Vaccines might be controversial right now, but historically they have always been a part of our lives. From the early polio and smallpox vaccines that were part of life in the 1960s to the current measles, mumps and rubella vaccines that are administered to infants and toddlers, we rely on vaccines to keep us healthy and save lives. Dr. David Totton, Ambulatory Pharmacist with Shore Physicians Group in Somers Point, weighs in on vaccines and provides some clarity and guidance.
Why do we need vaccines?
According to Dr. Totton, “Vaccination is a preventative tool that allows us to build immunity to a variety of infectious diseases without first becoming infected and getting sick. Much of what we do in medicine today is preventative. We would much rather be proactive and prevent illness than be reactive and deal with the negative consequences of the illness.”
Should I get a vaccine if I feel a cold coming on?
“In general, vaccination should not be delayed in the event of a mild illness such as the common cold as long as there is no fever. However, in light of the Covid-19 pandemic, it would be prudent to first speak with your primary care provider who will assess your symptoms and recommend Covid testing prior if necessary,” said Dr. Totton.
The flu vaccine
Flu clinics are opening up in the region. Dr. Totton said typically flu season will run from November through March. The peak of flu season typically falls in February. He suggests getting the vaccine annually no earlier than September and no later than the end of October if at all possible to provide maximum protection through the length of the flu season.
The 2020 flu season was mild, leaving people to wonder if they should plan to get a flu shot this year. Dr. Totton said, “Luckily we saw that our infection mitigation efforts through mask-wearing and social distancing were fairly effective last year which resulted in a mild flu season. This, however, may not be the case going forward. Pandemic restrictions are generally more lax at this point than they were this time last year and we will likely see a bit of an uptick in flu cases. In addition, there is some concern that with such low exposure to the influenza virus over the past year, our natural immunity may be a bit lower than normal, potentially leading to more serious outcomes. In addition, we are still concerned about overwhelming the healthcare system and reaching hospital capacity. A big focus going forward will be to reduce unnecessary hospitalizations due to preventable diseases such as the flu.”
Will the flu shot give me the flu?
A big question many people have every year is ‘will the flu shot give me the flu?’ Dr. Totton said emphatically, “No. Currently, 99% of all influenza vaccinations given are classified as ‘inactivated influenza vaccines.’ This means that they contain no intact influenza virus or genetic material that would allow the virus to replicate. For these reasons, it is physically impossible to contract the flu from an inactivated influenza vaccine.”
He added that some patients may experience mild flu-like symptoms post-vaccination, however this is due to the body’s natural and expected immune response to the vaccine. This is evidence that the vaccine is being recognized by the body, actively building immunity to the virus, and should only last for a day or two.
The concern is also, ‘can I get the flu even if I have a vaccine?’ Dr. Totton explained the influenza vaccine contains four of the most common strains of the flu that are expected based on previous flu seasons and variants seen in the southern hemisphere, which has its flu season during what is summer for us up north.
“There are, however, many other strains of the influenza virus that can potentially infect humans. Another factor to consider is that the influenza virus tends to rapidly mutate which can reduce the effectiveness of current vaccines. On average the flu vaccine is about 40-60% effective in preventing illness in any given year. So yes, it is possible that you can still get the flu even if you have received the vaccine; however, the infection will likely be less severe, you will recover more quickly, and your risk of hospitalization and death is much lower,” said Dr. Totton.
The older population is at somewhat of a greater risk for complications from diseases such as pneumonia. There is a pneumonia vaccine and it is available only to those 65 and older. Dr. Totton said current Centers for Disease Control and Prevention (CDC) recommendations are that everyone over the age of 65 should receive one dose of Pneumovax-23. Those at higher risk of pneumonia may also be advised that they should receive a dose of Prevnar-13 one year before Pneumovax. This means that they would get Prevnar-13 on or after their 65th birthday and then Pneumovax after turning 66.
Dr. Totton explained that the pneumonia vaccine is used beyond the over-65 population as well. “The pneumococcal vaccination is actually part of our routine pediatric vaccination schedule these days. We also commonly administer this vaccine to smokers and those with high-risk conditions including heart and lung disease. Pneumococcal vaccination does become more important as you age because both the risk of pneumonia and potential risk of negative outcomes increase as you get older.”
Dr. Totton advised even those who receive a pneumonia vaccine should absolutely plan on getting a flu shot as well. “The agents that cause pneumonia and the flu are completely different. Pneumonia is caused by a host of bacterial and viral organisms, however, we only vaccinate against bacterial causes. In contrast, the flu is only caused by the influenza virus. This means that getting vaccinated against one will not protect you from the other,” said Dr. Totton. Getting both shots at the same time is acceptable and he added, “There is usually only concern over co-administration of vaccines when using a live vaccine product. Since all injectable flu vaccines and all pneumonia vaccines are inactivated, patients can receive both vaccines at the same time. In the event of simultaneous administration, it is advisable to request that one vaccine is administered in each arm to reduce the risk of adverse effects such as pain at the injection site.”
