http://bmj.bmjjournals.com/cgi/eletters/329/7468/703-a#101547

Editor -

The results of the study (1) which suggest that hepatitis B vaccination (HBV) acts as a possible precipitating factor in the development of multiple sclerosis raise four important questions for the vaccine manufacturers and the regulatory authorities.

First is to what extent does HBV increase the risk of other autoimmune and neurological disorders. The manufacturers already acknowledge that such adverse events do occasionally occur, and there are numerous anecdotal reports in the medical literature linking HBV to serious conditions such as encephalitis (2), sero-negative arthropathy (3) and systemic lupus erythematosus (4). And as a physician with a particular interest in vaccine-induced myalgic encephalopathy/chronic fatigue syndrome, I now have details on a considerable number of people with this condition who predate the onset, or an exacerbation of pre- existing symptoms, to HBV (5).

Second is whether there are any reasons why HBV should be more likely to cause autoimmune and neurological complications when compared to other vaccines. A hypersensitivity reaction to the mercury-based preservative thiomersal in HBV is one possibility. Another possible explanation is that some individuals are genetically predisposed to such reactions - in a similar way to those who do not produce an adequate immune response to HBV - and that antigenic stimulation with HBV results in a pathological process, possibly involving immune complex formation, that leads to clinical disease..

Third is whether the current methods of vaccine post-marketing surveillance, which tend to concentrate on short and medium term side- effects, are capable of picking up these sort of adverse events.

Fourth is the issue of informed consent and whether people who are receiving a course of HBV are being properly informed about the potential risks - even though they appear to be very small. My own feedback is that most people are not. And this raises important medico-legal issues because many of those being vaccinated with HBV for occupational health reasons are being placed under considerable coercion by their employers to have this vaccine whether they want to or not.

Dr Charles Shepherd

References

1 Hernan MA, Jick SS, Olek MJ, Jick H. Recombinant hepatitis B vaccine and the risk of multiple sclerosis: A prospective study. Neurology 2004; 63: 838 - 842.

2 Tourbah A, Gout O, Liblau R, Lyon-Caen O, Bougniot C, Iba-Zizen MT, Cabanis EA. Encephalitis after hepatitis B vaccination - Recurrent disseminated encephalitis or MS? Neurology 1999; 53: 396 - 401.

3 Hassan W, Oldham R. Reiter's syndrome and reactive arthritis in health care workers after vaccination. British Medical Journal 1994; 309: 94.

4 Tudela P, Marti S, Bonal J. Systemic lupus erythematosus and vaccination against hepatitis B. Nephron 1992; 62: 236.

5 Shepherd CB. Is CFS linked to vaccinations? The CFS Research Review 2001; 2: 6 - 8. Available at: http://www.cfids.org/archives/2001rr/2001-rr1-article03.asp

Competing interests: CS has been involved as a medical expert in litigation involving hepatitis B vaccine.

Send response to journal:
Re: Vaccine-induced ME/CFS
 

Editor,

Dr. Shepherd (1) seems to many valid points in his response to the article on HBV (2) and the ill-health that appears to be associated with.

One point that he may not have the space to get across is that, if people getting the vaccine were listened to more, at least some of the cases of vaccine-induced ME/CFS might have been prevented or at least the severity of the resulting illness might have been lessened. I have heard quite a few people, who feel their ill-health was caused by a course of the HBV, say that they felt ill after the first vaccination but, for various reasons, ended up completing the course of vaccines despite their better judgement. Many appear to have had their lives ruined because of what happened.

I accept this is only anecdotal evidence but given the paucity of funding into biomedical aspects of ME/CFS, this is about all we have to go on at the moment.

Following the annoucnment of the Hernan et al study, which solely looked at whether the vaccine appeared to be associated with an increased incidence of MS, many, including the authors, have been quick to make comments such as "it is obvious that the serious risks of hepatitis B vastly outweigh any very small possible risk from vaccination." However, if the vaccine not only causes an increased incidence of MS, but also other illnesses, such as ME/CFS, perhaps this risk-benefit analysis needs to be re-assessed.

(1) Shepherd C. Hepatitis B vaccine - four important questions http://bmj.bmjjournals.com/cgi/eletters/329/7468/703-a#76555

(2) Hernan MA, Jick SS, Olek MJ, Jick H. Recombinant hepatitis B vaccine and the risk of multiple sclerosis: A prospective study. Neurology 2004; 63: 838 - 842.

Competing interests: None declared

Send response to journal:
Re: Re: Vaccine-induced ME/CFS
 

I have been quite convinced from my personal experience that CFS etiology is mercury induced, if not entirely causative. The symptom battery similarities between CFS and Hg toxicity is remarkable.

Considering the thimerasol content of vaccines previous to 2000, reported initiation of ME/CFS symptoms after HBV treatment protocol, is consistant. Though, Hg source is, very likely, though not limited, to dental amalgams, the added burden of Hg from, especially multiple vaccines, could provoke ME/CFS.

As an added evidence, GWI, which I personally believe is the same illness, may have been caused by numerous vaccines given to troops before being sent to duty in the gulf war. As reported to me, soldiers were given approximately 8 vaccines concommitantly. To a troop suffering from excessively high Hg, the addition of so much thimerasol, in such a short time, is extrordinarily suspect.

As evidenced by the reported methylization of Hg by certain organisms the suspect provoking vaccines could have a bilateral impact related to ME/CFS.

It is of great interest to me, if after the Iraq conflict, there is inconsistant level of GWI observed from returned troops. This would effectively isolate many of the variances between the two gulf incidences to further implicate/exonerate Hg.

Competing interests: None declared