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Scott Webb (Host): Welcome to Hally Healthcast, the monthly wellness podcast from Hally Health – your source for health and wellness resources, information and tips. Every month we’ll address a new topic important to your health, bringing in expert doctors, therapists and specialists who’ll offer advice and answer your most pressing questions. August is National Immunization Awareness Month, so our topic today is vaccines, specifically why shots and immunizations are not just for children. Joining me today is Dr. Steven O’Marro. Dr. O’Marro is an expert on infectious diseases at Springfield Clinic in Springfield, Illinois. So, Dr. O’Marro, thanks so much for being on. Let’s jump right in. We’re exploring five vaccinations that are important for adults and when to get them. So, vaccine number one and perhaps the most common vaccine adults hear about is the flu shot. So, tell us why it’s such an important vaccination to get.

Steven D. O’Marro, MD, FACP (Guest):  Influenza vaccine prevents of course a list called influenza the most common and the most difficult type is influenza A. The vaccine, when given to people, reduces their risk of dying two to five times relative to people who have not had the influenza vaccine. Patients who are age 18 to 49 years and 65 year of age and older who were hospitalized with just the flu were 30% less likely to be admitted to the intensive care unit if they had the flu shot than if they did not. So, even if you get the flu after you’ve had the flu vaccine; you are much less likely to have severe complications of it. And among children, with high risk medical conditions, vaccine reduces the risk of flu associated death by 51% and it reduces the risk of complications of the flu over 65% in children who are vaccinated.

Host:  So, number two, another vaccine people might know about is the shot for tetanus and diphtheria. Can you tell us more about these?

Dr. O’Marro:  Tetanus and diphtheria, there is also a component with acellular pertussis. It’s a vaccine for both adults and children. There are two variations one with increased strength of the diphtheria and tetanus component and then one with a lower strength of a diphtheria component for adults. They prevent childhood diseases and adult diseases associated with the bacteria named in the vaccine. Diphtheria, tetanus and pertussis. Diphtheria is a disease that we don’t see very often any more but is present still in the third world. It is a respiratory disease that causes breathing problems and can cause paralysis, heart failure and death by it’s ability to link up and interfere with certain types of cellular metabolism. It’s highly contagious, spread by coughing and sneezing. And it was a significant cause of morbidity and mortality and it will reappear if we don’t vaccinate for it.

Tetanus is caused by a bacterium found in the soil and once it enters the body, it releases a toxin. The toxin has extreme toxicity at very low concentrations. It can cause muscle spasms and eventually death if untreated as a consequence of respiratory insufficiency. Pertussis is a vaccine to prevent something called whooping cough. It produces significant coughing spasms and significant illness, coughing significant enough to break your ribs in some people who get this illness.

And all of these vaccines represent preventable illnesses. The major advances in medicine that have occurred, that have resulted in improved life expectancy, all relate to many of these vaccines that have been developed. If you look at the social security act that was passed in the 1930s under Franklin Roosevelt, the average life expectancy was somewhere around 50 to 60 years. With the introduction of vaccines and antibiotics, we have seen life expectancy into the 70s and 80s. And so if you do not avail yourselves of these vaccines, you kind of put yourself into the demographic that was existing in the 1930s.

Host:  That’s an interesting way to look at it and as you say, these vaccines are so readily available and really so helpful in preventing these diseases. So, number three, can you tell us about the human papilloma virus and the HPV vaccine?

Dr. O’Marro:  HPV vaccine or Gardasil protects against human papilloma virus infection which is acquired as a consequence of sexual contact. It is extremely important to introduce in people who are in their teens as they emerge into sexual activity and is administered as late as sometimes in the mid-20s. So, it was originally indicated for young women. It has also been extended to youth and young men. It’s primary role is to prevent certain genital cancers especially cervical cancer. And it is one of the initial vaccines intended to reduce the risk of cancer. The other being the hepatitis B vaccine that we have the reduces the risk of liver cancer.

Host:  Yeah, definitely. So number four, as we age, are their certain shots that we should get for example can you tell me about the pneumonia vaccines?

