First published by YOGA & HEALTH March 1997

A recent report prepared by a joint working group from the Royal Colleges of Physicians, Psychiatrists and General Practitioners(1) in response to the 1994 Task Force Report on ME/CFS(2) states that the causes of this illness are still unknown.

This report also asserts that as many as 3/4 of up to 1 million people believed to suffer from CFS (Chronic Fatigue Syndrome), the now recommended term, have underlying psychological or psychiatric problems.

But are the causes of this much maligned disease really that obscure? It may be more appropriate to talk in terms of 'cofactors' or 'links' in this disease, which almost certainly is multifactorial.

I still prefer to call it 'ME' (Myalgic Encephalomyelitis), to differentiate a distinctive group of subjects who are debilitated not just because of chronic fatigue, but who experience a great many other troublesome symptoms. When I started my postgraduate study into aetiological link factors of ME in 1989, we felt that many details on a large group of patients with the disorder would reveal certain patterns if they existed, and this is precisely what happened. There was evidence of many infections, viral, bacterial and fungal, treated with a variety of antibiotics and Septrin figured prominently amongst a formidable array of antibacterial agents used.

Oral contraceptives may play a role in over 2/3rds of women in my main study group. In some exposure to pesticides, toxic chemicals, heavy metals or powerful electromagnetic fields appeared to predispose subjects to develop ME. There were almost universal stress experiences and sometimes diet left much to be desired, but both of these also applied to control group subjects.

Cases where ME subjects had been vaccinated in the month before developing an infection and/or other health problems which resulted in ME, attracted my particular attention; in some instances there were no infections - an immunization alone seemed to have triggered the onset of ME. There was also a small group who informed me they had received long term corticosteroid treatment for health problems before receiving a vaccination which triggered their illness. Significantly perhaps, adverse reactions to vaccines, drugs as well as sensitivities to chemicals and foods were reported with almost predictable regularity. Results of my study were first shown at the International Conference on Chronic Fatigue Syndrome, Dublin, in 1994(3).

It is this relationship between vaccinations and subsequent ME, which I felt needed further exploration. A R Lloyd et al, quoting cases in which vaccines triggered the onset of the syndrome, suggest that antigenic challenge, not necessarily in the form of an infection, may be the prerequisite for the development of the disorder(4).

Almost 13% of 225 ME subjects in my main study group and 16% of a separate group of 55 young ME subjects had received one or more vaccines in the month before ME problems developed ­- in some cases onset was dramatic within 24 hours. As with antibiotics, many reported adverse reactions to vaccines and sometimes these were very severe (e.g. anaphylaxis). In most instances, patients developed some infection soon after immunization and naturally assumed this caused their subsequent ill health.

Reflecting on my son's medical history before he succumbed to ME problems, I recalled how he had prolonged screaming fits after receiving his measles jab at the age of one, how worried I was at the time, and how he nevertheless had this childhood disease not just once, but twice. His ME problems started after the second bout of what probably was 'atypical' measles aged 12 ½ in 1980, which was preceded by Glandular Fever two months earlier.

But what evidence was there in the medical literature which documented the kind of complications which my data suggested occurred in some ME cases? And had other researchers into this disorder discovered similar links?

To my amazement the answer to both questions was positive. Dealing with these questions in reverse order:

OTHER RESEARCHERS' OBSERVATIONS

Observations on vaccine involvement in ME/CFS emerged at the First World Symposium on ME/CFS, Cambridge, UK, in April, 1990.

Four eminent and well respected researchers voiced concerns over such links and three presented details at this conference.

The conference proceedings were published in a comprehensive publication on this disease(5).

In an overview on the disorder, Byron M Hyde (Canada) pays particular attention to an immunization link and an association with poliomyelitis(6) - see also separate section below.

Special risk categories and an occupational bias with teachers, healthcare and social workers were identified by Byron Hyde et al (7), i.e. people in close contact with infections and with many routine immunizations appeared to be at an increased risk of developing ME. CM Poser (USA), a well known consultant neurologist from Harvard Medical School, discussed Chronic Fatigue Post viral Syndrome (CFPVS) - another synonym for ME/CFS -, Multiple Sclerosis (MS) and Chronic Disseminated Encephalomyelitis (CDEM) (8).

He summarized his findings as follows:

Finally HH Fudenberg (USA), an eminent professor in immunology, states that problems encountered by ME sufferers are due to immune dysregulation, as a result of antigen stimulation (i.e. foreign bodies, which prompt our antibody responses) by incomplete, dead (and/or perhaps latent) viruses. (In other words, many of the 'attenuated' or weakened versions of viruses used in vaccines).

He adds that this occurs secondary to a defect in antigen presentation and/or processing. He also found that 50% of his patients experienced hypersensitivities to chemicals and foods(9).

