Tag: vaccine

RSV(P)

Respiratory syncytial virus (RSV) is a virus you may never have heard about, but you’ve probably had. It affects the upper airways with cold like symptoms, but it can cause a severe pneumonia, particularly in infants, older adults, and those with lung disease, or who are immunocompromised. By two years old almost all children have been infected. It causes roughly 2/3 of the number of hospitalizations and deaths as that cause by influenza (the flu). It tends to peak around the same time as influenza and COVID-19, constituting a triple threat.

There is a monoclonal antibody for infants and young children, but this year for the first time adults 60 and older can get a vaccine for RSV.

There are currently two vaccines approved, Abrysvo from Pfizer,and Arexvy from Glaxo Smith Kline’s (GSK). Abrysvo is also approved for women who are 32 to 36 weeks pregnant during September through January (to cover when RSV is typically active). Full disclosure – I was a primary research investigator for one of the Pfizer’s studies, but I make no money from sales of the product.

In one study with Arexvy and influenza vaccines there were two cases of acute disseminated encephalomyelitis (ADEM), and one case of Guillain-Barré syndrome, serious neurologic side effect seen with some other vaccines, and sometimes for no apparent reason. It’s not clear if it was due to the RSV vaccine component, the influenza component, the combination, or unrelated. There were 3 reported cases of Guillain-Barré in the Abrysvo studies.

Although there were few reported cases of Guillain-Barré in the RSV studies, given the severity of the side effect one needs to consider risk versus benefit. For those at high risk, I think the benefit outweighs the risk. It’s harder to know what to do for those who are approved to get the vaccine, but are otherwise at low risk, such as those in their 60’s who are generally healthy. Currently for those patients I’m not encouraging them to get vaccinated, and if they ask, I say they may want to consider skipping it this season. By next season we should have a much better idea of the true risk. If you’re 60-years-old or older, you should discuss with your physician/provider.

It’s not yet known how long the vaccine provides adequate protection, but probably for 2 years or longer. In fact when the companies realized the vaccines would last more than one year, they raised their prices as their original profit calculations assumed people would need yearly vaccinations.

Presidential Politics and Influenza Vaccinations

Recently a patient of mine expressed frustration with the presidential campaign, saying the other side wouldn’t listen to facts and just believed what they wanted to believe.

Knowing that she had repeatedly refused to get a flu shot, I asked her in that case if she’d like to get one, given that scientific studies have shown that the benefit outweighs the risk for most people. Although she hesitated, I unfortunately could not convince her.

Going Viral is Bad for Your Health

A few days ago CNN hosted the 2nd Republican presidential debate. Unfortunately, the topic of vaccines came up. Donald Trump had previously suggested that vaccines can cause autism. When asked about this he responded, “You take this little beautiful baby, and you pump — I mean, it looks just like it is meant for a horse, not for a child, and we had so many instances, people that work for me, just the other day, 2-years-old, beautiful child went to have the vaccine and came back and a week later got a tremendous fever, got very, very sick, now is autistic.”

He went on to say that he’s not against vaccines, but just thinks the same total dose should be given in smaller doses and spaced out more.

Donald Trump is not a doctor, so why is he giving medical advice? Republican presidential hopeful Dr. Ben Carson, a retired pediatric neurosurgeon, said, “We have extremely well-documented proof that there’s no autism association with vaccinations. But it is true that we are probably giving way too many in too short a period of time.” Although he at least discredited the theory that vaccines cause autism, he agreed with an alternative dosing schedule. Fellow debater Senator Rand Paul, who is also an ophthalmologist, said, “I’m all for vaccines, but I’m also for freedom. I’m also concerned with how they’re bunched up.”