Dr. O’Marro:   The Pneumovax, there’s actually two of them. There’s a 23 valent and a 13 valent pneumococcal vaccine. These vaccines are administered as a consequence of either immune responses or as a consequence of coincident illnesses such as congestive heart failure, obstructive lung disease. They reduce the risk of mortality and morbidity associated with one type of pneumonia. People often confuse this by saying I’ve had a pneumonia shot and they come in with pneumonia and they say why did I get pneumonia; I had a pneumonia shot? Well it reduces the severity of pneumococcal pneumonia if you get it but it doesn’t prevent pneumonia from other causes. It does prevent pneumonia and it reduces the risk of sinus infections of the most common cause of that which is pneumococcus or streptococcus pneumoniae. It’s extremely important to give to people as they enter into their 60s. This, like everything else, as age progresses, things in the body don’t function as well. And so we give these vaccinations to people with ongoing heart disease, we give it to people with underlying lung disease and we give this vaccination to people with advancing age in their immune system to reduce the risk of mortality and reduce the risk of death associated with this [00:06:58] illness.

Host:  Yeah, I can hear what you’re saying and you’re so right that people often get vaccinations and then they get the thing whether it’s the flu or pneumonia and they wonder how that’s even possible but as you are saying, those vaccinations especially in regards to pneumonia is about preventing mortality and lessening the effects not necessarily preventing pneumonia. Right?

Dr. O’Marro:  That is correct. The other thing that happens too is that especially in the fall; when influenza vaccination is administered, it’s usually sometime beginning late September through even as late as February or March of the year if people are late in getting their flu shots or the flu is late in presenting. The problem with that is it’s also given during a time when there are circulating viruses such as the parainfluenza viruses, the rhinoviruses and some of the lesser lethal coronaviruses that cause common colds. And so, when people get a flu shot and then all of the sudden, they get a reaction such as a common cold coincidentally and I can tell you if you vaccinate 100 million people, that’s going to happen to a lot of people. They always blame the flu shot for it. It’s important to know that the flu shot is not alive. It’s a killed protein. The only real contraindications to giving the flu shot are a Guillain Barre like illness within six weeks of administration of the flu shot and also the other contraindication would be an allergy to the influenza vaccine or one of its components. A lot of people claim allergies to eggs. There is an egg free vaccine. A lot of people are concerned about mercury in the vaccine and there’s a mercury free vaccine. We still a lot of people who just refuse to get the vaccination and like I said if you refuse to take advantage of the advances in infectious disease and a prolonged life expectancy, then you really kind of put yourself into the life expectancy tables of the 1930s. And that’s unfortunate.

Host:  Really good to have you kind of clarify things there. As I head into my 50s here, I think about shingles. I don’t know why I’m thinking about shingles but I’m thinking about it. So, number five, what exactly is shingles, and can you tell me about the vaccine that prevents that painful infection?

Dr. O’Marro:  Shingles is an infection due to a virus called herpes zoster. It is the same virus that causes chicken pox. The problem with chicken pox is that it establishes like all herpes viruses do an ability to replicate itself later in life. It is able to insert into the human genetic material in certain cells specifically nerve cells and the ganglia a copy of the blueprint to produce itself. And it doesn’t do that all the time. Otherwise, we’d really have a significant issue. But it will do that, and it varies in individuals with a certain risk over a number of years. It does not indicate, for example, if you get it when you are in your 20s that you have a defect in your immune system because we can see people who have had chickenpox get shingles even when they are eight or nine years old. It is however much more common when we see declination in immune function in this, I think I called it age-related immune deficiency or weakening of the immune system as you age.

And when it occurs, it occurs in random places depending upon where that virus decided to set up its blueprint. And it can occur on the body, it can occur on the face, it can occur in the first trigeminal nerves and involve the face and the eye and that’s very serious if that happens. And it also can occur in a form if you are very immune suppressed such as with advanced AIDS or if you are taking a medication to suppress a rejection response to a transplant. It also can occur in a disseminated fashion, behave much like the original chickenpox and present with pneumonia.

