FLU VACCINE AND ME/CFS - INFORMATION FOR 2020 2021 - ME Association
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October 2020
FLU VACCINE AND ME/CFS
INFORMATION FOR 2020 – 2021
ME CONNECT HELPLINE: 0344 576 5326 by Dr Charles Shepherd
Hon Medical Adviser to the MEA
COVID-19 AND FLU VACCINATION THIS YEAR
One very important additional issue this year is the impact of
COVID-19 and the Department of Health’s decision to encourage far
more people to have this protection - as a dose of flu plus COVID-19
is going to be a very nasty combination of infections to have.
So people with ME/CFS are going to have to take COVID-19 into
consideration when deciding whether they are going to have a flu
vaccination - as COVID-19 isn’t going to go away and there won’t be
a vaccine available for widespread public use until the worst of any
2020-2021 flu epidemic is over.”
INTRODUCTION WHAT IS THE SCIENCE
Seasonal flu (also known as BEHIND FLU VIRUSES
influenza) is a highly infectious AND FLU VACCINES? Flu Vaccine and ME/CFS -
illness caused by several types Information for 2020 - 2021 was
of flu virus. It causes up to 30,000 There are three types of influenza written by Dr Charles Shepherd
deaths per year in England alone. virus. Type A viruses are the most (pictured above), Trustee and
The flu virus spreads rapidly dangerous and cause outbreaks Hon Medical Adviser to The ME
through small infected droplets in most years. Type B viruses Association.
that are coughed or sneezed into tend to cause less severe disease
the air by an infected person. © The ME Association, 2020
and smaller outbreaks, often in
Even people with mild or no All rights reserved.
children. Type C viruses cause a
symptoms can infect other people. minor respiratory illness. Reproduction, in full or in part,
So the spread of infection is just is not allowed without the
the same as with COVID-19. Type A viruses are sub-divided
written permission of The ME
by the type of immune system
As there is no simple answer as Association.
markers known as antigens that
to whether you should have flu are found on the surface of
vaccine if you have ME/CFS, the virus. These are known as viral sub-types. So the changes
the purpose of this leaflet is to haemagglutinin (H) antigens and are constantly monitored by the
provide information on all aspects neuraminidase (N) antigens. These World Health Organisation in
of flu vaccination in relation markers help the virus to invade order to try and make sure that
to ME/CFS. You and your doctor the body cells. 18 types of H each year’s flu vaccine is going
can then decide if you ought to antigen and 11 types of N antigen
have this protection. to be effective against new and
have been identified so far. emerging strains of flu virus.
The surface antigens constantly Studies have shown that flu
change their identity by what vaccine reduces the risk of
is called antigenic drift (which catching flu. However, protection
involves minor changes from will not be complete and will vary
season to season) and antigenic
from person to person. Protection
shift (where a major change and
gradually decreases over time
new subtype of virus emerges).
and flu strains change over time.
Previous exposure to flu or flu So new vaccines have to be
vaccination will not provide made each year and people at
protection against these new increased risk are encouraged to
The ME Association n 7 Apollo Office Court, Radclive Road, Gawcott, Bucks MK18 4DF n 01280 818 963 l
www.meassociation.org.uk n admin@meassociation.org.uk n Registered Charity Number 801279
© ME Association 2020. Reproduction is not allowed without the written permission of The ME Association
1
FLU VACCINE AND ME/CFS: INFORMATION FOR 2020 – 2021 October 2020
be vaccinated every year. There is according to age and due to
also research evidence to indicate the decreased effectiveness in
that flu vaccine can reduce the people over 65, their vaccine
risk of having a stroke. also contains what is called an
adjuvant.
Swine flu is the popular name for
influenza caused by a relatively This is a substance that is added to
new strain of influenza virus A. a vaccine to increase the body’s
It was responsible for the flu immune response to the vaccine.
pandemic in 2009-10. The virus is
n Children aged 2 to 17 are
officially known as influenza virus
offered a live attenuated
A/H1N1pdm09.
quadrivalent vaccine (LAIV). This
THE 2020 -2021 FLU gives protection against four
strains of flu. The vaccine is given
VACCINES as a nasal spray.
For 2020-2021 there are three n Adults aged 18 to 64 are offered n Adults aged 65 and over will be
types of flu vaccine available. a quadrivalent injected vaccine – offered an adjuvanted trivalent
You will be offered the one that the vaccine will have been grown injected vaccine grown in eggs
is considered to be the most either in eggs or cells (QIVe or (aTIV).
effective for your age group. QIVc), which are considered to be
The protection provided varies equally suitable. WHO SHOULD HAVE A
FLU JAB?