At the International Conference on Chronic Fatigue Syndrome in Dublin in 1994, two other papers, apart from my own, documented the involvement of vaccines in this disorder. E Salit (Canada) showed that 10/134 (7.5%) of CFS patients had immunizations within 3 months prior to becoming ill (10), and BM Hyde et al found that over 3% of 1826 ME/CFS patients fell ill immediately after immunization(11), adding that if data from a separate hepatitis B immunization study were included, post-immunization figures would exceed 7.5%. 

MORE UK EVIDENCE

InterAction 14 (Autumn 1993), the journal of Action for ME, contained a small notice 'Vaccination/ME Connection?' - one ME sufferer wanted to hear from anyone who associated the start of their ME or relapse with a vaccination, but especially a flu vaccine. By the summer of 1994 she had been contacted by 14 people, all of whom developed ME shortly after a vaccination or experienced a relapse.

Other sufferers had developed ME after a flu vaccine, but hepatitis B was causing great concern, due to new Guidelines 'Protecting Health Care Workers and Patients from Hepatitis B' coming into force for most health care workers in 1995. Jane Leeming discussed some of the cases she heard from in an article 'Risks and Benefits'(12) in the light of these new Guidelines. She added observations made by Dr Charles Shepherd, the medical adviser to the ME Association, Dr Elizabeth Dowsett, Honorary Consultant Microbiologist to the Basildon and Thurrock NHS Trust and then President of this patient organization, and my own comments. All had come to very similar conclusions, i.e. vaccines can precipitate the onset of ME problems and/or trigger a relapse in certain circumstances:

By late 1994 Dr Shepherd became so concerned about a steady influx of notifications on cases of hepatitis B vaccines precipitating an ME-like illness, that he submitted a short report to The Lancet. Alas the journal declined to publish his observations. Instead his article was published in the ME Association's journal 'Perspectives' (13): 33/60 consecutive patients who predated the onset of their fatigue syndrome to immunization linked this to a hepatitis B vaccine. Cholera, influenza, tetanus and typhoid were vaccines most frequently mentioned by the remaining 27 patients in his group. (In my own study, tetanus appeared to cause problems most frequently). By June 1996 Dr Shepherd's file on vaccine-ME cases had grown to about 100, of which 60+ involved hepatitis B. He then sent a revised preliminary report on these 60 cases to another medical journal, simultaneously informing the Committee on Safety of Medicines (CSM) and the principal manufacturer (14). The outcome is not known at present. 

THE 1994 MEASLES/RUBELLA IMMUNIZATION CONTROVERSY & AFTERMATH

In the autumn of 1994 over 7 million UK schoolchildren aged 5-16 were given measles/rubella (M/R) immunizations, irrespective of whether they had these diseases or were previously immunized against them. Aware of the involvement of vaccines in ME onset and relapses, I compiled a report documenting links of immunizations with ME/CFS and expressing concerns over possible long-term problems and new cases of this disease (15). In April, 1995 results of a major study on long term problems due to measles immunizations were published (16). A large group of people given live measles vaccines in 1964 was compared to two large groups of unvaccinated cohorts. The researchers concluded that early exposure to measles may be a risk factor for later development of Crohn's Disease and ulcerative colitis. This study was criticized on methodological aspects (17). In August, 1995 the editor of the Bulletin of Medical Ethics published an article, asserting that doctors and parents had been knowingly misled by UK Government advisors over an impending measles epidemic, which would not have happened (18). He called for an independent enquiry.

Many newspaper and magazine articles discussed these problems. Yvonne Roberts' detailed report gave individual case histories and discussed mounting evidence of far greater numbers of long-term injury cases resulting from immunization procedures than was previously thought (19), e.g. Crohn's Disease, Irritable Bowel Syndrome, autism, epilepsy, meningitis and 'Subacute Sclerosing Panencephalitis [SSPS] - a neuro-degenerative disease. The very foundation of immunization policy, i.e. the notion that benefits to millions always massively outweigh risks to a few, might be challenged. TV/radio programmes covered these problems, e.g. Esther Rantzen's TV debate on BBC2, 30.1.1996.

By December, 1995 Jacky Fletcher, mother of a vaccine damaged child and coordinator of JABS (justice, Awareness and Basic Support) had heard of 175 serious reactions to these immunizations and 110 appeared to be long-term problems, including 19 cases of ME/PVFS [Post-Viral-Fatigue Syndrome] amongst cases of epilepsy, arthritis/arthralgias, Guillain Barree Syndrome, Crohn's Disease, ulcerative colitis, meningitis, encephalitis and anaphylaxis.

In June 1996 Brian Hubbard and Lynne McTaggart revealed in 'The Planet' that health workers but not parents were advised that up to 11% of immunized children, especially teenagers, could develop arthritis, which could affect over 120,000 youngsters. A solicitor now represented 320 parents who were seeking compensation from the Government under the 1987 Consumer Protection Act, but the Government asserted the campaign had been very successful, even though 530 serious adverse reactions had been reported,' estimated to be only 1/5th of all adverse reactions.