The varicella vaccination went through two iterations. We had a Zostavax which was developed approximately ten years ago that was alive attenuated vaccine. What that means is it’s an actual living virus that’s been stripped of it’s ability to cause significant illness but still can stimulate a really active immune response. That vaccine was not useful for giving to people who are immune suppressed. We now have a vaccine that is much like the current influenza vaccine. It is a killed protein and it causes a – I should actually killed the nucleic acid component. It cause a reaction to the virus that results in an improved immune response and significantly reduces the risk of getting shingles. It does - it reduces things like post-herpetic neuralgia, the tingling, or the persistent pain that can last for years at the site of the infection. It reduces the risk of ocular damage and it reduces the risk of other potential complications if you are severely immunosuppressed.

Host:  I’m going to put you on the hot seat here before I let you go. With all that’s been going on in the world this year, I have to ask this of course, many people are wondering have scientists developed a vaccine for COVID-19, that is the disease caused by the novel Coronavirus yet?

Dr. O’Marro:  There are several things in my lifetime that have occurred that have been extremely important. There was a lot of criticism about the time table from the initial finding of HIV infection in the 1980s and the development of effective therapies. But I will tell you that never in the history of mankind has a disease presented, the cause been found, and the underlying treatments developed in such a short period of time that have saved so many lives as the antiretroviral therapy for HIV. A lot of the virology that went into making that possible in the 1980s and early 1990s is now being used to attack Coronavirus. And so, it took approximately three to four years to even characterize HIV and subsequent to that, we developed something called a PCR test to which is famous on some of these crime shows, these pathology shows at nighttime. But this PCR test was able to amplify and characterize the virus. We have gone on to develop the ability to recognize and treat hepatitis C as a consequence of this technology and now we are applying that to Coronavirus.

The other thing that I have never seen happen is that we have a combined effort between usually competing pharmaceutical companies worldwide, universities and the government to develop this vaccine and share information about it. and I can tell you, I’m looking at vaccines in development and I’m flipping through ten pages with at least three to four candidate vaccines per page. And those are all in development and the most promising ones are also being produced while they are in development so that as we get data from the initial phase one and phase two trials and it becomes time to say we can give this; that we don’t have to wait six months for the vaccine to be made in sufficient quantities to give to people.

There is a history of a virus just like this in 2002 to 2003 called SARS1. Coronavirus is also given the name SARS2 or COVID-19., this current infection. It is in the same family of viruses and SARS1, there was a vaccine developed that was never administered because SARS1 went away. It is becoming apparent that the number of people who have had COVID-19 infections and don’t know it, is very, very high.

In May of 2020, May 4^th, there was a press conference given by Governor Cuomo referring public health data from New York State and when you look at New York State because they’ve had the most cases in the US. And at that time, they reported that two thirds of their cases were coming from people who were sheltering in their home. That is extremely important because a lot of people are asking people to stay out of work and to forgo their economic viability for the purpose of preventing infections because sheltering at home was felt to be a safe place.

Well in March, we all may have sheltering at home because we didn’t have enough personal protective equipment for providers let alone for people. So, there has to be something more than sheltering at home and we have to figure out why that happens. Well it turns out that between one third and one half of people who get Coronavirus infections have no symptoms at all. And so, the people who shelter at home don’t do this on an island. They have to have people come in and help them for various things. Meals, cleaning, taking out the garbage, whatever. And as a consequence, this virus has the ability to get into places like a trojan horse. Which means that sheltering at home is not enough for those people who are at high risk.

They also need to make sure that the people who are coming in to help them wear a mask and the surgical masks are meant in the way that they are designed to prevent the humidified air from the surgeon or operating team to get into a wound. So, they are not meant to protect the person wearing them, they are meant to protect the person in the environment of a person wearing them. So, we wear a mask, if not to protect ourselves but to protect those around us. And if you are out in the community and you’re wearing a mask, you really should expect that people within three to six feet of you reciprocate and return the favor. Because their masks are what prevent you from getting infected.

So, that’s kind of where we are with Coronavirus.

Host:  Thank you so much Dr. O’Marro for all this information, guidance, knowledge and thanks for all that you do at Springfield Clinic. And that’s it for today’s podcast. Tune in next month when we’ll explore five of the most common myths about the flu and flu season. And remember – Hally Health is your source for a wide variety of health and wellness resources, information and tips. Visit us online at Hally.com. Let us help keep you and your family healthy and well.
Thanks for listening. We hope you tune in next month