CAN SOMEONE WITH ME/CFS HAVE A FREE Flu vaccine is offered free on the
FLU JAB IF THEY CHOOSE TO DO SO? NHS to people in certain at-risk
groups. These are mainly people
Having a chronic neurological disease is one of the who have a medical condition
recommendations for having an NHS flu vaccination. ME/CFS is that places them at greater risk of
classified by the World Health Organisation as a neurological disease. developing serious complications if
This classification is fully recognised by the Department of Health. they catch flu.
So The ME Association believes that people with ME/CFS should
therefore qualify for a free NHS flu jab if they decide to have one. The list includes a number of
pre-existing health conditions –
If your GP is querying whether someone with ME/CFS is eligible to neurological and immunological
have a free flu vaccination on the NHS you need to point out that the diseases, heart and respiratory
answer is YES they can because: diseases, pregnant women, and
n People with a chronic neurological disease are eligible for an NHS obesity.
flu jab (NHS Green Book - Chapter 19, page 14) - https://tinyurl.com/ As a result of the COVID-19
yf2spxpm pandemic, the Department
This publication is produced by Public Health England and provides of Health has widened the
detailed guidance on the administration of all vaccines. The list of list of people who should be
medical conditions where flu vaccine is recommended makes it clear encouraged to have flu vaccine.
that the list of neurological conditions (and other conditions) is not So this now includes health and
exhaustive and that decisions on individual neurological diseases can social care workers, people in
be made on clinical judgment. residential care homes, household
contacts of people who are
n NHS England classifies ME as a neurological condition: https:// shielding, and people aged 50 to
tinyurl.com/y6h33er2 64 - subject to vaccine availability.
n Dame Sally Davies, former Chief Medical Officer at the Department People who receive a Carer’s
of Health, stated in 2014: Allowance, or are the main carer
“As you know, the risk of serious illness from flu and consequent for a sick or disabled person,
hospitalisation and death is higher among those with underlying are also eligible for a free NHS
health conditions such as M.E.” vaccine.
“We know that people with chronic neurological conditions are The best time to have a flu jab is in
approximately 40 times more likely to die if they develop flu than the autumn – from mid-September
individuals who have no other underlying health conditions.” onwards through until early
November. It takes two
“The best way for people at risk from flu to protect themselves and
to three weeks for the
their families is to get the flu vaccine. People with clinical risk factors
vaccine to become
are eligible to receive the seasonal flu vaccine free each winter.”
fully effective.
2 © ME Association 2020. Reproduction is not allowed
without the written permission of The ME Association
FLU VACCINE AND ME/CFS: INFORMATION FOR 2020 – 2021 October 2020
in the British Medical Journal. Both
WHAT ARE THE developed moderate to severe
POINTS IN FAVOUR OF symptoms and were unable to
return to work.
HAVING A FLU JAB IF
Reference: Should influenza be
YOU HAVE ME/CFS? mandatory for health- care
workers? British Medical Journal
n Flu vaccination should provide
(2013), 347:f6705. Online here:
a fairly high degree of protection
https://tinyurl.com/y2rf3g7 An MEA website online poll carried
against the strains that are likely to
be around this winter. out in November 2008 asked how
WHAT ARE the flu jab affected ME symptoms.
n Overall, the vaccine produces
a different degree of protection
THE POSSIBLE There were 191 responses. 86 (45%)
reported no change; 52 (27%) said
each year – usually around 40% - DISADVANTAGES? they were much worse; 42 (22%)
50% said they were slightly worse; 7
There are anecdotal reports
n Protection continues for about of people with ME/CFS (4%) said they were slightly better
a year. suffering a relapse, or even and 4 (2%) said they were much
developing ME/CFS, after better after the jab.
n Anyone with serious health
problems in addition to ME/CFS this vaccine. This is possibly It is impossible to predict if
such as chest (especially asthma because research into immune someone with ME/CFS is going to
or bronchitis), heart, liver or kidney system dysfunction in ME/CFS experience an adverse reaction
disease, diabetes, a weakened has found evidence of what is to flu vaccine. However, some
immune system, or who is taking called immune system activation. doctors (myself included) believe
steroid medication, is particularly This equates to a persisting and that this may be more likely if you
at risk of developing serious overactive immune response to still have on-going flu-like/infection
complications from flu. a triggering infection. Vaccines symptoms such as enlarged
mimic the infection they are glands, sore throats, problems with
n If you have already had a flu designed to protect against and temperature control, etc.
