Amanda Wilde (Host): Vaccines work with your body's natural defenses to stimulate immunity, building protection against disease. We'll talk about what's recommended, success rates, benefits, and risks of vaccines with Clinical Pharmacist Maggie Montgomery, Director of the Pharmacy Residency Program at Montefiore St. Luke's Cornwall.

 Welcome to DocTalk presented by Montefiore St. Luke's Cornwall. I'm Amanda Wilde. Maggie, thank you so much for being here to explain vaccines.

Maggie Montgomery, PharmD, BCPS: Thank you very much. I'm glad to be here.

Host: Well, it's very timely because we generally hear a lot of speculation about vaccines these days and we're recording this in the fall when they're top of mind. So can you explain the basics of vaccines in terms of how they work?

Maggie Montgomery, PharmD, BCPS: Yeah, so just kind of the basics of how a lot of these ones that we, we use, we recommend sometimes every year, sometimes it could be less than that. So generally it's an inactivated... piece of the virus that gets injected into the patient. Your body is then able to respond and really just build up immunity.

And it's kind of like a test for the immune system so that when they see it in the real world, when they're actually exposed to the virus, the immunity is already there. One of the things that we talk about a lot of especially when it comes to COVID and the flu, some of those annual vaccines that we, well, we think COVID will probably be an annual one, is that it doesn't necessarily prevent you from getting it, but it already kind of preps your immune system so that essentially whenever it is exposed, it might not prevent you from getting it, but your symptoms should be less severe.

And hopefully it keeps you out of the hospital and kind of prevents some of those severe reactions to getting that virus.

Host: And then some vaccines are preventive in terms of when we think about smallpox, for example, or measles.

Maggie Montgomery, PharmD, BCPS: Yeah, and so some of that, it's still the same basic principles, however, a lot of that has to do with what's our percentage of the population that's going to get that vaccine. Because if we get that high, you know, almost everyone has it, then that virus doesn't have a chance to kind of jump from person to person because everyone's vaccinated.

And then essentially, it dies out because it has nowhere else to go and it kind of is a process where it has to do with, you know, herd immunity and things of that nature when it comes to, you know, how many people have and where that virus can go. And part of that also is preventing it from mutating and getting around our defenses as well.

 So if it doesn't have as many opportunities that that's kind of where that comes from and it, where we've seen that in the past.

Host: Well, with that in mind, what vaccinations should we always make sure to get? And then what time of year should we get them? If there is such a thing for, there is such a thing for some vaccines, not for others.

Maggie Montgomery, PharmD, BCPS: Yeah, so, for the purpose of this conversation, I'm going to focus a little bit more on adult vaccinations because pediatric, it's a whole nother ballgame, and there's a lot of different vaccines, but for kind of our general population or our adult population is what I'm going to focus on, and really a lot of those CDC recommendations.

So generally, the ones that we should be keeping our eye on, COVID, which is obviously a new one, that one, there is a new 2023-2024 version of the vaccine that I think everyone's probably been hearing about. So that one, I just want to mention now that that one, we should be getting one dose now. And the only caveats to that, that recommendation came out with anybody six months and older, is if you've received a COVID vaccine in the last two months, to wait two months.

Or if you've had COVID, because a lot of people right now actually have had a mild case of COVID, that you should wait three months, before really getting that vaccine. I will just state, there are some patients who, you know, people who are moderately or severely immunocompromised, and they really need to talk to their doctor because they actually might need more doses based on how many doses they've gotten in the past. There's different algorithms for that.

Host: Yeah, well, speaking of people that have immune issues and things like that, is there a downside to vaccinations for some people?

Maggie Montgomery, PharmD, BCPS: Not necessarily in our immunocompromised. Usually, and when I say immunocompromised, mostly I'm talking about cancer patients on chemotherapy, transplant, patients who have received some kind of transplant, people who are taking chronic medications that suppress their immune system that could be chronic steroids, medications that go along with their transplant.

They are just not able to mount the same immune response as maybe everyone else around them. So I usually, the only kind of caveat I would say, live vaccines, we usually don't give to those patients, which there's very few live vaccines. None of the ones we're talking about today are live vaccines, but generally live vaccines, we do use caution in those patients.

 However, our inactivated ones, if anything, they're the ones who need to get it more, or higher doses. So for our flu vaccine, for example, there's actually a higher dose vaccine that we might consider for some of those patients or our older patients. So just trying to give them a little bit more to get that immune system to work a little bit better.

But generally the downside is some of the vaccines might not work as well because their immune system isn't as activated, they're immunocompromised, but generally they do still need that protection even more.

Host: Well, there's been a lot of information out there and I think some misconceptions about the COVID vaccine. Is there anything you'd like to set straight right now about that?

Maggie Montgomery, PharmD, BCPS: Yeah, I think, when it comes to the, the COVID vaccine, there's obviously a lot of different speculation, but I think one of the main things that I discuss with my family and friends is, the safety of the COVID vaccine has been shown to be safer than getting COVID. So yes, you might have some side effects.

