glad you stood up for yourself!

  9. I am 51. I have had a Hashimoto’s diagnosis for 26 yrs, although routine thyroid labs have never been abnormal. 6 years ago following my annual flu shot, I developed chronic tinnitus, balance issues, heart palpitations, fibromyalgia, and Paroxysmal Hemicrania headaches. My TPO antibodies were tested 6 months after flu vaccine and were extremely elevated (>500/1000). I worked with an independent nutritionist specializing in Hashi’s to modify my diet and heal inflammation.within a year my TPO #’s decreased (89/120). I have remained strictly GF since.

    I have seen several integrative/functional med MD’s who have all advised against the flu vaccine but cannot/will not provide me with medical exemption documentation for work purposes. I have not had my flu vaccine since the time 6 yrs ago that I believed triggered my autoimmunity issues. Proof of flu vaccination is now being required by my employer, so I am faced with a dilemma.

    My current primary care internist & rheumatologist believe the vaccine is not contraindicated for “Hashimoto’s or fibromyalgia”. I have been told, and have good reason to believe my symptoms continue to flare with hormonal cycle fluctuations. So every month I suffer increased fibromyalgia symptoms with PMS & PH headaches/migraines pre & post menses. I have also read research suggesting people with autoimmune issues should wait until after flare to get flu vaccinations, but I feel I am in a flare monthly!

    I would like to make an informed decision but am at a loss without consistent guidance from medical providers. I don’t want to lose my job, but I’m afraid getting the flu shot may exacerbate the symptoms I have been managing since my flu shot 6 yrs ago.

    Please advise.

    • If you have a documented adverse reaction to the flu shot, then your doctor should be able to provide you with that medical exemption. If they don’t, then you can find another physician that will. Any doctor who denies medical exemptions for those reactions are doctors that are not providing good care for you.

    • Thanks for sharing this Karli, really interesting. I’ve recently been diagnosed with Hashimotos and at the moment it’s sub clinical, anti bodies have come down with a strict diet, GF, dairy, egg etc free and I’m not on meds. I’m not sure if the hashimotos was triggered by Covid in March but I’m worried about the flu vaccine. Reading comments here I think I will decline. Thank you Dr Jenny Bennett for a great article.

  10. How do you feel about covid vaccine? I have 5 autoimmune diseases and not sure what to do when it becomes available.

    • This is a difficult question Cindy. We don’t have much information on the recent COVID-19 vaccine at this time. There was some evidence in the pfizer trial that there was a 2% increase in arthritis symptoms in the vaccine population but we don’t know if that was inflammatory arthritis or could be related to autoimmune diseases. Risks and benefits should be weighed at this time – if you are at high risk for covid complications or if you are concerned about passing covid to someone with high risks, then getting the vaccine may be a benefit. Or waiting to see how the side effects are playing out is also a reasonable approach as well.

  11. I am over 65, live in the UK and have an autoimmune condition. I had the 2018/2019 trivalent flu vaccine with added adjuvant included for the first time which was supposed to boost the immune system in those aged over 65. The under 65 were given the quadvalent vaccine with no added adjuvant as I understand. Two days after the jab my formerly very mild tinnitus went crazy. Thankfully it gradually quitened over the coming weeks but never returned to it’s formerly mild state. For the 2019/2020 flu vaccine, because of my suspicions that the newly introduced adjuvant in the 2018/2019 flu vaccine had exacerbated my formerly mild tinnitus, I requested and recieved from my GP,the quadvalent under 65 vaccine with, as I understand it, no added adjuvant. Result was positive with no change in my tinnitus. Today I was vaccinated with my first dose of the AstraZenica covid 19 vaccine with the result that 3 hours later there was a significant increase in my tinnitus, the intensity of which I have not experienced since my 2018/2019 quadvalent flu vaccination with added adjuvant. I’ve just researched the AstraZenics covid vaccine to find it also has an adjuvent in it though I’m not sure if it is the same type of adjuvant in both vaccines. Whatever, obviously I’m hoping this current tinnitus flare will eventually calm down. Goes without saying that I am nervous about having my second dose of AtraZenica vaccine in 12 weeks time, which is the recommended time period, for better or worse, here in the UK.

    Would like to hear off anyone who has had a similar experience with tinnitus?

    • Thank you for sharing your story!

      We have been seeing this here in the US as well – those with autoimmune conditions tend to be more susceptible to flares with all forms of the vaccine from AstraZenica to Moderna to Pfizer. Immune support during this time is important. We will be posting a post-vaccine treatment plan soon for those concerned about flares after their vaccination. So stay tuned!

  12. I have developed lichen planopilaris that might have been caused by the flu shot. Should I not get the shot again. I have been getting the shot for about the last 25 years but developed LPP right after getting it shot in September of 2020.

  13. I am very concerned about getting the vaccine. I have fibromyalga and Hashimoto’s. Flare ups can be so bad. There is not enough data available about peoples experiences with thies side affects. My husband is due for his second dose in 6 days, no issues at all. He is at the point of bullying me to get it because he doesn’t see the pain I endure every day. He even asked his dr who I have never ever talked to if I should get it.
    Is there anything in writing to share with him.
    Once its done, there is no way to undo it.

    • This is a difficult question. There is not a lot of evidence to show how people flare when they get the vaccine in relation to autoimmune disease. But there is a study in the works that Pfizer is doing to look at people with autoimmune diseases and their responses to the vaccine. So hopefully that will come out within the year and we will have more answers.

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