No reason this West Nile patient should skip the flu vaccine

Dear Dr. Roach: I am a paraplegic due to complications from the West Nile virus. I am getting conflicting information concerning flu shots. My primary care doctor says that the flu shots are contraindicated for West Nile victims; my pharmacist says the vaccinations are OK; and my hematologist is unsure. I would like to get a flu shot and a vaccination for COVID-19 when available. Please give me a definite answer. — P.H.L.

Dear P.H.L.: West Nile virus was relatively unknown in the U.S. until 1999, when an outbreak occurred in New York. It is an arbovirus, related to the Japanese encephalitis virus. As such, it can cause neurological symptoms. It may also cause an acute flaccid paralysis. Only polio virus causes poliomyelitis, and polio only exists in the wild in Afghanistan and Pakistan now, but several viruses can cause symptoms that act similarly. A third of people with acute flaccid paralysis do not recover.

There is no definitive answer on flu shots, because there are little data. However, I found no published information that would lead me to recommend against a flu vaccine in people with neurological compromise due to West Nile virus. I suspect your primary doctor is concerned because there is a syndrome from West Nile similar to Guillain-Barre, about which there is controversy. It is unlikely that you have paraplegia from a Guillain-Barre syndrome from West Nile. Even if you did, the benefits of influenza vaccine outweigh the risk, according to multiple studies.

I cannot comment on any COVID-19 vaccine until efficacy and safety data from large studies are available, which is not the case as of this writing.