Dr. Kevin Most: Vaccines and the Future

Dr. Kevin Most

Flu season- expected to be one of the worst flu seasons in decades, reasons are many

1. Early flu season allowed for rapid spread across the country with holiday travel, 45 states have wide activity now
2.
This year we are seeing a peak of Influenza B early, which is unusual
3. Influenza A is now ramping up, concern is we are at classic peak levels already
4.
Influenza A can be more concerning for Seniors and children, so as that increases concern is raised
5. Influenza B strain- Victoria is a close match to the Influenza B in this year’s vaccine
6.
Anti-viral medications – Tamiflu, Relenza and Xofluza all appear to be working well against the strains seen thus far
7. Not too late to get a flu shot- but remember it takes 2 weeks to reach full effectiveness. It is not good for those who were just exposed
8.
We made 160 million doses of Flu vaccine- we have 350 million people living in the US

The second segment – we can cover vaccines in general as there is some confusion about vaccines- Flu- Pneumonia- Shingles. Also some interesting news on Ebola and Alzheimer’s vaccines that we can discuss.

We are all probably confused with all of the issues with vaccines, what do I need a vaccine, which one should I get, when should I get them, how do I know I am getting the right vaccine, who pays for them, where do I go…… the list goes on.

It can be very confusing. Vaccines have made a huge impact in the history of medicine and it appears that this will continue. I thought we would talk about some common vaccines and get some clarity as well as some new research information on some potentially exciting future developments with vaccines.

The concept of a vaccine is very simple, take a portion of a foreign object, inject a small safe portion of it into the body and teach the body’s immune system to see this as foreign. When the body sees this object again it turns on the immune system to fight it. This occurs in the body even when we do not use vaccines as the body’s immune system is built to fight foreign items, including bacteria and viruses. We take advantage of the immune system with vaccines to teach the body before it is exposed to a potentially dangerous foreign source.

Diseases we thought were eradicated in the US are now popping up again and are causing many health related illnesses and deaths. For many physicians practicing now, the thought of seeing a patient with measles was unheard of. If you are physician under the age of 55 you probably learned about measles by reading a medical book not by treating a patient, even those who trained in large pediatric hospitals may never have seen a case of measles. This past year we had 1300 cases of measles reported from 31 states, this is the largest number of cases of measles we have seen since 1992 when we had an outbreak over a few years that was noted in poor urban areas of preschool children. That was slowed and eliminated by a commitment to increase vaccination rates regardless of the ability to pay.

Historically prior to the vaccine release in 1963, we had over 500,000 reported cases of measles each year, estimates actually placed the real number closer to 4 million cases a year, and close to 500 deaths each year due to measles. We learned over the next 15 years that the vaccine was good but that a booster vaccine was needed to get the full impact and that was started in the late 80’s. By the year 2000 we declared that measles had been eliminated from the United States.

I share that as the impact of vaccines has changed the world in spite of the few vocal anti vaxxers that remain. The interesting thing I find is that many of the Anti vaxxers actually were vaccinated and thus received the benefit of the vaccine and yet now without any scientific backing they tout how unsafe vaccines are. The claims they make have been discounted and eliminated with well controlled very large studies around the world.

You may be wondering why this is so important, well the research that is currently being done, will in the future change the world even more than the infectious disease vaccines we have seen since the 1700’s.

I thought touching a few common vaccines and what we are seeing coming in the future for them may be interesting, as well as some vaccines that are being worked on that are fascinating.

Influenza

Each year we discuss the importance of the Flu Vaccine. Influenza even with a vaccine accounts for 20 million cases, 300,000 hospitalizations and 30,000 deaths each year. This year looks to be a bad flu season. Already this year the CDC estimates that we have seen over 9 million flu illnesses, 90,000 hospitalizations and 7,000 deaths. This is extremely concerning as the main peak of flu season has yet to hit many parts of the country, and the expected more deadly strain is now being seen increasing.

We discuss each year the importance of the vaccine. Historically there was a single vaccine and it was comprised of 3 strains of viruses that were predicted to hit the next year. The vaccine is produced starting in the spring based on information from the previous year as well as the activity in the Southern hemisphere. As we say each year it is a calculated guess as the virus mutates thru the year, so hitting the vaccine perfectly is unheard of. In many years the effectiveness for coverage can be in the 50% range, however even at that range the vaccine will decrease the impact of the illness and shorten the duration of illness.

Has the vaccine changed over the years? Absolutely, we now have better data and more accurate data in choosing which strains to include in the vaccine, we now have vaccines with 4 strains included instead of the standard 3 strains, we have developed a much stronger vaccine for seniors who need that boost as their immune system is not as strong as it is for those younger. These have all been great but still have the fault of needing to receive the vaccine each year with the hopes they have chosen the correct strain.

What if we had a single flu vaccine that you received that protected you from all strains of the flu and that you may only need to get it once to give you wider and longer protection. This may not be as far off as one would think. Last year a study testing the effectiveness of a “Universal Flu Shot” was begun by the NIH. The premise is to be able to teach the body how to identify any of the flu viruses and attack them versus the current vaccine that looks for specific strains you may have been exposed to. This vaccine would attack apportion of the virus that does not change. They treated over 50 individuals with the vaccine and now will be looking to see how the vaccine works. With good results this will be expanded to a much larger group of individuals with the hopes of having a universal vaccine within the decade.