vaccine while suffering from ME/ will therefore trigger an immune
CFS, and not suffered any adverse system response. WHAT ARE THE
effects, it is reasonable (but not
guaranteed) to assume that you In a small survey carried out by GENERAL CAUTIONS &
The ME Association among its
should be OK this time round
members a few years ago, seven
CONTRA-INDICATIONS
(although the viral make-up of the
vaccine is changed from year to out of 21 people had no problems Flu vaccine may be contra-
year). at all with flu vaccine; 13 reported indicated in people who have
an exacerbation of symptoms had a previous reaction, or are
n Serious adverse reactions are ranging from mild (3) or moderate allergic to eggs and poultry – as
very rare although minor transient (7) through to a severe relapse in the inactivated vaccine contains
problems such as malaise, three cases. Interestingly, there small amounts of egg and poultry
headache and muscle pain do was also one report of a teenager proteins. This is something you
sometimes occur. A full list of who noticed a slight improvement need to discuss with your doctor
potential side-effects is listed later in symptoms following vaccination. because there are now egg-free
in this leaflet.
vaccines available.
The only published research study
You should also inform your doctor
into adverse reactions to flu
if you are allergic to any of the
vaccine in people with ME/CFS
possible vaccine components and
concluded that people with ME/
preservatives: eg, formaldehyde,
CFS were no more likely to have
gentamicin sulphate and sodium
a serious adverse reaction than
deoxycholate. One further contra-
people receiving this vaccine for
indication is having an active
recommended reasons.
febrile illness.
Reference: Influenza Vaccination:
Some flu vaccines used to include
Is it appropriate for Chronic
thiomersil – a controversial
Fatigue Syndrome? (2002)
mercury-containing preservative.
American Journal of Respiratory
This has now been gradually
Medicine (2002),1: 3-9).
withdrawn from
However, two case reports vaccines following
involving health workers who concerns that it could
developed ME/CFS after swine flu cause neurological
vaccination have been reported problems.
3 © ME Association 2020. Reproduction is not allowed
without the written permission of The ME Association
FLU VACCINE AND ME/CFS: INFORMATION FOR 2020 – 2021 October 2020
caught by contact with infected
WHAT ARE THE surfaces, including hands – so
RECOGNIZED SIDE- regular handwashing with soap
– as for COVID-19 – is a sensible
EFFECTS? precaution to take.
Common and normally transient Sneezing into your elbow – not the
side-effects include a slight palm of your hand – reduces the
temperature and aching muscles risk of spreading the virus.
for a couple of days after having
the jab. Your arm may also feel a
bit sore. If you do experience a
RESEARCH INTO FLU
The use of a specific adjuvant
sore arm after vaccination, use
known as AS03 – an emulsion
VACCINES AND ME/CFS
a heat pack or warm compress
that was added to stimulate the The effect of influenza vaccination
on the area and take a painkiller
immune response in a previous on ME/CFS was examined in an
such as paracetamol or ibuprofen.
vaccine – has been linked to Australian pilot study which found
Serious side-effects are very rare.
narcolepsy. that vaccination is accompanied
Recognised potential side-effects by a degree of immune system
listed in the literature provided WHERE CAN YOU HAVE dysregulation in ME/CFS patients
to doctors include local redness, A FLU JAB? compared to healthy controls and
swelling, pain, bruising, fever, that the vaccine has the ability
malaise, shivering, fatigue, Most people have a flu jab at their to increase cytotoxic activity and
headache, sweating, myalgia GP surgery – where it is free if you pro-inflammatory reactions post-
(muscle pain), arthralgia (joint have one of the conditions listed vaccination (Brenu et al 2012).
pain), generalised skin reactions above where flu vaccination is
(itching, urticaria}, neuralgia (nerve recommended by the NHS. If you However, Prinsen et al (2012) found
pain), paraesthesiae (abnormal are on the list of people who are that humoral and cellular immune
sensations in the skin). eligible you will probably receive responses following influenza
a letter asking you to book an vaccination were comparable
As many of these side-effects are in ME/CFS patients and healthy
appointment at one of their flu
also ME/CFS symptoms, this may controls.
vaccine clinics.
help to explain why some people
with ME/CFS feel worse after a flu Some community pharmacies offer References: Brenu EW et al.
