Description: This is a passage about mayo-clinic-patient-portal. Dr. Pritish Tosh, an infectious diseases specialist at Mayo Clinic, discusses vaccine recommendations for adults and take a look back at flu season.
I’m Dr. Tom Chives and I’m Traci McCray. Last fall the Advisory Committee on Immunization Practices at the CDC they got a lot of committees. They released new vaccine recommendations for adults.
Among the recommendations were a booster shot for mumps and the new and improved shingles vaccine for those over the age of 50. Here to discuss vaccine recommendations is Mayo Clinic infectious disease specialist Dr. Pritish Tosh.
I got to get a mumps vaccine. It’s recommended. That makes sure that everybody is mumps immune. If people have not gotten their full vaccine regimen with their kids or we’re not sure if they got it when they were earlier to make sure that everybody has been vaccinated or some UHN.
If you had the vaccine as a kid or if you had mumps, you don’t need to get it. But the idea is to make sure that we are not missing people. Why are we hearing about all these mumps all of a sudden? You haven’t heard about mumps for decades. All of a sudden everybody in the hockey team gets mumps or the cheerleaders went to Dallas. What’s going on?
Mumps was a disease of vaccine preventable disease that we saw a big dip after that vaccine was available. This is a disease that was the number one cause of central neural, hearing loss and children before they rock. It’s a major cause of morbidity.
You can lose your hearing. The vaccine of the full regimen is about 88% effective in preventing mumps if you compare it to the other parts of MMR, measles mumps rubella. For the measles part of the rubella we’re looking in the 90s in terms of efficacy. But for mumps it’s about 88% which is still good but not as high as we would all like.
That depends on population immunity. If you have over 90 percent of your population and with full vaccinations than something or somebody coming in with mumps from overseas, that’s not going to spread through a community.
We have entire generations of kids where their parents are questioning whether they should vaccinate their children. We’ve had decrease in vaccination overall. Because the mumps efficacy is not in the high 90s. We will start to see dips in vaccine uptake and increases in mumps outbreak.
What did you call it? I know it as herd immunity but you say that’s a nicer phrase. I would have used her herd immunity or population immunization. I’m a farm kid. I got you identified with cattle.
What else is new on the list from the CDC about adult immunizations? The big thing is the new vaccine to prevent shingles. Shingles for those who may not know is a reactivation of the chickenpox virus of varicella-zoster. Once you have chickenpox it gets into your nerve cells and then later on many decades after you’re infected.
That virus reactivates from the nerves and causes painful blisters. It can be debilitating. It is also called post herpetic neuralgia. After you get shingles that pain can last for years and be debilitating. We’ve had vex a vaccine that can reduce shingles.
We’re trying to reduce as post herpetic neuralgia. The vaccine we had was a live vaccine and the efficacy was about to 60% in the best population and those before age 60 and 69 and about 51% overall which is not great but certainly better than nothing.
The new vaccine has much better efficacy. We’re looking in the 90s and across age ranges. It’s better if it’s a little earlier. But across age ranges into the 70s and potentially even the eighties for people get it in preventing shingles but also post Redick neuralgia.
Are shingles like chickenpox and once you’ve had shingles you don’t get them again? There are different aspects of the immune system. The cellular immunity is important for preventing reactivation of varicella zoster virus.
If you’ve had shingles, that means your immune system and your cellular immunity have decreased with age. This virus was being kept in check. So it is recommended that even if people have had shingles that they get the vaccine.
This is not an uncommon disease. There are about a million cases a year of herpes zoster. If you are over the age of 85. There’s a 50% chance you’re going to get herpes zoster. This is a huge deal to get this vaccine, nooshin Grix.
That’s the one and it’s not a live vaccine meaning that people who have poor immune systems can get the vaccine. This is a two dose vaccine. You get another dose either two to six months. It seems to be first of all well tolerated but also great efficacy.
The CDC has recommended this one over the previous Aust of X. It is covered by insurance. That’s being worked on. Medicare is going through the process and many health insurances have embraced this and will be doing that.
The guidance from the ACIP is often used to further define what vaccines will be covered by insurance companies. But it’s a bureaucratic lead time that takes place until this could happen.
Medicare will cover it. It’s two hundred and eighty bucks for the two doses. But the other question is when is it available? is it out there now? It’s out there now. I gave it a few months waited until about January, February before I sort of recommend getting it to make sure that people’s insurance companies had a chance to catch up to what the recommendations are.I’ve been giving it to people.
What is the vaccine schedule for adults? We’ve got shin Grix in there. A few things one other vaccine preventible disease is about pertussis. Every adult should have a single adult booster of Tdap which includes the acellular pertussis. But also Pneumovax is vaccination of laconia Cockell. New evacs is a brand name but there’s a new pneumococcal vaccine and the previous ones were targeting the sugar on the outside of the bacteria.
This one is taking those sugars and then combining it with a diphtheria toxoid so that the immune system has a much more vigorous response to those antigens and therefore it gets more deep immunological response and hopefully has a better response.
You’ve got the Tdap which is the the tetanus diphtheria, pertussis and the pneumococcal. That takes two shots.You’re a part. There are different recommendations based on whether it’s being done at a certain age or if you’re being done because you’re immunocompromised in some way.
It’s best to go to your doctor to find out exactly which is best for you. There’s a new vaccine that has better efficacy and inspector certainly work better in older adults and immunocompromised people to prevent infection with pneumococcus.
We’re discussing recommended vaccinations with an infectious disease expert Dr. Pritish Tosh. We’ll look at the flu season and discuss the flu vaccine. We’ve talked about all the vaccinations. You need to get it as an adult to protect yourself.
