Maggie McKay (Host): It seems like the topic of vaccines has been in the news since COVID and continues sparking conversation. So to shed some light on what we need to know about adult vaccines, is Dr. Wendie Grader-Beck, Primary Care Physician with University of Maryland St. Joseph Medical Group Primary Care Associates in Towson.

Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm your host, Maggie McKay. Welcome, Dr. Grader-Beck. Thank you so much for being here.

Wendie Grader-Beck, MD: Thank you so much for inviting me and for choosing such an important topic.

Host: Definitely. So why is it important that adults get vaccinated? Is it more important for certain groups of people than others?

Wendie Grader-Beck, MD: Well, I think adults really like to be prepared and vaccines are an opportunity to prepare our body to prevent infection. So many vaccines are for all adults based on their age. And then there's a few vaccines that are offered earlier, for people that have high risk conditions. And a lot of the recommendations are based on age of the adult. 

Host: So what are some important vaccines for adults to get and how often should they get them?  

Wendie Grader-Beck, MD: I would say in the cold winter months, a vaccine that's important is the flu vaccine. And that's a vaccine for all adults and for children that can prevent severe influenza. It doesn't just prevent getting the flu, it also prevents heart attacks and strokes for people that are older. So it's not just the illness you're preventing. And that vaccine also is helpful for preventing severe disease like hospitalization and death.

Some vaccines that I think are also important to consider are the pneumonia vaccine. There's a new guideline that just started in 2025 to prevent invasive bacterial infections from the pneumococcal bacteria that is recommended for 50 and above. And previously that was recommended for age 65 and above. So that's actually a new recommendation that will be important for people to be aware of.

Host: Wow, I had not heard of that. So they went from 65 down to 50? Why?

Wendie Grader-Beck, MD: Really why vaccines are given is to do prevention before you get an illness. So what they've found is that if people are given the vaccine early, they're less likely to get severe complications of a bacteria because your body can fight the infection off. There's been many more pneumonias. I'm sure you've heard this year of all of the outbreak in our community of different types of pneumonia, the bacterial pneumonias. Younger adults are tending to get these severe bacterial infections, and that's why they've changed that guideline.

The same is true for the shingles vaccine that was initially recommended for an older group and now is recommended for 50 and above. That's been for quite some time. But as you watch a population and see who's at risk for getting the disease, if you get the vaccine earlier, you can prevent the illness.

Host: Can you explain how those vaccines work to protect adults, especially those who already have health conditions? Is it similar to how they work in children?

Wendie Grader-Beck, MD: It's very similar to how they work in children. Adults have the benefit of having a fully developed immune system. So we don't need vaccines as frequently. We don't have to train our immune system, as frequently. So a lot of the adults, for instance, the tetanus vaccine, which is recommended for all adults every 10 years; for children, they'll need that vaccine, you know, four times in the first year of life, whereas we need it every 10 years. But it does work similarly. A very small particle is introduced to our body and our immune system trains itself. So, our immune cells are able to make the proteins and develop the cells that can attack that infection if it's seen inside the body. it's a very similar mechanism. Another thing to remember, and I think we need to remind ourselves is with the development of vaccines over the decades, we've gotten better and better at not needing entire germs.

So nowadays there are no live vaccines that adults are getting, unless there's a special circumstance. So all of these are just particles, a part of a vaccine. There's no live vaccine that's needed.

Host: And how can adults assess their risk factors to figure out which vaccines are most essential for them?

Wendie Grader-Beck, MD: The best resource that's geared exactly to you, is your primary care physician. That relationship with your primary care physician, they are seeing you for your physical, really for prevention. The goal is to talk with you about vaccines that can help you along with other things you can doto stay well. So that's one huge resource.

I think the second resource is to go to the cdc.gov and just write in adult vaccines. You'll see the entire list of vaccines. You'll see the ages when they're recommended. You'll see, what particular chronic illnesses would cause that vaccine to be required earlier, and you would also see what is the disease? What are we trying to prevent? So, when you see that often you're preventing death as one of the possibilities, I think that brings it home.