vaccine. flu vaccination and it is now widely (2012). The effects of influenza
available for a small charge (or vaccination on immune
Nasal spray side-effects include a function in patients with chronic
free if your are eligible) at many
runny or blocked nose, headache, pharmacies such as Boots and fatigue syndrome/myalgic
tiredness and loss of appetite. Lloyds. encephalomyelitis. International
More serious side-effects Journal of Clinical Medicine, 3, 544
GP surgeries and pharmacies will
include convulsions, transient – 551.
be following the social distancing
thrombocytopenia (lowered rules and only seeing one person Prinsen H et al. (2012) Humoral and
level of platelets in the blood), at a time. So most will require cellular immune responses after
encephalomyelitis, vasculitis some form of advance pre- influenza vaccination in patients
(blood vessel inflammation), booking. If you are housebound, with chronic fatigue syndrome.
neuritis (nerve inflammation) and you can ask your GP surgery if BMC Immunology, 13, 71.
Guillain Barre syndrome. These someone, possibly a practice
complications are much more nurse, could come out and do the PNEUMOCOCCAL
unusual. vaccination in your own home.
VACCINATION
The flu vaccine cannot cause flu.
HOW CAN YOU This vaccine is now being offered
REDUCE THE RISK OF to people over the age of 65 and
those with other health conditions
CATCHING FLU? (e.g. heart and lung disease) that
place them at increased risk from
Children are a major source
this bacterial infection. It provides
of infection – because flu is
very valuable protection against
essentially a disease of childhood.
an infection that can cause a
So, just as with COVID-19, keep
severe type of pneumonia.
a safe distance – at least two
metres – from anyone who is I know of a small
coughing, sneezing, or may have number of people
flu, and avoid crowded public with ME/CFS who
places. The virus can also be have received the
4 © ME Association 2020. Reproduction is not allowed
without the written permission of The ME Association
FLU VACCINE AND ME/CFS: INFORMATION FOR 2020 – 2021 October 2020
pneumococcal vaccination and
we have not received any reports
of significant adverse reactions
occurring to this vaccine so far.
ME CONNECT
However, that is not a guarantee
that you will not have any side-
effects, or an exacerbation of your
ME/CFS symptoms.
If there are good indications We’re here to help 0344 576 5326
for having this protection (and
a pneumococcal infection
would probably cause a Do you need to talk?
significant relapse of ME/CFS), ME Connect is the telephone helpline
this is something that you should service of the ME Association.
seriously consider and discuss with It provides information and support for
your GP. people with ME and those
who live with or care for them.
Please note that it is normally
sensible to defer being vaccinated ME Connect provides a safe and
if you are currently having any understanding environment for people
with ME so that they know they are
significant flu-like symptoms (i.e.
being heard and understood.
sore throats, tender glands, feeling
feverish) in relation to your ME/CFS
More information on “Thank
you for being there,
pneumococcal vaccine can be you provide a wonderful
found here: https://tinyurl.com/ service”
y928j2xw
“MEConnect gave me
information, reassurance
FURTHER and the tools to
cope”
ME Connect is a member of the
INFORMATION Helplines Partnership
which promotes high standards.
The NHS website gives helpful and
more detailed general guidance
on flu vaccine and how to obtain
CALL 0344 576 5326
flu vaccine: 10am-12noon, 2pm-4pm, 7pm-9pm
https://tinyurl.com/y2tdpvna
every day of the year
Boots flu vaccine service:
https://tinyurl.com/y5v6lcdo Calls cost the same as other standard landline numbers (starting 01 or 02).
If you have a call package for your landline or mobile phone then
Lloyds flu vaccine service: calls will normally come out of your inclusive minutes.
https://tinyurl.com/y3rhckqv
The ME Association
September 2020 July 2020 August 2020
UNIVERSAL CREDITNUTRITION EXPLAINED ASSESSMENT
DISCLAIMER
ME CONNECT
Information and Support Line IN ME/CFS
A benefits briefing from The ME Association
website shop:
by Ann Innes
ME CONNECT HELPLINE: 0344 576 5326 by Hilary Briars by Dr Charles Shepherd
U
ME Connect Manager Hon Medical Adviser to the MEA
niversal Credit (UC) is a Universal Credit will normally be
term medical conditions. And
INTRODUCTION payment to help ME withCONNECT
your paid monthly in a single payment,
ARE SOME PEOPLE having any form of malnutrition
living costs. It’s normally directly to the person making the
Neil Riley, Chairman of The ME paid monthly and you Hilary may be able ME claim.
