Medical Monday: Ask Dr. Joe

Q: As this month is vaccination awareness month, I feel it’s a good time to ask my concerns about vaccines in general. As a family pediatrician, how do you best advise your patients on vaccinations when there’s so much controversy on the side effects and long-term ramifications. I am not an anti-vax mom and vaccinate all of my children, but recently have been tuning into the controversy after the measles outbreak in 2019 and now with the push of the non-FDA emergency use COVID vaccine. I have real concerns/questions and would love a bit of a background and short explanation and education if possible. Can you explain in “Mom Terms” the differences in the scheduled infant/childhood vaccines and how they work. Live/ non live/ RNA etc., how flu shots differ etc.?  Why some need boosters or more than one and why some are lifetime.

A: This question comes at a great time. Vaccines have been around now for a while.  Technology and better understanding of our immune system has really made a big difference in vaccine safety and effectiveness. “Live” virus vaccines are essentially a modified strain of a particular virus (chicken pox, measles, mumps, rubella, or nasal influenza being the most common) that appear to our immune system no different than the actual virus, but don’t cause the disease (it is normal to get a fever or mild rash after the MMR, a mild form of chickenpox after the vaccine, and congestion after the live flu vaccine). Because they are active viral vaccines, there is some caution for those with immune deficiencies and/or being treated with chemotherapy or immune modulation medications (for autoimmune disorders). The vaccines “work” very much like the “natural” virus — infecting cells, including white blood cells that fight infection, causing a normal immune response which will then help protect against infection from the actual virus.  Booster doses are given because our measure immunity drops below what is believed to be a protective level (this occurs mostly with chickenpox and measles). Chickenpox also can reactivate in the adult (shingles). A vaccine similar to the chickenpox vaccine exists for adults to help boost protection and reduce the risk of shingles developing.  Live flu still has to be given annually as the strains continue to change from year to year.

Most childhood vaccines are not “live.”  DTap, Tdap, Pneumovax/Prevnar, Hepatitis A and B vaccines, flu vaccine, Polio and HiB meningitis vaccine are the most common vaccines given. They are either “killed” virus, pieces of the virus or bacteria, or toxin-like chemicals (diphtheria and tetanus) that, when taken up by the immune system, develop antibodies to either the infecting agent, the portion of the surface of the infecting agent that allows for the infection (a protein in the capsule surrounding the bacteria or virus) or an antibody to fight the toxin produced. The only risk for these vaccines in their current status are sensitivity to the vaccine components. Egg allergies have always been the biggest concern with the flu vaccine, but that has largely been dismissed. Many doctors (including me!) still prefer the allergists to administer the flu vaccine for severe egg allergic individuals until the allergist has cleared them.

mRNA virus vaccine technology has been around for over 20 years.  The science behind this technology allows for more rapid development of vaccines and has allowed the COVID vaccine to be produced very effectively in a relatively short period of time.  The basis of the vaccine works as follows. The mRNA (instructions on how to make a protein-in this case the “spike”) is injected. The instructional message is taken up by the immune cells and the instructions are then carried out by the cell using the cell’s natural ability to produce proteins (it does not have any effect on the DNA at all and doesn’t alter the cell). The cell shows this protein on its surface after it is made. This protein is recognized as foreign, and the body’s immune system then produces the antibodies to the “foreign” protein, thus providing immunity. This is very similar to how viruses, themselves, get into our bodies and use our cells to reproduce copies of themselves and allow the virus to spread. The big difference is that this is only a harmless piece of the virus that is being produced. The only real risk is the possible reaction to components of the vaccine. We’ve heard in the news about blood clots from the vaccine and myocarditis (inflammation of the heart muscle). Although these conditions are still being studied and appear to have some relation to the various vaccines, the exact cause is still not known. It is likely to be some sort of immune response in a very small subset of the population, and when compared to the risk of the same from the virus itself, it is much lower.

All the vaccines are safe and effective. If we look back at history, going back to the 1940s and 1950s when polio was so prevalent, vaccines have made a significant impact in reducing or almost eliminating some of the deadliest infections (nobody gets smallpox anymore). Vaccines do not cause autism.  Vaccines are not a religion to be believed in or not. They are scientifically proven interventions that work.  Like everything in life, there is no 100% effective treatment and vaccines are the same, and the effectiveness varies from vaccine to vaccine. Overall, the vaccines available now have been shown to be safe and the benefits of their use far outweigh the risks.

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