Herbs and Vaccines: Can herbal medicines make vaccines more effective?

As the vaccines debates rage, one thing we can probably all agree on: If you get them, you want them to work. When you are navigating the vaccine debate it can be discouraging to hear about the occurrence of a vaccine not providing the immunity expected. Is there anything we can do to increase our effective response to the vaccine?

Vaccines work in a variety of ways, but the general idea is to expose your immune system to a pathogen (or antigenic region of one) so your body can recognize it and mount a sufficient immune response to convey immunological memory. There is a fine line between something which is toxic or harmful to the immune system and something which so benign that your body doesn’t even notice it is there. Of course, we all react individually, so public health recommendations call for measures which are most likely to convey immunity to most people. At least in the most likely scenarios.

But what happens when that measure of protection fails? There are a couple of things which can happen which render a vaccine less effective or ineffective. First, the vaccine is manufactured for a predicted pathogen which tends to mutate, such as the influenza virus, and the prediction wasn’t very accurate. This would make the vaccine less effective. The other common scenario would be that, for any of variety of reasons, the individual did not mount a sufficient immune response to the vaccine and as a result did not develop immunological memory and immunity.

The second scenario is where vaccine adjuvants come in. A vaccine adjuvant is a substance that is added to the vaccine to increase the body's immune response to the vaccine. In the US, the only adjuvants which are currently licensed are aluminum gels or aluminum salts, although a variety of things were previously used (CDC). The balance here is to use a limited amount of a less desirable substance to induce an adequate immune response without causing any unnecessary toxicity or harm.

So, where does herbal medicine come into this mix?

Herbal medicines are cunning little things and their actions in the body are diverse and often ingenious. Many herbs which are considered immunologically active have surface proteins which induce the body’s immune response without being harmful or toxic. In essence, these herbs have polysaccharides which look similar to those harmful to the body but are benign. They induce the body to mount an immune response and in the process increase your immune activity and ability to monitor its exposures. Can you see where I am going with this?

In a series of studies, Du et al looked at the polysaccharides from Astragalus membranaceus (a commonly used immune-modulating medicinal herb) and noted that they significantly enhanced the immune response to a hepatitis B vaccination. Another study looked at an herb used in traditional African medicine, Alchornea cordifolia, in a similar scenario and also concluded that the herb showed promise and warranted further investigation as a vaccine adjuvant. Repeat with investigations intoLycium barbarum as an adjuvant as well as the exploration of “ginseng saponins” for use in increasing dendritic maturation, the type of immune response we are generally looking for in adjuvants.

Why is this such good news? One of the main reasons is the minimal toxicity and overall benefits of these plants. With other adjuvants there is the desire to minimize the amount because of their potential harm – with plants this may not be the case. In essence: Why not take immunologically active botanicals concurrently with vaccines?

There are still a lot of things we don’t know about this. We don’t know which plants can be used this way (based on what I have read, I would hypothesize that most immunologically active herbs and fungi could be considered for use). We also don’t know if concurrent oral use would have a comparable effective to an injected adjuvant (please don’t try that at home!). But we do know that it can’t harm with the excellent safety record of something like Astragalus membranaceus.

As a clinical herbalist, I would consider taking herbal medicines we call “immune tonics” which support healthy immune function prior to, during, and after immunization. Herbs I may consider would be astragalus (Astragalus membranaceus), reishi (Ganoderma lucidum – actually a fungus), American ginseng (Panax quinquefolius – which is threatened so only but organically grown) and licorice (Glycyrrhiza glabra). In particular astragalus and reishi are safe and well tolerated by children. Of course, this is something which needs to be considered within the context of your individual physiology and is a good thing to bring up with your herbalist and your primary care provider.

There is another way which herbs may be able to better increase the effectiveness of a vaccine, and there is some irony here because as herbalists we are constantly trying to avoid the model of substituting herbs for drugs (Why? It’s not a good idea to do this if you have a genuine need for pharmaceuticals, and more importantly it’s just not how herbs work, they work in an entirely different model of application based around supporting health, not treating disease). It’s looking at the relationship of the commonly recommended “Tylenol” for vaccine pain and the effect it may be having on the vaccination itself.

Many doctors recommended the use of an OTC analgesic such as Tylenol / acetaminophen / paracetamol for the pain and discomfort associated with many vaccines (often locally, and especially with those administered intra-muscularly). A number of papers have examined the effects on the immune response induced by a vaccine. And, in general, it’s not good news. Das, Panigrahi, and Naik reviewed the research on prophylactic antipyretic administration on antibody response and concluded that, “Though prophylactic antipyretic administration leads to relief of the local and systemic symptoms after primary vaccinations, there is a reduction in antibody responses…” and that “Recent study [sic] finds that they may also decrease the antibody responses to several vaccine antigens.” Meaning that in some cases, the attempt to mitigate the discomfort of the vaccine is discounting the resulting immune response and rendering one less immune to the disease you were vaccinated for.

