Wednesday, January 19, 2005

Hepatitis B vaccinations - Dr Shepherd writes to the BMJ - Hepatitis B vaccination and multiple sclerosis (and ME/CFS)

The following article was posted 4th October 2004 at the website of the M.E. Association:

As indicated in our recent news item on hepatitis B vaccination and MS, Dr Shepherd has written to the editor of the British Medical Journal:

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


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:

- If you have ME/CFS and predate the onset of your illness, or an exacerbation of pre-existing symptoms, to hepatitis B vaccine then you may wish to submit a short case history report to the BMJ e-discussion on the recent paper in Neurology:

- See also Hepatitis B vaccination and multiple sclerosis (and ME/CFS) - 24th September 2004
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Hepatitis B vaccination and multiple sclerosis (and ME/CFS)

Also at the MEA website, posted 24th September 2004:

The British Medical Journal has today carried a short report on a new study published in Neurology (2004; 63: 838 - 842) which supports the view that hepatitis B vaccination is a risk factor in the development of multiple sclerosis. This is an important development because other recent research has not found any such link and many doctors are now sceptical about the potential for this particular vaccine to cause autoimmune and neurological side-effects.

As people may know, I have a research interest in the link between vaccination and ME/CFS - in particular those cases where hepatitis B vaccine has either triggered ME/CFS or exacerbated a pre-existing diagnosis. Unfortunately, the BMJ rejected my submission of case reports on this subject to the paper journal because there were no controls in it. However, I now intend to submit an electronic report so that this information can enter the public domain. This I will do next week.

The BMJ report can be found at:

For a review of the possible link between vaccinations and ME/CFS that I wrote for the American The CFS Research Review

Dr Charles Shepherd, Medical Adviser, The ME Association

Follow-up: Dr Shepherd writes to the editor of the BMJ - 4th October 2004


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