Intro: It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie Cole, MS (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And today, we are clearing up the confusion about vaccination recommendations. Joining me, fan favorite, Dr. Anirudh Rai. He's a primary care physician at Henry Mayo Newhall Primary Care. Dr. Rai, thank you so much. This is a topic that you and I talked about—talking about—a few times ago.

So recently, the federal government changed some of the schedules for recommended vaccinations. Tell us a little bit about the new recommendations, and if you have some thoughts on why some of these changes were made.

Anirudh Rai, MD: Yeah, absolutely. So, to give you a better idea, these vaccinations were initially invented or I would say introduced to fight some of the viruses that are out there. For instance, hepatitis B, all these viruses that kids get that tend to lead to a lot of their mortality, meaning a lot of their deaths.

So, the vaccination schedule has been well-studied. And some of the changes that was introduced have their reasons and their quips here and there. To give you an idea, initially 17 vaccinations or obviously 17 vaccinations against 17 different organisms was likely recommended initially. Now, they've reduced it down to approximately 11. So, it was not a huge reduction. And the reduction they recommended is basically instead of having a hardcore, "This is 100% required," about four of the vaccinations they said, "Talk to your doctor, see if it's a good fit for you or not." And we'll go more in depth about these particular changes. But majority of the vaccinations have been about still the standard.

The ones they've changed, and we could talk about it step by step, would be the hepatitis A and B, which are one of the ones that we could talk more about, as well as the meningococcal virus and the rotavirus. These are the particular ones that have seen a bit more change. And of course, they mentioned at least in some of the newrecommendations or addendums that some of the new chemicals, and at least the flu one, they removed some of these more mercury-based chemicals as well. At least they're more strict about them now. But we could go in more detail about at least these major changes, which typically involves about at least four of the vaccinations.

Melanie Cole, MS: So, I do want to do that with you. But quick question, did the AMA endorse these recommendations?

Anirudh Rai, MD: Typically not. Usually, AMA and the other associates, even the pediatric associations—

Melanie Cole, MS: Yeah, the American Academy of pediatrics.

Anirudh Rai, MD: Yeah, they typically recommend—well, they said keep with the current schedule. And based on these recommendations, it's not really like a strict guideline. They said that each state and each sort of regulatory sort of institution has say in it no matter what, but it's going to be up to the state and up to your doctor, of course, to determine, okay, what's going to be the best vaccination schedule.

But pediatrics and the other institutions likely said, "Hey, keep the current recommendations at bay." And we can always talk about the quibs because at least from my perspective, at least I looked at the data and some of it, I mean, I would agree about 50%, I would say.

Melanie Cole, MS: Okay. So, tell us about some of those changes, specifically hep A and B, you said. What do you think about them, and what does the science tell us about these?

Anirudh Rai, MD: Yeah. Initially, hepatitis B came out in a very integral part of, I guess, human existence, because hepatitis B used to be, back in the day, a huge mortality driver for infant death, and we really didn't have much of a treatment for it or even a cure. The vaccination came out, and that typically put an end to that. So, hepatitis B is one of the few heroes of child mortality, so to speak. So, it decreased that significantly.

The issue with that is we gave it to everyone as a blanket sort of scenario. We're saying, "Okay, we'll just give this to the baby just in case." But we found out, at least in the literature, with hepatitis B, the way it becomes transmitted is what we call vertical transmission, meaning it goes from mom to the baby. So, the baby can't really have hep B unless mom has hep B. And we have really good lab work and good ways to actually detect hep B in mom. So, the current guidelines are saying that we shouldn't do a blanket hep B vaccination. The current ones are saying that if mom is tested negative and there's no reason for baby to get hep B, usually, they're not seeing any sort of data saying that we should give the baby hep B back in the day where hep B was prevalent, there was no other vaccination, and it was a blanket statement. In third world countries, this is also another issue because hep B is quite prevalent. So in those scenarios, they'd be more stringent.

But however, in America, we're not seeing a lot of hep B, at least in our native population. In fact, it's almost nonexistent. Hep B in itself is one of the few recommendations in this sort of scenario I would say. It makes sense because we're actually following the data rather than doing a blanket sort of vaccination without any sort of evidence saying, "Okay, does this actually prevent hep B even if the patient has not had hep B at all?" So, this was likely a preventative in the sense of vertical transmission.

The other one that they also recommended, particularly like you mentioned hep A, that one's a little bit more trickier because hep A again is more of a third world condition where if you have bad sanitary conditions or if your drinking water is affected not so well, hep A is more likely to be introduced. And that, of course, does cause mortality, particularly in kids.