Medical Literature Evidence

THE POLIO CONNECTION

The term 'ME' was first mentioned in the late 1950s following an epidemic outbreak at the Royal Free Hospital, London, in 1955. Dr Melvin Ramsay, a practising physician at this hospital at the time, describes the outbreak, which affected 292 hospital staff and a mere 12 patients, in his book 'Myalgic Encephalomyelitis and Post viral Fatigue States' (20). He stresses that in epidemic form this disease has struck medical establishments most frequently, affecting mainly nurses and staff. The earliest epidemic outbreaks occurred in the wake of polio epidemics, the first at Los Angeles County General Hospital in 1934 (21); this was referred to as 'atypical polio'.

Subsequent outbreaks affected officers and men in Switzerland in 1939 (22), now referred to as 'abortive poliomyelitis', and so was a 1950 New York State outbreak (23).

A recent major-article on this topic 'ME A polio by another name' (24) states that of a dozen outbreaks of ME, nine occurred during or right after outbreaks of polio. Jane Colby has written a book on this topic, highlighting particularly the plight of children with ME (25).

The problem appears to be that polio virus types 1-3 are just three of a large group of viruses, collectively called the 'Picorna Group', which consists of at least 72 enteroviruses, including Echo and Coxsackie viruses, subdivided further. These group member viruses are mutually antagonistic and infection with one may protect individuals from worst effects of others.

However, the introduction of polio immunization between 1954 - 1959 brought about changes in the balance of the gut viral population of enteroviruses. There now was a marked reduction of the wild polio virus types 1-3 (which sometimes caused paralytic poliomyelitis), but non­paralytic enteroviruses became dominant. As BM Hyde stated in his 'Historical Perspectives' on this disease (6):

 J Richardsorn of the Newcastle Research Group in discussing the role of immunizations, concludes that this changed or modified the host response to these viruses (26) and AM Ramsay states that the trigger factor may lie in the immunological state of the patient (20,p26).

The problem is more complex still, insofar as the presence of these non-polio enteroviruses appears to modify the response to polio­immunization, as was observed in Icelandic children during a 1955 epidemic of Type 1 poliomyelitis in areas which were previously exposed to an outbreak of Epidemic Neuromyasthenia (another early name for ME), but there was an increased response to polio virus types 2 and 3 (27). This highly complex area has yet to be properly investigated. Some light has been shed on these problems in a major publication on the Post Polio Syndrome (28), which in many ways is almost indistinguishable from ME.

GENERAL REFERENCES

Earlier literature provides important information on vaccine complications. GS Wilson devoted a chapter of his book The Hazards of Immunization' to provocation disease, i.e. the activation of a different latent or incubating viral infection by any vaccine, but especially polio(29), whilst most of his book discusses allergic manifestations, anaphylaxis and abnormal sensitivities to vaccines. CM Poser (see Ref 8) in 1969 published a complex article, in which he reviewed post-infectious and post­vaccinal neuropathies; he concluded that these were allergic phenomena­clinical and pathological manifestations were indistinguishable. (30).

One longitudinal study showed that most hospital patients with post-vaccinal neuropathies had a concomitant illness (31). Two principal contraindications for any vaccination are a) the presence of a febrile illness, b) for people on high dose corticosteroids (32); ~ In two studies a relationship between Rubella Vaccine [RA27/3] and Epstein Barr Virus [EBV] infections was discussed (33, 34).

EBV usually manifests itself as Glandular Fever. AD Lieberman(34) points out g historical link between EBV and atopy (an allergic predisposition), dating back to early post World War II years. He also discusses a possible link with sensitivities to foods and chemicals, implicating IgG4 as a mediator, a notion recently promoted by other specialists in food allergies and intolerances. - The above references and others may explain much of what is seen in ME/CFS cases triggered by vaccines. 

CONCLUDING COMMENTS

There is overwhelming evidence of serious health problems arising due to vaccine complications, not only in relation to ME/CFS. but also in respect of many other diseases like Guillain Barree Syndrome, 'Crohn's Disease and others. Reports of such complications are not new - they have been documented for decades. Yet there seems to be little enthusiasm for investigating these problems in depth, no more than there is for scrutinizing problems arising from excessive or inappropriate antibiotic use, or looking at long-term effects of now restricted antibiotics like Septrin. Ill health following exposure to OP pesticides has only recently attracted attention because of the possible/ likely involvement of these substances in Gulf War Syndrome cases, and some Gulf War veterans have already died.

However unpalatable such 'cofactors' or 'links' may be in ME/CFS and other serious diseases, these problems need to be addressed by suitably qualified and independent researchers in appropriate fields, i.e. virology, microbiology, immunology, neurology, endocrinology and pathology. To attribute such complications to psychological or psychiatric disorders may buy a little time, but is unlikely to solve the problem or help affected sufferers. More importantly, it will not prevent further cases from occurring. 

REFERENCES

Invest in ME are grateful for permission from the editor of YOGA & HEALTH for permission to reproduce the above article.