The human papillomavirus or HPV vaccine used to only be available for girls age 12 to 16 and now it is recommended for boys and girls with the first dose around 11. Dr. Totton said, “It is important to receive the HPV vaccine as early as possible. This is because HPV is a sexually transmitted infection and once a person becomes infected, the virus stays locally inside the cells where it can evade the immune system. There is currently no cure for HPV meaning the earlier we can vaccinate and protect our teens, the less likely they are to have problems down the line and spread the virus to others.”
The current HPV vaccine contains inactive proteins from nine strains of HPV that have been implicated in the development of various cancers. It is administered in a three-dose series. No booster doses are recommended at present. HPV infection has been associated with many serious complications including cervical, vulvar, vaginal, anal, head, and neck cancers, as well as genital warts.
Dr. Totton explained how the HPV vaccine helps keep an individual from developing certain cancers 30 years after it is administered.
“HPV infection is usually asymptomatic, meaning a person will not immediately become aware that they were exposed. Once infected, certain strains of the virus may cause changes to the cells they contact and force them to divide rapidly. If left unchecked, this will develop into cancer down the line. HPV infection is typically only discovered years later when a patient goes for a routine pap smear or develops a complication such as cervical cancer. In our eyes, this is much too late and can be prevented with a few simple vaccinations,” said Dr. Totton.
Shingles, much like HPV, can lie dormant in your body for years and then suddenly appear. Not everyone will develop shingles, so why is it prudent to get the shingles vaccine?
Dr. Totton explained, “Shingles occurs when the varicella virus (the virus that causes the chickenpox) reemerges from nerve cells where it lays dormant. Due to how widespread the varicella virus is, even if you have no recollection of getting chickenpox, it is believed that we are all exposed at some point and therefore are at risk of developing shingles. Active shingles infection causes an often very painful and uncomfortable rash and may leave some patients with lasting nerve pain even after the rash subsides. The newer shingles vaccine, Shingrix, is recommended for everyone age 50 and up and I encourage all of my eligible patients to receive the vaccine.”
But patients ask, ‘if I had the chickenpox vaccine, should the immunity from the chickenpox vaccine keep me from getting shingles?’ Dr. Totton said, “Unfortunately, no. Even though the virus that causes chickenpox and shingles is the same, the dose of the shingles vaccine is larger and it also contains an adjuvant. These both help your body produce a strong enough immune response to protect against the emergence of shingles.”
The biggest question of the year is ‘why is it important to get the Covid vaccine?’ Dr. Totton said, “The Covid vaccine is the best tool in our fight against Covid. A recent study from the Department of Health and Human Services reports that the vaccine has prevented an estimated 265,000 infections, 107,000 hospitalizations, and 39,000 deaths among just the Medicare population in the first five months of 2021. These are promising numbers, however the longer it takes to get everyone vaccinated, the longer the virus is allowed to mutate and potentially reset the clock on all the progress we have made. Getting vaccinated is the only way we are going to suppress new Covid cases enough to return to normal life.”
We hear in the media about Covid-19 variants. Why are variants like delta and mu showing up? Dr. Totton said, “We know that, unfortunately, the Covid virus tends to mutate quickly. When a virus mutates, it changes the proteins on its surface to evade our immune system and, in some cases, the vaccines that target the virus. This is not a new concept and we now have a lot of experience with influenza which requires constant monitoring for variants and routine changes to annual flu vaccinations to correspond with these mutations. These mutations only occur when the virus is allowed to spread and continue to proliferate inside each new host. What this means is that the best way to slow the emergence of new variants is to protect yourself and others from the current strain through vaccination, mask-wearing, and distancing as recommended.”
Covid-19 booster shots
The status of booster shots is changing in concert with CDC recommendations. Those over 65, immune-compromised and front-line personnel are eligible. Dr. Totton said on the expansion of booster shots, “This is where some distinction between additional doses and booster doses is needed. We consider a third dose of an mRNA vaccine in someone who is immunocompromised to be an ‘additional dose.’ This is because we have seen that 2 doses of an mRNA vaccine do not produce the same immune response in these patients when compared to the normal population. The third dose is acting to bring their immunity to the level of those who are not immunocompromised,” said Dr. Totton.
