Should Individuals with Unexplained Fever and Infections Get Vaccinated?

Please advise on the administration of the COVID-19 vaccine for individuals with this type of constitution?

Hello Dr.
Gao, I have been experiencing unexplained fevers since 2014, with daily episodes lasting at least 6 hours, usually not exceeding 38.5 degrees Celsius.
During severe episodes, I can have fevers for up to 12 hours, accompanied by extreme fatigue.
Initially, I was referred from a local hospital to National Taiwan University Hospital, where blood tests consistently showed elevated white blood cell counts (11,000 to 13,000) and slightly elevated inflammatory markers (2 to 3).
A series of tests revealed no significant abnormalities, but a GA67 whole-body scan indicated inflammation in the parotid gland, which I did not feel.
The ENT department at NTU stated that the gland was hardly swollen and unlikely to be the cause of my fevers.
Ultimately, no specific diagnosis could be established, and it was suggested that there might be an issue with my immune system.
I am reluctant to take steroids, and using quinine has significant side effects.
After two years of follow-up blood tests, I stopped going.
In the past two to three years, the frequency of my fevers has decreased, but I still occasionally experience fevers from evening until dawn, particularly during seasonal changes.
Over the past decade, I have been prone to infections, with ear or nasal cleaning often leading to complications.
Since 2016, I have had three noticeable infections of the left parotid gland, all treated with antibiotics, but CT scans did not reveal any stones.
In early 2020, I was hospitalized due to a severe parotid gland infection, and CURAM-level antibiotics were insufficient to control the infection.
Additionally, I have experienced mild allergic reactions to contrast agents during an IVP for urinary tract imaging.
Given my history of unexplained low-grade fevers and susceptibility to severe infections, do you think I should receive vaccinations? I am concerned about an overreaction of my immune system and have not received any doses yet.
If vaccination is advisable, which brands would you recommend? Thank you for taking the time to clarify my concerns, and I wish you good health and safety throughout your life.

Mr. Huang, 30~39 year old female. Ask Date: 2022/08/12

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
I believe that if possible, you should continue to follow up at the Rheumatology Department of National Taiwan University to try to identify the cause of the chronic fever.
I have a patient who also experienced persistent chronic fever, initially thought to be due to a potential immune dysfunction, but later it was discovered that there was an intrahepatic bile duct obstruction.
After treating the biliary issue, the fever was better controlled.
In cases of unexplained fever, I would recommend not receiving the COVID-19 vaccine at this time.
Especially given that COVID-19 symptoms are currently relatively mild, the side effects of vaccination are difficult to predict, and the risks are higher when there is a suspicion of underlying immune disorders.
Additionally, whether it is worth taking on the risk of side effects to potentially avoid mild symptoms is a matter of personal judgment.
That is my opinion.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/08/12

More Info

When dealing with unexplained fevers and recurrent infections, the decision to get vaccinated can be complex and should be approached with caution. Your situation, characterized by persistent fevers, elevated white blood cell counts, and a history of infections, raises important considerations regarding your immune system and overall health.

Firstly, it is essential to understand that vaccines are designed to stimulate the immune system to produce a protective response against specific pathogens. In individuals with a history of unexplained fevers and recurrent infections, there may be concerns about how their immune system will respond to vaccination. However, it is also important to recognize that vaccines can provide significant benefits, especially in preventing serious infections that could further complicate your health status.

Given your history of recurrent infections, particularly with the salivary glands, it is crucial to consider the types of vaccines that may be beneficial. For instance, vaccines for influenza, pneumococcus, and other common pathogens can help reduce the risk of severe infections that may exacerbate your condition. The flu vaccine, in particular, is recommended annually, especially for individuals with underlying health issues, as it can prevent complications from respiratory infections.

Regarding your concerns about immune system overreaction, it is worth noting that most vaccines are well-tolerated and have a favorable safety profile. While some individuals may experience mild side effects, such as fever or fatigue, these are generally short-lived and indicate that the immune system is responding appropriately to the vaccine. In your case, it may be beneficial to consult with an immunologist or an infectious disease specialist who can evaluate your specific immune function and provide tailored recommendations.

As for the choice of vaccine brands, it is advisable to discuss this with your healthcare provider, who can consider your medical history, any previous allergic reactions (such as your mild contrast agent allergy), and your current health status. They can recommend specific vaccines that are appropriate for you and monitor your response to vaccination.

In conclusion, while your history of unexplained fevers and recurrent infections may raise concerns about vaccination, it is generally advisable to consider vaccination as a preventive measure against serious infections. Consulting with a specialist can help you make an informed decision that balances the risks and benefits of vaccination in the context of your unique health situation. Vaccination can be a crucial step in protecting your health and potentially reducing the frequency and severity of infections in the future.

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