Scott Webb (Host): Vaccinations are a hot topic in America these days, and my guest today is here to encourage us all to be vaccinated, to protect ourselves, families, and community at large. I'm joined today by Dr. James Lew. He's a Family Medicine Physician at Salinas Valley Health Prime Care. This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about vaccines and getting vaccinated and there's probably never a bad time to talk about vaccines. Yes, there's a, you know, cold and flu season, but let's be honest, you know, people get vaccinated year round for lots of different things.

So let's just start there. Like, why are vaccinations considered one of the most effective tools for preventing infectious diseases?

James Lew, MD: Well, simply because of the historical record, vaccinations have saved literally millions of lives, around the world. No other medical innovation has had such an impact on a global scale and continues to have such a remarkable impact on humanity.

Just the story of smallpox alone. A disease that just ravaged human communities everywhere. Millions and millions of people, throughout history died of smallpox. And within less than 200 years, from the inception of the smallpox vaccine by Edward Jenner, it was eliminated from the Earth.

Host: Right.

James Lew, MD: And that's the remarkable story in itself.

Host: Yeah, we could do a entirely separate podcast on how we eradicated, you know, smallpox and, yeah, there's been so many advancements. I don't need to tell you doctor, of course, in medicine, it makes me wonder, doctor, you know obviously they help protect individuals, but they also help the broader community, right? Like that's how we get to what they call herd immunity, right, is through everyone vaccinated, right? Yeah.

James Lew, MD: Correct. Right. So when you vaccinate yourself, you're protecting not only yourself, but those around you from getting sick. That is you prevent the transmission of disease. That herd immunity, that is when a community is vaccinated, you can actually prevent outbreaks.

And, that's one critical point to remember, especially vulnerable are the very young and the old, and as you know, multi-generational households are prone to outbreaks, when especially let's say the children aren't vaccinated or teenagers in this day and age, you know?

Host: Yeah, for sure. Yeah. Would you say these multi-generational, homes, which are very common in Salinas and Monterey, and so, you know, once something gets into the house, so to speak, right? So obviously you get herd immunity, within a home, in communities, all of that. And you touched on smallpox, but I also want to maybe get into polio, measles, just some of the other, some of the other biggies, if you will, that vaccinations have helped to reduce or eliminate of course, sort of omnipresent might even be COVID, of course.

James Lew, MD: Right, for example, polio is an incredible story, you know? That eliminated, polio from, many countries. Unfortunately, you know, this, it still lingers in some parts of the world, hasn't been totally eliminated. But, I still have patient's, who as children had polio and to this day, now that they're older, suffer from post polio syndrome. And it's a constant reminder to me, you know, of the effect that polio has had. Thankfully we don't see that now anymore. You know? Measles unfortunately is a very infectious virus that, uh, we're starting to see an uptick in.

And it was, I guess in 2000 almost, eliminated from the United States, but unfortunately, because of, you know, sentiments against vaccination and we're starting to see an uptick in outbreaks unfortunately.

Host: It's hard for me to believe like that some of these things, like we're still talking about them. You know, I, we are, and we can stay out of the you know, the politics and social media and all of that other stuff, but the reality is, that we're still talking about measles, even though it had basically been eradicated and eliminated, and it's just hard to get my mind around.

James Lew, MD: It's a very infectious virus and the more infectious the virus is, the faster it'll be transmitted if you give it a chance. That is if, if the vaccination, the herd vaccination, community vaccination rate falls. And, and we're seeing that unfortunately in real-time, again in the United States.

 More reason to be more vigilant, double down in our vigilance as a community and make sure our children are vaccinated in a timely fashion. Because again, it's, the youngest, the most vulnerable that get severely ill.

Host: Yeah, they do. And I, I wanted to talk to you, you mentioned children there, the most vulnerable, of course, but especially for children, adults too. Why is it so important that we just stay on our schedules?

James Lew, MD: Well, the way vaccines work is that it, especially the early childhood vaccines, you're training your immune system, to protect yourself against different, obviously, you know, diseases, infectious diseases. And what happens is that these vaccines have to be taken in a certain sequence so that you can, boost your immune system to an adequate level of protection.

And so, yeah, delaying your vaccinations can delay your protective immunity. Thankfully I would say, in our community, from what I see, most, I would say parents are very conscientious in, bring their children in, in a timely fashion.

Host: Yeah, that's good to hear. I want to talk a little bit, doctor, about pregnancy and, and or not vaccinations are recommended, and if so, which ones?