Since we're in the West, where drinking water is essentially mandatory and everyone has good drinking supply, they're thinking about, okay, I mean, think about that more in the basis of how the patient is living. If they're in an area where you say, "Okay, maybe you're not getting the best drinking water," then they'll be considering that as part of their vaccinations.

Right now, what they're doing for these two vaccinations, which I tend to agree on because it makes sense from a scientific standpoint. But at the same time, again, talk to your doctor because hep B in itself has been proven to be effective and overall has less side effects.

The other thing I did fail to mention before is they actually split up the MMR, which is the measles, mumps, rubella, and the varicella, which is the chickenpox. The new mandate says they split that into MM and R and they split the varicella apart, meaning the chickenpox should be given separately. And these two, the hep A, B as well as the varicella, do have some scientific standings. What they found out that is with the varicella vaccine, kids tend to have a very intense reaction.

Even adults, when they get the shingles shots, which is quite similar, tend to have a very intense reaction, headaches, fevers, chills. And they found out that in this vaccination, it's very low, it is measured about one in 3,000 or even maybe even less than that, that kids sometimes get what they call febrile seizures, meaning they get a fever that's relatively hard and they tend to have a little bit of seizure, which is scary. Thankfully, it is safe, and as long as you go to see a doctor and make sure they're evaluated. But they found out giving these vaccinations together that they did see a little bit rise in what they call febrile seizures. So, they recommend basically splitting those vaccines apart. They would still say give them to the, to the pediatric population, but they recommend, "Hey, let's split apart to avoid these sort of reactions."

These two I do agree with. The other two, which we could delve into a bit more is going to be involving the meningococcal and the rotavirus, which I don't tend to agree with the current sort of idea, which is they're downgrading it to, I guess, based on the patient population and if you feel they're at high risk. I personally think these two vaccinations, they do have a high degree of data showing that they're helpful.

Melanie Cole, MS: Wow. Well, thank you for telling us that really straight and clear. And if we follow the science, and it sounds similar to me, Dr. Rai, like with Gardasil and HPV, how that really changed the Pap smear recommendations. If you're testing someone and they don't have HPV, then maybe you don't need a Pap smear every year as you follow the science between the interaction of those two. So, that is really interesting that you pointed that out, and thank you for clearing that up.

Now, you must be running into parents and patients that have questions, concerns, because we hear it all now in the media. What do you tell them?

Anirudh Rai, MD: That's a good question. Just to kind of give you a quick background about the two that I disagree with. The rotavirus, which, tends to be a cause of what they call intussusception in kids, meaning the bowels get twisted, I personally would agree to getting that vaccination, even though it's, well, let's say it's not the best tasting kind of vaccine because it is given in that regard, as well as the meningococcal, which is given when you're a bit older, like 11 and 12, because it does prevent some form of meningitis, which again, back in the day, and even today to a certain degree, has some form of mortality associated with it. So, I would recommend that more stringently, I would say. So I would want to keep those two vaccines at bay.

When it comes to introducing vaccinations to our patient population, I mean, since the whole introduction during the COVID era, I mean, patients tend to have this natural hesitancy these days just because they saw the data and the news, et cetera. Usuall,y what I tell my patients are these vaccinations have been studied quite well, like for instance, all the ones that are mandated for our kids, as well as the flu. These have been well-studied. They haven't made the new changes they did, let's say, with the COVID vaccine, and I would try to introduce them at least gently and with a lot of facts saying, "Yeah, these vaccinations are well-studied. They are helpful. They prevent these kind of diseases." And usually, it takes some time to have that sort of trust form with the patient. But at the same time, we always let them make their decisions and say, "Hey, just be cautious about these symptoms. If these things occur, give us a call, and we could see if we could treat any of these symptoms earlier in case you do get any of these viruses."

More often than not, vaccinations is a team sport. It does require two to tango, so to speak. So, generally talking to parents and even talking to the patient themselves, it takes a lot of patience, so to speak

Melanie Cole, MS: Well, it does. And even for those of us, you know, commoners that are not doctors, we have these discussions, and we see these discussions going around, and everybody has their own opinions, but the science has shown us over the years. And you do get people that still will say, "Well, we don't see polio anymore," or whatever. And then, you know, you might say, "Well, that was because of the vaccine that we don't see those anymore." So, it can be this ongoing discussion, this ongoing conversation. And yes, it can take some patience. It can be frustrating, but you're clearing up a lot of this for us.

Now, what do you say when people say that certain diseases, specifically chickenpox is mentioned a lot, but measles, that they're harmless, and rather than be vaccinated, they just want the kids to get the disease, get it over with, you know? And what do you say to people about that?

