Dr. Kevin Most: Vaccines

Bennett get a flu shot.

We have discussed vaccinations numerous times in the past and at times it can be confusing so a quick primer as well as some new information on the delivery system for vaccines is timely. Believe it or not everyday we add 10,000 individuals to Medicare as we have Baby Boomers turning 65. The reason I couple this with vaccinations is that many vaccines are important to the health of seniors. We will touch on a few that protect you, as well as others that are needed to protect people around you.

First how about some history. Do you know why these shots we get are called Vaccines? A little history, in the late 1700’s parts of the world were being hit with outbreaks of smallpox. This was a viral illness that killed as many as 400,000 people each year, and with no treatment there was little that could be done. Between 20-60% of individuals with smallpox died from the illness and it was almost always fatal in children. Dr Edward Jenner noted that his milkmaids who had contracted cowpox did not seem to be affected by the smallpox virus. He was a very highly respected physician, in 1796 he convinced his gardener to allow Jenner to inoculate his son with cowpox. Two months later he then inoculated the same boy with smallpox and the child did not end up with smallpox. In order to prove himself right he inoculated the same individual many times over the years to show that the individual now had immunity. The boys name was James Phipps and perhaps we should be calling vaccinations “Phipps”

Another area we have to understand about vaccines is that they are not 100% effective, although we all think that I got the flu shot so I can’t get the flu, or I got my shingles shot so I can’t get shingles, this is not true. The effectiveness of the vaccine varies from person to person and in the case of Flu vaccines varies from year to year. The variation in part is based on the immune response of the individual and in the case of influenza how accurate is the strain in the vaccine to the strain that we are seeing in the public. The vaccine works by showing the body a portion of a virus in the form of the shot. The body then reacts to this foreign injection and learns how to defend itself from a future exposure to the same virus. So the bodies immune system sees it as foreign and remembers that exposure, the next time it is exposed to that virus, the body is ready and makes antibodies to fight the virus before it has a chance to get in and multiply, thus causing infection. So all of this has to work to get a good protective response, in some cases the body does not make a good response, in other cases the virus changes a little bit and makes the vaccine less successful.

The other thing we are learning is the body in some cases needs a booster to remind it about a previous vaccination. We thought that many vaccines would give us life long immunity but we are finding that some may need to be reminded in order to give a good response, thus the booster is needed.

So vaccines are not 100% but they are much better than nothing.

The most important is that we understand that vaccines often protect us from illnesses that can harm or hurt us and that they are safe to receive.

Lets just touch on a few of the vaccines that may help us stay healthy and may be confusing to us.

Shingles- This is a illness that causes a very painful rash. It is caused by the chicken pox virus that lies dormant in our body. The virus will cause the inflammation and rash often when we are ill or not in perfect health. It also will hit seniors more as their immune system can be weakened and not able to keep the virus in check. That being said we do see this in many younger adults as well, often it is noted when an individual is under a lot of stress or in an immunocompromised condition, so it is not only in Seniors. Interesting thing about shingles, it will be found running along one nerve, so it stays only on one side and is predictable as to how far and where it will end up.

We see over 1 million cases of shingles so by no means it is rare. We do have a vaccine for shingles and it is indicated for individuals over the age of 60. The CDC has not made a recommendation for the 50-59 yo group. The vaccine is actually fairly new with its debut in 2006, so although it is thought that this may be a one time vaccine time will tell to see if a booster is needed and many expect that there will be a recommendation for a booster. Even if you have had shingles in the past you can still receive the Shingles vaccine. Again this vaccine is not 100% effective but studies have shown it will reduce the chance of getting shingles and the long term pain some patients have.

Pneumonia vaccine- this is a set of vaccinations that helps prevent a bacterial infection in your body. Infections can be caused by many different bacteria and this vaccination protects you from one of the most common cause, a strep bacteria that is often found in our body and can cause many different infections. This bacteria has 90 different types, yet the vast majority of infections are caused by one of ten strains. Pneumonia can be a very dangerous infection so any protection one can get is a good idea. There are two vaccines for this coverage, and between the 2 vaccines you are covered for over 30 of the strains. With these vaccines there are timing implications. The first one you should get is the PCV 13, and it should be followed by the PPSV23. The timing of the second vaccine should be discussed with your doctor. For some patients the timing between the shots may be up to a year. You should not receive both vaccines at the same time.

Tdap vaccine- we all have heard of a tetanus shot and the need to have a booster every 5-10 years, well now we have added the pertussis portion back into this vaccine. Initially we thought that our pertussis shot as a youth would give us life long immunity but now we are seeing outbreaks on college campuses showing us that this is not the case. Pertussis or “whooping cough” can be treated and cured with antibiotics, however our concern now is around children and more importantly new borns. Whooping cough can be deadly to a newborn, So anyone getting ready to have a new born or grandparents should make sure they are immunized against pertussis. CDH actually gives the immunizations to the new fathers while the baby is still in the hospital, if they had not done it before.

Flu Vaccine- every fall the new flu vaccine comes out and its composition is based on the projected flu season ahead. We have discussed it many times and the biggest message is to get vaccinated to prevent the 10 days of agony the flu can cause. In seniors and young children influenza can be more serious than 10 days of fever and body aches.