Briars, Connect’s WITH M.E. AT RISK
If you think you will have a has an important adverse effect
Association, writes: to get it if you’re on a Manager,
low income, writes:problem managing your money, on health. This includes decreased
OF BECOMING
Medical information contained
out of work or cannot work because you can ask for fortnightly or even immune system function, decreased
When you I am very proud of the fact that
you are disabled. muscle strength, delayed wound
are ill with ME Connect takes thousands of MALNOURISHED?
weekly payments. You can also ask
for your rent to go straight to your healing and an increased risk of
a chronic It is a relatively new, non-taxable
calls each year and I’m equally
landlord. falls.
The ME Association has the largest
condition like benefit for people of working proud of our volunteers who There is a great deal of positive
ME there are age that has been introduced respond to will be at thediscussion
to theseIt calls. DWP’s discretionon ME/CFS internet It will also cause a further reduction
many things replace means tested benefits as to whether they forums allowabout
these the benefits of in energy levels and exacerbate
in this leaflet is not intended
about; giving help to those Council
(excluding who TaxWe are all really pleased to be
Reduction, unproven special diets, restrictive
you want to requests. So any written evidence cogni-tive problems – both of
need it at a difficult
which time in claimed
is still their able to help
separately via so many people and with exclusion diets, and dietary
know. What from a health professional to back which areCredit
This guide to Universal very relevant in ME/CFS.
lives. your local authority). ME and those who care for them.
treatments up your reasons supplements.
for needing help was written by Ann Innes,
However, we would like to help So a proper nutritional assessment,
Our volunteers do UCthatis inevery managing your finances or for
selection of ME/CFS advice leaflets
work, where its infancy andmore legislation (pictured above), consultant
people and thus we need At the same time, very little which includes both food and
can I find day. Why? Because it is intensely
is changing all the time. Therefore, rental payments to your landlord, welfare rights adviser to The
more volunteers to take calls.attention is being paid to the fluid intake, should form part of
a doctor who understands ME, rewarding for them pleaseto help
be awareothersthat the would be useful to submit with your ME Association.
dangers of cutting out or reducing the medical assessment and on-
to be a substitute for
where can I get guidance on and they want toinformation
contributein this leaflet, Thewhilst request.In a short
work is rewarding.
the intake of specific food groups
Ann has beengoing
supporting
care of everyone, especially This guide to nutrition in Severe
filling in my benefit claim. Even something in their lives to
correct atsociety. callcould
time of writing, you cango help a person with people with ME/CFS to claim
their problem orCAN help a Idistressed
CLAIM
By helping othersout it in such as dairy or wheat. And those with moderate or severe ME/ ME/CFS was written by Dr
more important is to hear another ofturn
dateenriches
at any time.
their lives. caller get through their day. With people with more severe the ME benefits they
CFS. are
Andentitled
it must involve a dietitian, Charles Shepherd (pictured
voice, someone who understands
UNIVERSAL CREDIT?
in the UK on:
For the very latest information to since 2012 preferably
– when sheone waswho has experience
how ME affects everyday life. so muchyou information to hand may and have significant problems above), Trustee and Hon
I hope you will come and join
can access the Govt. website here: in obtaining groceries, preparing employed byof the Stockport
seeing peopleMEwith ME/CFS.
Someone who will listen. an understanding You ofmust
ME, be we ofcanworking age. This Medical Adviser to The ME
our volunteer team. They are a
https://www.gov.uk/universal-credit Group.
really help people. usually means meals, and even 18 eating a full Association.
medical advice or treatment
lovely friendly bunch. Many have you must over The assessment should take
The role of ME Connect is simple. It meal.
Means-tested benefits are those She is now in account
private practice
is there to support people with ME or have had ME and all of them So many callers but say under pension
to us “Thank age to claim. of all the factors that © The ME Association, 2020
benefits awarded to households However, in some circumstances it helping disabled people
and their carers to make informed understand the illness. You’ll make you so much for giving your time, All ofit this could be having an increase the risk of malnutrition in All rights reserved.
on a low income with savings and access benefits, social care
choices. It is there to listen to a friends and you’ll learn a lot. Just is just so nice to isspeak
possible to claim
to someoneadverse fromeffect
age 16. onFortheir overall vulnerable groups of people with
capital below £16,000. example, people estranged from support, appropriate housing Reproduction, in full or in part,
caller and try to understand all the pick up a phone or email us. We who really understands what Ihealth. am So do we need to start long-term medical conditions.
their parents orlookingwho are and other services. is not allowed without the
issues they are facing. Each year it would love to hear Thefrom you.
means-tested going
benefits UCthrough.”
has atdisabled
diet and nutritional Physical factors include the
may be able to claim from 16 years © The copyright for this leaflet written permission of The ME
replaced are: status in ME from both a clinical
from your doctor.
does this for thousands of people.