 Some people really do have chills, fever, fatigue, headache, after getting the vaccine. However, it's usually a much less than when they, people actually get COVID. That's the other piece of it too, is, you know, I'm already going to get the immunity from getting COVID, which is true, but you just don't know if you're going to be that person who doesn't really have a super severe case, or you're someone who has a really severe case. You end up in the hospital and you could be recovering from that for months to, you know, a year, sometimes longer than that. So, it's just rolling the dice where it's a little bit more reliable and safer with the vaccine. It is still new and I totally acknowledge that, but thankfully, we've been very fortunate to the studies that have come out that it is still safer, than getting COVID itself.

Host: hmm. So back to recommendations, flu annually? COVID annually?

Maggie Montgomery, PharmD, BCPS: So COVID's still kind of to be determined. It looks like it's probably will be in that type of thing. I know that there are even some manufacturers that are looking at putting COVID and flu in one vaccine, which would be really convenient for everybody, if we are going that way. For flu, yes, it's one dose annually, and it is recommended to get it by the end of October.

Getting it sooner than that, like in the summer, you think maybe you're being really proactive, but then the immunity might wane by that time, and sometimes it's better to wait till September, October, um, so that you really have the bulk of that immunity throughout the flu season.

And then the other thing just to note for those 65 years and older, there are some recommendations this year to get a higher or kind of a, a stronger flu vaccine. So that's something you can ask your doctor, your pharmacist about, just getting that, that recommended kind of higher dose flu vaccine, which really just triggers the immune system a little bit more and adds a little bit more protection.

Host: So your pharmacist is a great resource for all of this.

Maggie Montgomery, PharmD, BCPS: Yes, they're also, it's very convenient generally available, you know, at your local pharmacy. And a lot of things like flu, COVID, they're even able to counsel you and have different protocols that they can give it to you right there in the pharmacy rather than making an appointment and all of those different things. So, they can definitely help you there.

Host: Well, speaking of counseling, and we touched on this a little earlier, but I wanted to ask, do you run across some real common myths or misconceptions about vaccines? And if so, how do you address those?

Maggie Montgomery, PharmD, BCPS: Yes, I think some of the most common one by far that I hear, is that those people getting the flu from the flu vaccine. And that's just one thing. Again, it's a really common one. And there's a couple different things to think about for that. So, for one, generally speaking, the flu vaccine is an inactivated vaccine. It's not a live vaccine, unless you're getting a Flu Mist, which is a nasal spray. Vast majority of people do not get that. So if you're getting the flu shot, it's not an active vaccine or a live vaccine, but it does take about two weeks for the vaccine to kick in and add any protection.

It's also not a hundred percent effective. So if you get the flu after getting it, it's one of two things. Either could have been, you know, you got it pretty close after getting the vaccine and you didn't even have any added protection yet. It's just bad luck, bad timing. And the other thing is, again, it's not a hundred percent, so you can still get the flu after getting the vaccine.

The goal is that that was a less severe case of the flu. Hopefully it was something that you were able to stay home for a couple of days and feel a little bit sick. However, you didn't end up in the hospital, end up with a secondary pneumonia or something like that. So, those are, that's the biggest one.

The other one that been thrown around over the years is kind of this link to autism with vaccines. And I know that's a touchy subject for some people. However, the main study that the only study, that claimed this, was actually debunke, and the authors actually retracted their findings and were found guilty of ethical and scientific misrepresentations and even fraud.

So it was a really damaging study that was put out that was inaccurate, that still has some, you know, repercussions to this day.

Host: Yeah, yeah, it just stays in people's minds whether it's true or not.

Maggie Montgomery, PharmD, BCPS: Mm hmm. Exactly.

Host: Is there anything else you'd like to add about vaccines or the importance of vaccines?

Maggie Montgomery, PharmD, BCPS: Yeah, I think there's one other that I want to just mention quickly is a new vaccine that was just released or approved in September. So last month. It's really, really new. It's this RSV vaccine, respiratory syncytial virus. So there's ABRYSVO is the new vaccine. There's two different manufacturers, but the main one, actually, you can use it for individuals, 60 years and older or pregnant women who are 32 to 36 weeks gestation. And this is really exciting because previously we really didn't have a lot of things to prevent really severe cases of RSV, which end up resulting for some, you know, more of our vulnerable population with a lower respiratory tract, like a pneumonia.

So pregnant patients, if they get it at that time during that seasonal administration, which is kind of coming up right now, it can prevent their infants from getting that respiratory tract pneumonias. And then also individuals 60 years and older. This recommendation isn't as strong that everybody over 60 should get it, but it should be something that you should talk to your physician because if you have, you know, lung disease, heart disease, other different comorbidities, those are the patients that were shown to really benefit from getting that vaccine, to really lower their risk of getting a severe case of RSV that might land them in the hospital.

Host: Well, Maggie, thank you so much for this information on vaccines and your recommendations and also the updates on the vaccines for this year.

Maggie Montgomery, PharmD, BCPS: Yeah, thank you for having me.

Host: That was Clinical Pharmacist Maggie Montgomery. For more information about our pharmacy services, visit www.montefioreslc.org. Thanks for listening to DocTalk. Please remember to subscribe, rate, and review this podcast and all other Montefiore St. Luke's Cornwall podcasts.

This has been DocTalk, the podcast for Montefiore St. Luke's Cornwall.