The American Academy of Pediatrics put out a statement saying there is no alternative dosing regimen. Based on lots of scientific literature and much expert opinion, the current schedule was designed to optimize benefit versus risk. Delaying vaccinations increases the risk that children will catch the disease before they have been protected. It’s also psychologically more traumatic. Studies have shown that a child is just as traumatized if they get one shot or three shots at one visit, but 3 visits with a shot at each one is worse than one visit where they get 3 shots. Spacing out the vaccines also means more cost, and more exposure to sick kids each time they are brought for a vaccination.

So where did this idea of spacing out vaccines come from? Pediatrician Dr. Sears published “The Vaccine Book” in 2007 that proposed alternative vaccination schedules.  But that was just his opinion, and was not based on studies to show that it’s safe and effective.

The belief that vaccines can cause autism came from a study published in 1998, that has since been retracted because it was found to be based on fraudulent data. Some people still choose to believe it.

You might argue that spacing out the vaccines is better than nothing. That’s true, however that’s like saying that only wearing seat belts every other day is better than nothing. That’s true, but it’s still much better to use it the way you’re supposed to.

Republicans don’t have good record when it comes to vaccines. Four years ago Rep. Michele Bachmann (R-Minn.) attacked Texas Governor Rick Perry for mandating that young women get HPV (human papilloma virus) vaccine. He later backed down. That vaccine prevents women from getting cervical cancer.

I may not agree with politicians when it comes to issues regarding such things as  immigration, taxation, use of the military, domestic spying, or abortion, but those are legitimate areas for politicians to debate and legislate. They can even debate the wisdom of the Affordable Care Act (ObamaCare), but they should stay out of the science of medicine. That includes politicians who happen to be physicians, unless they are stating medical facts, rather than pandering to what their constituents want to hear.

Medication Small Print

WhenSolu-Medrol_crop I give a cortisone injection, I have to document it in our electronic medical records. I’ve always included the dose, how administered (intramuscular), and the lot number. This week my company added the requirement that we include the NDC number, as insurance companies wanted the information.

It’s just one more administrative requirement, but what really makes it bad is trying to read the number off the bottle. As you can see from the photo, the font is very small! I suggested the policy was age discrimination, but that didn’t get far.

Avoiding the Flu Shot

A patient of one of my colleagues, away on vacation, came in for a problem he was having. We were in a fairly severe flu season and I noticed he had not been vaccinated. I asked him if he wanted a flu shot and he replied that he can get it for free at work. When I asked him if he was going to get one, he said no, that he didn’t believe in flu shots.

Right for the Wrong Reason?

In 2007, Texas Governor Rick Perry signed an executive order mandating that teenage girls be vaccinated with Gardasil, a vaccine that helps prevent cervical cancer by providing protection against Human Pappillomavirus, or HPV. This was subsequently overturned by the Texas legislature. Now it’s a matter of discussion among Republican presidential candidates. Representative Michelle Bachmann has criticized not only that, ““To have innocent little 12-year-old girls be forced to have a government injection …is just flat out wrong,” but has also suggested that he was motivated by political donations from pharmaceutical company Merck.

We’ll have to see how things play out in regards to whether Governor Perry made his initial decision because of political donations, but it least has the appearance of impropriety.

From a medical point of view, I think he was right to mandate vaccination against HPV, even if he did so for the wrong reason. According to the CDC and the American Cancer Society, at least half of sexually active people will get infected with HPV in their life. Half of those people are infected between 15 and 24 year of age.

In the United States, about 12,000 women are diagnosed with cervical cancer, and 4,000 die from it, each year. HPV causes most of these, as well as many cases of anal and oropharyngeal (mouth and throat) cancer, and genital warts.

As a father of daughters, I get that when they’re 10 to 12-years-old, you don’t want to think of them being sexually active. But most people eventually are, and you can’t be certain that it will only be with one uninfected person the rest of their life. Once they’re infected, it’s too late.

The policy for vaccination against HPV should not be different than for other infectious disease, such as tetanus, polio, measles and chicken pox. If you love your children, you should seriously consider vaccinating them. Even if he had ulterior motives, I think Governor Perry had the right idea.