Importance of Vaccines

Our Clinical Advisory Panel (CAP) and Society for Endocrinology have advised that there is no need to routinely increase glucocorticoid dose in patients with adrenal insufficiency, including Addison’s, at the time of vaccination if you have no significant symptoms, as most people tolerate the flu jab well.

However, if you know you are prone to developing side effects or are unsure, you may want to take an extra dose of steroids about an hour before getting the jab and rest well following your vaccine.

Vaccines are different for everyone, as everybody is different - so please listen to your body and do what is right for you. If you are particularly anxious/ stressed before a vaccination, this will "use up" your cortisol, so you may feel you need to up-dose in response to how you feel.

• Check if you have an allergy to any ingredients in the vaccine
  Increase your glucocorticoid as you would normally for the sick day rules
• Take paracetamol to help reduce your symptoms making them easier to manage
• Rest and drink plenty of fluids
• Visit the NHS website to find out more about reactions to vaccines and the Yellow Card scheme for reporting.

Side effects, such as feeling tired, are a sign that your immune system is kicking into action to protect you - the vaccine can’t give you the illness it is protecting you from. Your immune system will be learning to respond to the virus.

Can vaccines cause bad reactions?

Everyone is different, and some people may have a reaction  due to an allergy to the ingredients, for example. Ask your healthcare professionals to discuss the ingredients with you if you are concerned.

For any individual circumstances, for example any conditions you have alongside adrenal insufficiency, always speak with your healthcare team.

For any further concerns you have and to find out more about reactions to vaccines and the Yellow Card scheme for reporting reactions, please visit the NHS website.

Am I more at risk of a bad reaction because I have adrenal insufficiency?

No, not as a general rule, but everyone is different and there are lots of factors at the time of having the vaccine that may make it appear that a bad reaction is related to the vaccine.  Many people feel some mild symptoms after a vaccine, and this is the same for people with adrenal insufficiency.

As with all bouts of illness or physical stress on your body, you should follow the sick day rules if you have symptoms of low cortisol. 

Live vaccines contain a live version of the virus it is designed to protect you from.

Whilst NICE guidance recommends that people receiving immunosuppressive doses of corticosteroids should avoid live vaccines, people who have adrenal insufficiency alone are on replacement doses of steroids and NOT usually on daily doses of steroids that are significant enough to be immunosuppressive.

Yes, you can have vaccinations if you are taking fludrocortisone to replace your missing aldosterone hormone, and have Addison's or another type of primary adrenal insufficiency.

In the UK, those with Addison's and adrenal insufficiency should be automatically invited each year for a free NHS flu jab, usually by text, via the NHS App, or letter. Here is our guidance to make sure you receive your invitation:

Check with your GP surgery: GPs computer systems and procedures for issuing invitations vary - there is no single national system. Therefore, you'll need to ask about how things work at your local surgery. Your GP surgery should be able to add a marker in their system to show you are eligible for a flu vaccine. This marker is what prompts the automatic flu jab invite.

Ensure your medical record is up to date: Ask your GP surgery to confirm that your Addison’s disease or adrenal insufficiency (steroid dependency) is clearly coded on your health record. You can use our Summary Care Record letter template to help with this.

Be proactive: If you haven’t heard by late September or early October, contact your GP practice to book your jab, don’t wait for the invitation. You can also book flu jabs online and via the NHS App. You may find that you need to make checking this an annual part of your routine when the flu vaccine programme starts.

If your GP advises that you shouldn't receive the flu jab, it is likely due to a lack of awareness of adrenal insufficiency or Addison's disease.  You can try the following: 

1. Endocrinologist Support Letter: Ask your Endocrinologist/ medical team to write a special covering letter/ email referencing the information on this page and in the 'Managing You Addison’s' leaflet to send on to your GP. Points to include are noting your specific medical conditions so it is relevant for your circumstances. If doing by email, be sure to include the endocrinology secretary department as so many endocrinologists are very busy in their NHS roles.
2. Next steps with GP inc PALs: After sending this email/letter from your endocrinologist to the GP, if the GP still goes on to refuse, ask the GP to answer why they are going against the expert advice and guidance of the Addison's Clinical Advisory Panel (CAP) and your Endocrinologist. This is so you have their response in writing and helps provide clarity. Let your GP know it is your intention to include their answer when writing formally to PALs about their unsafe management of your Addison’s or adrenal insufficiency. 
3. Care Opinion Website: It can help to post some informal feedback on the Care Opinion website as well as going through the formal trust process via PALs. Every comment on the Care Opinion website that mentions adrenal insufficiency or adrenal crisis – positive or negative – helps to put the needs of adrenal patients on the map, and all patient feedback on their site is searchable as a reference with the aim to contribute to improving standards of care in the future.  

Raising Concerns about your NHS care

Chickenpox and shingles are caused by the same virus.

Yes, you can have shingles even if you had chickenpox many years ago. This is because it is caused by the same virus, which can lie dormant in your body for years.

If you have been in contact with any young children with chickenpox in recent years, this will have primed your immune system to keep your resistance to shingles up.

Shingles itself is not contagious, but the virus is. Shingles and chickenpox are caused by the same virus. Therefore, you can pass the virus to another person, which could cause them to develop chickenpox, if they have not had chickenpox before.

A person can transmit the virus when the shingles rash is in the blister phase. To prevent transmitting the virus, keep shingles rashes covered. Cover the rash from when the blisters appear to when they crust and scab over.

• Follow the Sick Day Rules and increase your steroid replacement medication.
• Contact your GP to confirm the shingles diagnosis and prescribe antivirals to help speed up your recovery and avoid longer-lasting problems. This works best if taken within 3 days of your symptoms starting. Another useful tip is to ask about prescribing Gabapentin if you are experiencing neuropathic pain.
• Don’t waste time. Leaving things until they get worse might lead to more serious infections.

Read more about shingles on the NHS website.