Recently, the FDA and CDC authorized booster doses for those who received the Pfizer vaccine. They recommend the booster dose six months after their second dose for people over the age of 65; those who reside in a long-term care facility; or those aged 50-64 with certain underlying conditions. They also say that those aged 18-49 with underlying conditions or those 18-64 at increased risk of occupational exposure may get a booster dose.
“Keep in mind that at the current time, this only applies to those who received the Pfizer vaccine. We are still awaiting data from Moderna and Johnson & Johnson before a booster dose is approved. However, stay tuned, from what I am hearing we should expect to see more on this by the end of October,” said Dr. Totton.
As for booster shots, Dr. Totton said there is some good news. “From what we have seen in the booster dose trials, we can be fairly confident that a third dose of mRNA vaccine should produce similar effects as the second dose.”
Breakthrough cases of Covid-19 in vaccinated persons persist. While a vaccinated individual may still contract a mild version of Covid-19, can they spread the virus to someone as well? Dr. Totton said, “While the Covid vaccines are our best tool in the fight against Covid, nothing is ever 100%. There is still a small chance that you will become infected, especially in light of some of the newer variants we have been seeing. However, it is much more likely that you will have a mild case that does not result in hospitalization, ventilation, or even death. We are also seeing that in the event of a breakthrough infection, the virus is still able to be transmitted and cause further infection. This is the reason that the CDC still recommends following all pandemic precautions whether you are vaccinated or not.”
Can I get the flu vaccine and the Covid vaccine at the same time?
It is safe to get the flu and Covid vaccine at the same time. “Recently the CDC has made the official recommendation, based on the experience we have with other vaccines, that it is safe and actually encouraged to receive both vaccines at once if eligible to ensure all required vaccinations are received on time,” said Dr. Totton.
The Covid-19 vaccine has become a flashpoint with wide-ranging opinions and claims on its use, whether it should be mandatory and even claims of alternate cures for Covid-19. Dr. Totton offered his scientific opinion on several of the claims that have been made about the Covid-19 vaccine.
- Myth: The Covid vaccine has aluminum in it and 5G technology will be able to track individuals that receive the vaccine.
- Fact: Dr. Totton said this is a baseless conspiracy theory and has no grounds in reality. The ingredients in the vaccine are readily available online and all components of each vaccine are rigorously tested for safety and evaluated by the FDA.
- Myth: The Covid-19 vaccine is putting Covid into my body and will give me Covid.
- Fact: According to Dr. Totton, this is false. The Moderna and Pfizer vaccines are mRNA-based, meaning that the only part of the Covid virus that is injected is a small strand of genetic material that codes for the outer “spike” protein. They do not contain any other components of the virus that would allow it to replicate and cause infection. The Johnson & Johnson vaccine contains a weakened viral vector. This is a special viral vector that is incapable of replication and expresses Covid virus proteins. In both cases, there is no way for the virus to multiply and cause illness.
- Myth: The approval of the vaccine was rushed so it is not safe.
- Fact: The Covid vaccines that are in use today were approved through what’s called an emergency use authorization (EUA). Much of what is expedited in the approval process of an EUA involves advertisement, marketing, and planning about the rollout and distribution of the medication/vaccine. Safety and efficacy trials are virtually the same as a normal FDA approval process and may just be lacking in long-term follow-up data. Due to the nature of this global pandemic, many companies were able to work together with the federal government to speed up some of the unnecessary or time-consuming steps of the full approval process and instead focus on the important clinical data to get the vaccine out quickly. The FDA will only approve products that have shown that their benefits outweigh the risks.
- Myth: Ivermectin kills the Covid-19 virus.
- Fact: Dr. Totton said, “At the present time, there is not enough data to say whether or not ivermectin is safe or effective for treating Covid-19. Historically, ivermectin has been used as an antiparasitic medication (dewormer) and has never been used against viral illness. For now, it is not recommended to take ivermectin for Covid-19 outside of a clinical trial designed to test its effectiveness. We simply have little-to-no data about whether this medication works against Covid-19 and it does come with its own risks. Recently, I have also seen news stories about people taking things into their own hands and purchasing ivermectin meant for animals to self-treat Covid. This has already led to multiple hospitalizations as the doses and inactive ingredients may not be consistent or even safe for human consumption. If you have any concerns about the treatment or prevention of Covid-19, I highly encourage you to speak with your primary care provider about your options and discuss which is right for you.
David Totton, PharmD, is the ambulatory care pharmacist on staff with Shore Physicians Group. He consults with physicians regularly about medication management, conducts Medicare annual wellness visits, provides comprehensive medication reviews, and more. Dr. Totton sees patients in Marmora, Ocean City, Somers Point, Margate and Northfield. Click here to learn more about how an Ambulatory Care Pharmacist can help you. To find an SPG primary care provider, click here.