We’re winding down as we go through the flu season. You can still get it in through March and into April but how was this year’s flu vaccine? To summarize that season, we’ll talk about this two different ways. One is about the season and one’s about the vaccine.
This is the worst flu season we’ve seen for a decade in terms of many things including hospitalizations, the number of people who have gotten sick, including her early data about actual death and children death and adults related to this flu season.
A few reasons about why this flu season has been worse than others. One is about the virus itself. Every influenced season is between one of the two different influenza A viruses big group of h1n1 and then h3n2.
It turns out that these epidemics that have an edge year that are the ones caused by h3n2 viruses tend to be more aggressive. This last season was an h3n2 virus and it turned to be more aggressive than even previous age three and two seasons.
There are a lot of talks whether or not this was related to vaccine failure. There are different aspects of this. It looks like we had a good match. The vaccine antigen was very similar to the circulating strain of H 3 and 2.
It’s guesswork. I mean you take the best guess about what virus is going to be? You see the fire shoot out of his eyes when you said that guess. It’s an informed guess. I wouldn’t call it again. If you asked me which pocket my phone is in, based on my experience it’s in my right pocket.
There’s a little bit of nuance subjectivity in knowing what strains have been circulating throughout the year in different parts of the world to say this is what’s like to be coming up next year. You can’t vaccinate against every strain. You have to pick the ones that you think are most likely to cause the influence in this year.
That’s right. The WHU and CDC 90% of the time are absolutely on that. The strains they pick are the ones that are going to be circuits. That would be an educated guess. They picked to the antigen exactly right. The issue is about the vaccines themselves.
It turns out that near the influenza vaccine is not as good as anybody would like. We’re talking about 50 years old technology is what we’re using. For shingles you’ve got it 80 to 90 percent vaccine success rate not so much with flu.
Previously we had thought it was 70 to 90 percent efficacy but that’s relying on some other types of studies to look at whether or not somebody got infected. You can stick swab in somebody’s nose and do a PCR to find out whether they have influence or not.
It’s when you look at that as the endpoint that the vaccine efficacy is 50 to 60 percent. It’s even lower. That part is when you look at the h3n2. It’s probably about 30 percent. This year in the US looks about 25% efficacy.
How do you make them better working flu vaccine? The important thing to know is that the vaccine works and I want people to use it. I got my vaccine this year. I’ll get it next year. My entire family gets it and it’s very good at preventing death.
If you look at all the pediatric deaths that happen this season, the majority are unvaccinated children. There are studies that look at the mortality associated with influenza infection. You’re looking at death from underlying medical corporate babies.
If somebody has heart disease or lung disease, it’s a death that is caused by the underlying disease they’ve got tipped over because of influenza infection. The vaccine can prevent death from these other causes very well.
I will still want people to get the current vaccine. But there’s a longer discussion about what do we have to do to get a better vaccine. Influenza is tricky. The outside parts that we get that antibodies to the hemagglutinin and neuraminidase are variable. They change every year.
Most of the antibodies that your body will generate to natural infection is against these variable regions. If those are things that are changing and we have to keep changing the vaccine every year. The viruses are smart. They can adapt. There are conserved areas within the virus between viruses.
If we were to get an antibody that could target those conserved regions then we may be able to develop a universal vaccine. We don’t have to change it every year. Unfortunately those conserved regions have the least antigenic potential meaning that when you get infected your antibodies are not going towards those conserved regions.
So it’s tough to know what one of those conserved regions we need to target. Even if we target it, it is going to confer sterilizing immunity meaning that if you have antibodies to that area, you will prevent infection.
There’s a lot of work that needs to be done and hopefully this last season is good wake-up call in terms of what we need moving forward to get a game-changing influenza vaccine.
When you leave, we want you to get to work on that. Because it would be better. I had heard that 80 to 85 percent of the children that died had not been vaccinated. Ends of the vaccine we have now are good at preventing death. If you got vaccinated and you got influenza you are likely to have better outcomes less likely to have complications.
I want people to continue to get the vaccine that currently exists. From a broader sense as a society we need to work on better influenza vaccines. About the different routes of administration as I recall this year they were recommending that you not get the nasal vaccine. What about individuals over the age of 65? Are there special vaccines for those?
Let me start with the over 65 one. Because it is a little bit easier. There are some newer vaccines high-dose vaccine and adjuvant vaccine. That seems to allow those who are of age 65 or older to have a better immune response and better protection against influenza. Those are recommended for older people.
As for the nasal, live attenuated influenza vaccine for a long time was thought to be better for children. You’re putting it in the nose where people get influenza where it comes in. That’s where you want through the antibody response to be.
Initial data which would have suggested that was better especially in children. Until about 2009 when the new h1n1 replaced the old h1n1 because of the pandemic, we started to see lower efficacy of the live attenuated vaccine.
And to the point where we didn’t see efficacy. It was taken off the recommended list and therefore manufacturers stopped making it with the idea that they’ve reformulated that it has been re-evaluated and it’s likely to be good for next season.
I’m not sure I want to go on a cruise. Why do you see an outbreak Norovirus? I was on the ship and everybody gets set. Norovirus is that most people would call stomach flu which is not influenza at all but usually your gastrointestinal illness or is going to be with norovirus.
It’s self-limiting. You get diarrhea or vomiting for a day. It’ll go away. It’s contagious. It’s called fecal oral transmission. Shaking hands and washing their cruise ships are especially prone. Because of audience floating petri dish, one thing you can do before going on your cruise is to go to the CDC website where they have all the list of different cruise ships and whether or not they’ve had outbreaks.
Updated adult vaccination recommendations, a little bit about a review of the flu season and norovirus are with infectious disease specialist Dr. Pritish Tosh. Thanks so much for reading.