James Lew, MD: Yeah, good question. Pregnancy itself, is an interesting state in that the maternal immune system is downregulated during pregnancy. That makes the mother vulnerable to infections. And so we recommend that, expectant mothers do get their timely vaccinations, for example, against, the flu if it's nearing flu season.

Also we recommend they get a booster dose of TDAP, which is tetanus, diptheria and pertussis. Pertussis, you may recall is also known as whoopping cough. And it turns out that, whoopping cough, is actually, still around and particularly troublesome to young children.

And so by the mother getting this vaccination, she gets a boost in her protective antibodies, which she can then pass on to the unborn child. And when that child is born, has some passive immunity for a while until they can get their own vaccinations on board. The other vaccine that recently came on the scene is an RSV. That is, respiratory syncytial virus vaccine.

And as you may know, RSV season happens every year around the winter months, and is a very harsh infection for babies to endure. And, many times, they can end up in the hospital for days recovering. As you can imagine, has a quite an emotional impact on the families and parents.

And now with this vaccine, which we also give to the expectant mother, between 32 and 36 weeks gestation, she mounts an immune response. And again, produces antibodies, protective antibodies against RSV that she passes on to the unborn child, affording them some protection. Yeah. So it's wonderful.

Host: Yeah. It really is. Yeah. Wondering about potential health risks, doctor, you mentioned delaying or skipping. Is it just that we're more vulnerable, we're more likely to get the flu, or it might be more severe if we get the flu? You know, what are the downsides, I guess, to delaying or skipping these recommended vaccinations?

James Lew, MD: To my chagrin, I have a lot of my own patients, you know, adult patients, uh, declined to get, for example, the, the influenza vaccine. The influenza vaccine can either prevent or if you do get the influenza, decreases your risk of hospitalization and death, actually. What's underappreciated among adults, especially adults who might have underlying heart disease, which you know, is actually very prevalent, is that influenza vaccine actually decreases your risk of a heart attack and stroke, during the influenza season. And, what happens is it appears that getting influenza increases your immunity and during the response against influenza, the inflammation, the increased inflammation, affects plaque instability and in people will have, heart attacks and strokes. So that's an underappreciated fact. And in fact, there's, uh, other interesting, effects of just vaccinations that aren't unintended. For example, the shingles vaccine is also recommended, for people 50 and over. But some data coming out recently is by some groups have shown that getting the shingles vaccine and decreasing the incidence of shingles actually, decreases, the risk of vascular dementia by 50%. So that, that's interesting. You know.

Host: Yeah, I love hearing about these things. These sort of maybe unintended consequences or benefits maybe is the right word of some of this stuff where we've done podcasts on the weight loss drugs and all the many sort of, you know, unknown and still being discovered benefits of some of these weight loss drugs.

And as you're saying, some of these vaccinations might cover you for shingles and also, you know, other things. Which, kind of leads me to this next question, doctor. I wanted to ask about seniors. You mentioned 50 and over for shingles. Is there some sort of greatest hits vaccinations that you recommend for all seniors?

James Lew, MD: Influenza for sure. There's also a Pneumococcal vaccine, that we certainly recommend. It's gotten better over the years. Some people know it as, Prevnar 20. And then we just spoke about the shingles vaccine, which is a two shot series.

Those are pretty much it. Now, if you're a grandparent, yeah, I would probably get a booster of TDAP just for pertussis protection, boosting your pertussis titers so that if you're around your newborn grandchild, you know, you don't have to worry about inadvertently infecting them with pertussis. Yeah.

Host: Yeah, I've never had shingles, but from what I've heard, most people wouldn't wish it on their worst enemy. And so it's all sounds like good stuff. Flu, shingles, RSV, COVID, you know, you name it. It all sounds right to me. Just give you a chance here, doctor. We like to ask the expert. So a chance here for the expert that that's joining us today, just final thoughts, takeaways? I, I know we talked about it's never too late. That's going to be on my list. But anything else?

James Lew, MD: Yeah, don't put off when you have the opportunity, we all live very busy lives. You have the opportunity in front of you to get your vaccine, do it. Don't put it off. Remember that it's quick, easy, and effective. It protects not only you, but those around you and the community you live in.

Host: Right. Yeah. And I think that that's such a key message, doctor, is that it's not just about protecting you, yourself, but also potentially family members, you know, classmates, coworkers, the community at large, trying to achieve that herd immunity. Like it all sounds right to me. Definitely appreciate your time. Thank you so much.

James Lew, MD: You're welcome.

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.