The impact of this vaccine would be huge, think of the lives saved, the pain of influenza and hospitalizations being eliminated and the cost on the healthcare system being dramatically decreased.

Shingles and Pneumonia

These are 2 illnesses that most people are aware of, many are aware that there are vaccines that protect them from these illnesses but boy can it be confusing. Let’s try to end some of the confusion

Pneumonia
There are actually two pneumonia vaccines and it is not that you have a choice which one to get, and the timing can be a little confusing as well. First if you are over the age of 65 and have not had any pneumonia vaccine you should discuss with your doctor and get the PCV 13 vaccine, Prevnar 12, that vaccine protects you from many strains of pneumonia, it is then followed up one year later with the PPSV 23 vaccine, Prevnar 23. The combination of the 2 vaccines gives you great protection against pneumonia caused by the most common bacteria.

Shingles
If you have ever had Shingles, you know painful and uncomfortable this illness can be. It is an illness caused by the same virus that causes Chicken Pox, except in older individuals it is not a simple itchy rash it is a painful rash that inflames nerves and the pain can last for months. The virus which is alive and dormant in almost all of our bodies, finds a time of stress when the immune system is not at its best and it multiplies and finds a nerve to inflame. It multiplies and continues along what is often a single nerve on a single side of the body as nerves do not cross sides of the body.

In 2006 the first Shingles vaccine was produced under the name Zostavax. It was approved for individuals aged 50-59 to help prevent Shingles from occurring in seniors. This vaccine was essentially a big dose of the chicken pox vaccine as that is the virus that causes Shingles. It was found to be effective just over 50% of the time and its duration of protection was unclear. For 11 years it was all we really had. In 2017 the new Shingles Vaccine was released, Shingrix. This vaccine is now the recommended vaccine as it has been shown to be over 90% effective and appears to have a longer duration. The downside is that it takes 2 shots, 2 -6 months apart for the full effect of the vaccine. It is also been seen to have some worse side effects for a few days after the vaccine.

If you are over 50 you should discuss the Shingles vaccine with your doctor and make sure you get the more effective Shingrix vaccine. Due to its popularity you may need to look around to different pharmacies in order to find it. Shingrix is covered by most insurances but you will need to check with your insurance plan. It is also covered by Medicare Part D, so check with your plan and status it is not covered by Medicare Part B

Alzheimer’s

Just the word makes us stop in our tracks, we all know someone who has been affected by this terrible disease. It takes away many years of life from individuals and also impacts those around them as well as they are cheated out of quality time. This is a disease that frustrates doctors as well as other research scientists. Why do individuals get this disease, what can we do to prevent it, what can we do to treat it? All questions that we are struggling with in the medical world.

A study just published last week is showing promise of some potential future prevention and possible treatment options. Alzheimer’s is a disease where proteins named beta amyloid and neurofibrillary tau tangles builds in our brain that leads to neurodegeneration and cognitive decline. It is an awful disease. Treatment that focuses on the beta amyloid has not proven to be as successful as desired. A group of scientists in California have looked at this problem and said if they can target both the beta and tau they may be able to modify the illness. In layman’s terms, we don’t need these proteins in our brain so if we can stop them from being produced we won’t harm our brain and we would stop the progression of this illness. This group of scientists is working on vaccine to stop this from happening in the brains of mice, the results they just published shows that this vaccine worked in mice and now the next step is developing the vaccine for testing in humans.

Imagine a time when a vaccine may be able to eliminate Alzheimer’s disease.

Ebola

In 1976 the first case of Ebola was identified in Zaire, Africa near the Ebola River. The first outbreak infected close to 300 people with more than half of them dying from the illness, a few months later the next outbreak occurred and close to 90% of those individuals died from the illness. The outbreaks caught the attention of many physicians and scientists but it was not until 2014-2015 outbreak in West Africa that spread to urban areas and across borders did it get the attention globally. Even here in Chicago we prepared for the international traveler that would land at O’Hare and be infected. We had 4 hospitals prepared to care for the patients and we trained all of our ER staff on how to initiate the evaluation and treatment of this disease. It was an expensive drill with changes made in hospital rooms, large dollars spent on equipment and training. It faded but has not left our minds as we continue to hear about this devastating illness popping up in areas of Africa. They are currently fighting an outbreak in the Congo.

This virus was and continues to be very strong with death rates still approaching 50% in many cases. Shortly after the global concerns raised in 2014, scientist had been working on a vaccine to prevent the spread of this illness. Within a short time a vaccine was ready to be tested, however there were no outbreak areas to test it so it was tested on few as the demand was not there. Just a few weeks ago the FDA in December approved a single dose vaccine against one of the strains of the Ebola virus and another vaccine is being tested to combat the current outbreak that is seen in the Congo.

Hopefully we will have a vaccine that can protect the world from this virus that kills at an alarming rate and spreads at an alarming rate as well. Without this vaccine, one could imagine an outbreak in large metro area and the impact it would have on individuals as well as the health system structure we have. Hospitals would not be able to handle the patients or contain the disease.

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