Medical Management
Many of our volunteers
of age. have presence of nausea and/or loss Association.
Of all that The ME Association and research point of view? remains vested with Ann Innes.
of appetite, swallowing difficulties
does for people with ME it is our “It is really ngoodIncome support (IS);appreciated the fact that they
that you From 15
can do their training and take May 2019, if you are in a and bowel symptoms that involve the ability to obtain food
Telephone Helpline of which I am n Income-based jobseeker’s
offer this service, it is such a calls in their owncouple home.and SO WHAT’S THE
Othersone member is below
You must not bemay affect both
in education digestion and
unless and prepare meals.
proudest. It is what a charity is all allowance (IBJSA); and the other above pension age,
relief to speak ntoIncome-related
someone whoemployment have said that helpline work has
the couple
ANSWER?
will no longer be able to
you are a parent,absorption of food.
disabled student
The assessment should record the
given them anda sense of purpose or a young person on a non- factors can include
understands.”
support allowance (IRESA); claim pension
and a feeling of job satisfaction. credit until they have
This is a very important advanced
Psychological
question. course (e.g. A-levels, person’s normal daily intake of
Mental Health
both exceeded working age and depression – if this occurs – and its food and fluid in terms of total
n Housing benefit (HB);Please do join us; The whole issue of nutritional GCSEs, NVQs, etc). For a full list
willyou will be
instead given
have to claim Universal effect on appetite. Social factors calories, carbo-hydrates, proteins,
assessment in people with ME/CFS,
of non-advanced and advanced
n Child tax credit (CTC) a warm welcome! Credit (if they meet the eligibility fats, sugars, vitamins and minerals
The ME Association
along with the risk of malnutrition courses, please follow this link
CALLn OUR Working tax credit (WTC).
criteria).
in those with more severe ME/CFS,
to the relevant page at the UK and micronutrients.
ME CONNECT “Thank you soYour much for giving
savings and capital must
is something that I will be Government
raising website: https://tinyurl. For example, although fruit and
This means that if you are making
SUPPORT LINE up your time beto work
under on this
£16,000.
during Savings and
the preparation com/y2gx58nb
of the new vegetables are very healthy they
ME Connect
a new claim or if you are currently
capital includeNICE any guideline
cash, money on in ME/CFS.
on any of these benefitsHelpline. and have It is just so nice to You must not already be in receipt contain very few calories. And
accounts or other savings or capital
0344 576 5326 certain changes of circumstances, of Severe Disability Premium. This while dairy has become a ‘bad
speak to someone you mightwhohave really
Asbutthisexcludes
is such an theimportant and
recommends that you
you will be asked to claim UC is because there is currently no food’ in the eyes of some it is
home in whichneglected you live. topic, I have prepared
instead of the old ‘means-tested’
365 days a year understands what I am going a fairly detailed reply. equivalent amount in UC. People
an important source of calories,
equivalent. You must be on a low income. who currently receive a severe protein and calcium. Fluid intake
10am-12noon, 2pm-4pm, 7pm-9pm through.” Firstly, it’s worth noting that should be in the region of five or
Diet & Nutrition
The ME Association n 7 Apollo Office Court, Radclive malnutrition is surprisingly
Road, Gawcott, Bucks common
MK18 4DF n 01280 818 963 more cups per day of water, juice,
www.meassociation.org.uk among peoplenwith
admin@meassociation.org.uk chronicCharity
Registered long- Number 801279 coffee, tea, etc.
The ME Association n 7 Apollo Office Court, Radclive Road, Gawcott, Bucks MK18 4DF nn01280 818 963
© ME Association 2020. Reproduction is not allowed without the written permission of The ME Association
always consult your doctor or
www.meassociation.org.uk n admin@meassociation.org.uk n Registered Charity Number 801279 The ME Association n 7 Apollo Office Court, Radclive Road, Gawcott, Bucks MK18 4DF n 01280 818 963
© ME Association 2020. Reproduction is not allowed without the written permission of The ME Association 1 www.meassociation.org.uk n admin@meassociation.org.uk n Registered Charity Number 801279
1 © ME Association 2020. Reproduction is not allowed without the written permission of The ME Association
General Information
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healthcare professional about
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We also recommend that ‘To Whom It May Concern’ letters
any medical information
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provided by The MEA is, where
gifts from our website shop: https://
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