Another study by Doedee looking at the timing of the administration of these medications found that “Only prophylactic paracetamol treatment, and not therapeutic treatment, during vaccination has a negative influence on the antibody concentration after hepatitis B vaccination in adults. These findings prompt to consider therapeutic instead of prophylactic treatment to ensure maximal vaccination efficacy and retain the possibility to treat pain and fever after vaccination.” They defined the therapeutic use of NSAID’s to be at 6 hours post-vaccination. So, if you are going to use them, wait a good many hours after the administration of a vaccine to use them. Or try herbs!

Clearly, there is a lot more investigation to be done in these areas, but the data thus far points to the desire to minimize pain through the use of substances which have an activity which is different from that of NSAID’s. Coming from a traditional herbal medicine perspective, because we really don’t have the data to make any other types of recommendations, there are a number of ways an herbalist may choose to mitigate the pain associated with a vaccine. Some of the most broadly applicable and safe measures I would consider are the use of gentle nervines like chamomile (Matricaria recutita) or linden (Tilia europa) which relax and calm and are used extensively for teething babies. Other possibilities include the use of botanical anti-inflammatories such as turmeric (Curcuma longa) or calendula (Calendula officinalis) which can be used both locally and internally.

This type of multi-paradigm approach to the places where conventional and complementary medicine meet is often overlooked, and given the safety and tolerability of botanicals, at the best case scenario they may allow you to receive full benefit from your choice to vaccinate and in the worst case they will offer you a better supported immune system or a calmer disposition. Can we agree that it’s worth a try?

Chen Z, Lu J, Srinivasan N, Tan BK, Chan SH. Polysaccharide-protein complex from Lycium barbarum L. is a novel stimulus of dendritic cell immunogenicity. J Immunol. 2009 Mar 15;182(6):3503-9. doi: 10.4049/jimmunol.0802567. PubMed PMID: 19265128.

Das RR, Panigrahi I, Naik SS. The effect of prophylactic antipyretic administration on post-vaccination adverse reactions and antibody response in children: a systematic review. PLoS One. 2014 Sep 2;9(9):e106629. doi: 10.1371/journal.pone.0106629. eCollection 2014. PubMed PMID: 25180516; PubMed Central PMCID: PMC4152293.

Doedée AM, Boland GJ, Pennings JL, de Klerk A, Berbers GA, van der Klis FR, de Melker HE, van Loveren H, Janssen R. Effects of prophylactic and therapeutic paracetamol treatment during vaccination on hepatitis B antibody levels in adults: two open-label, randomized controlled trials. PLoS One. 2014 Jun 4;9(6):e98175. doi: 10.1371/journal.pone.0098175. eCollection 2014. PubMed PMID: 24897504; PubMed Central PMCID: PMC4045752.

Du X, Zhao B, Li J, Cao X, Diao M, Feng H, Chen X, Chen Z, Zeng X. Astragalus polysaccharides enhance immune responses of HBV DNA vaccination via promoting the dendritic cell maturation and suppressing Treg frequency in mice. Int Immunopharmacol. 2012 Dec;14(4):463-70. doi: 10.1016/j.intimp.2012.09.006. Epub 2012 Sep 21. PubMed PMID: 23006659.

Du X, Chen X, Zhao B, Lv Y, Zhang H, Liu H, Chen Z, Chen Y, Zeng X. Astragalus polysaccharides enhance the humoral and cellular immune responses of hepatitis B surface antigen vaccination through inhibiting the expression of transforming growth factor β and the frequency of regulatory T cells. FEMS Immunol Med Microbiol. 2011 Nov;63(2):228-35. doi: 10.1111/j.1574-695X.2011.00845.x. PubMed PMID: 22077226.

Nworu CS, Esimone CO, Tenbusch M, Nabi G, Proksch P, Uberla K, Temchura VV. Adjuvant properties of AcF1, an immunostimulant fraction of Alchornea cordifolia extract. Immunol Invest. 2010 Jan;39(2):132-58. doi: 10.3109/08820130903496793. PubMed PMID: 20136620.

Takei M, Tachikawa E, Umeyama A. Dendritic Cells Promoted by Ginseng Saponins Drive a Potent Th1 Polarization. Biomark Insights. 2008 Apr 18;3:269-286. PubMed PMID: 19578511; PubMed Central PMCID: PMC2688358.