Anirudh Rai, MD: Well, those two diseases are quite separate. Measles is quite deadly, so I would definitely let them know and say, "Hey, measles is extremely contagious. We would definitely recommend vaccinations because treatment for that is, is quite intense, and sometimes even the kids themselves can't really tolerate all that."

Chickenpox, there's a lot of debate about that. Sometimes there's a debate saying more is natural immunity better than, let's say, a vaccination immunity. Overall, when it comes to these kind of questions, when it comes, particularly varicella or the chickenpox, I definitely say, "Hey, I definitely recommend the varicella vaccine." it's a bit more intense for kids because you tend to have a more robust reaction with the immune system, which you might get some headaches, the fevers and chills. I would say it's better to get this reaction momentarily rather than have a week-long or even a month-long course of the chickenpox. And it's hard to determine where parents are, I'll be honest, because they tend to be a bit more cautious or even, I wouldn't say distrusting so much, but more they take everything with a grain of salt these days, and they do a lot of their own research.

But whenever I have patients who have these issues, especially if they want to say, let's say, the measles and the chickenpox, I would definitely reiterate the measles for sure. I would recommend vaccinations because there's not a lot of, like, a straightforward cure for these kind of conditions, and measles stuff is quite contagious.

Varicella or chickenpox is something that is well-studied, and we know it quite well. And then, I wouldtalk to them about saying, "Hey, vaccinations tend to make it easier if you don't get the disease. And even if you do get the disease, you tend to be able to fight it off quite well." A lot of back and forth with parents for sure, but it is something that with a lot of patients can pay off.

Sometimes getting kids who have never been vaccinated up to date is a huge sort of a cost-effective way to keep them out of the hospital and the emergency room. So I always tell them it might be less expensive as well if they get the vaccine, they don't get the condition, and if they do get the virus, they fight it off pretty well.

Melanie Cole, MS: Well, I'm old enough, Dr. Rai, to remember before we had measles or chickenpox vaccines. And I remember my brother getting measles and mumps. I got the chickenpox. I remember how awful those were, and my brother did end up in the hospital. So, I remember how these were. And so, I hear you when you're saying that it's contagious. It can be a very dangerous disease to have. And chickenpox, like you say, there's a lot of discussion going around, but I can tell you, having had it, it is terrible. It was uncomfortable and terrible and lasted quite a while. So, I mean, I was out of school for a while, but still, you know, not a pleasant situation. So, thank you for clearing a lot of that up. You're always so good at this. Bottom line, Dr. Rai, on vaccination recommendations, the changes in the recent federal government recommendations, what do you want us to know?

Anirudh Rai, MD: So in summary, I would say vaccinations overall have not been changed too much. So, we still have the core vaccinations we recommend for everyone. Like you mentioned polio before and majority of like the DTaP, tetanus. A lot of them are still there, the MMR, varicella. So, majority of them are still there.

Right now, they're recommending, okay, maybe these two vaccines, which I tend to somewhat agree with, like the hep B, since we're not seeing a lot of hep B in our moms population, so there's less chance of vertical transmission. I personally don't see any sort of basis of giving a blanket state vaccination. But at the same time, I would let the patient know saying, "Hey, this is something that we can consider. It's a safe vaccine, well-studied." And it's up to them to kind of determine that.

As for the meningococcal and the rotavirus, I would highly recommend continuing those vaccines just because it does prevent a lot of the issues associated with those viruses. So, those two vaccines I would definitely consider. Definitely talk to your doctor, definitely talk to your pediatrician. They'll have a lot more information about these viruses because they actually have seen the cause and the instances of these viruses. So, it's important to have their perspective as well.

But the bottom line is, overall, the main vaccine schedule is relatively unchanged, except for at least these four that we mentioned before, which is the hep B, hep A, the meningococcal, the rotavirus, as well as the split between the MMR and varicella. so definitely talk to your doctor. There's a lot of debate, a lot of information out there, but your own doctor will definitely give you more information about this as well. And hopefully, this gives you a little bit of insight about what some of the changes are. Overall, vaccinations are helpful, well-studied, and they can prevent a lot of death and a lot of hassle for sure.

Melanie Cole, MS: Thank you, Dr. Rai. You are really just a wealth of knowledge. And I can say as a parent, when my kids were going to college, I was glad they got the meningitis vaccine because college, you know, it can be running around there as well. So, thank you for telling us about those changes and why they were made. This was really an important episode today. So thank you again.

And to book an appointment with Dr. Anirudh Rai, you can visit our website at henrymayoprimarycare.com. You can always get information from the free Henry Mayo Newhall Hospital online health information library at library.henrymayo.com. And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Remember to subscribe, rate, and review It's Your Health Radio on Apple Podcasts, Spotify, iHeart, and Pandora. Thanks so much for joining us today.