Host: That's a motivator. If someone feels they need a vaccine, but their doctor doesn't recommend it, how can they effectively advocate for themselves? Are there situations in which certain vaccines are not needed or not recommended?

Wendie Grader-Beck, MD: I would say for the most part, you know, if a patient has kidney disease, if a patient has diabetes, if a patient or a person has lung disease, heart disease; there may be instances when a vaccine would be given earlier or would be given, mostly it's earlier. It would be hard to imagine a time when a physician would not want to give that vaccine.

Sometimes that vaccine may not be available in the office, it may need to be ordered. Some situations you can get it at a pharmacy instead. But I think just bringing it up is mostly what you need to do. I will recommend one other vaccine that I think, the guidelines changed over the last two years or so for all adults to get vaccinated against hepatitis B, which has been given to healthcare providers for decades, been given to children for decades, and finally is covered by insurance to be given to all adults. And that can prevent an untreatable viral hepatitis that can cause liver failure.

Host: Okay, that's good to know.

Wendie Grader-Beck, MD: Yeah, so sometimes physicians may not have the focus on the vaccines. They may be dealing with a chronic illness with you, but it's also important. That's why the annual physical is an important time because it's all about prevention at that visit. And really a big part of that is the vaccinations.

Host: What are some strategies for finding affordable vaccine options if insurance doesn't fully cover the costs?  

Wendie Grader-Beck, MD: That's a wonderful question. I think the good news is that in 2023, Medicare began covering all recommended vaccines. And so the tetanus vaccine, was covered, which prior to that was a cost for patients. RSV is covered. That's another one to mention. The guidelines have changed, this year. And then insurance should cover the doctor's office for people who don't have Medicare, really every vaccine that is recommended. So, I think the only challenge is when a vaccine is new and may not be recommended for someone's age group yet, that they may not get covered. But in the vast majority of cases, insurance does cover the cost. And I'm not aware of working with a company, you know, a pharmaceutical company to be able to get a vaccine covered. Really it happens through the physician. And most of the time you do not even need a physician order.

If you have that age group and that eligibility, you can go directly to the pharmacy, show them your insurance card and get your vaccines.

Host: Right. And so it's free, like at the pharmacy, if you have an insurance card?

Wendie Grader-Beck, MD: There may be an administrative cost. So it may cost like 10 or $15 because they're taking the time to administer the vaccine safely to you. I think the best place to get your vaccines is at your physician's office, honestly, because they're keeping a close record of this. And for instance, at our office, whenever we give a vaccine, we put it through the statewide Immunet system.

So no matter where you go in the state of Maryland, anybody who has access to Immunet, any hospital, any other physicians know exactly what you got. So then we know, okay, you did get your tetanus eight years ago and maybe you didn't remember that, or, you know, you got your pneumonia vaccine four years ago and you don't remember that.

Host: Do the pharmacies have access to those records?

Wendie Grader-Beck, MD: The pharmacy can have access. Do they use that? oe pharmacies are very good at putting it in. So if a patient, let's say, they went and got their influenza vaccine, their high dose influenza because they're over age 65 at the pharmacy earlier. Sometimes I can look in Immunet. I always look in Immunet before I discuss vaccines with a patient, and see that. Other times we will put it in for them if we have the exact date. So, it's variable, unfortunately.

Host: Are there any side effects or safety concerns that adults should consider before getting vaccinated? Because I'm sure you've heard it a million times. Like just a lot of my friends or in conversations in general, people say, did you get the flu vaccine? They're like, no, cause last time I got the flu and it was worse than getting, you know, or same with COVID. No, I had side effects, so I'm not going to get the booster. What do you say to those patients?

Wendie Grader-Beck, MD: What I would say is there are some known side effects. So for instance, every 10 years when we get our tetanus vaccine, boy, is it going to hurt. And I say to people, this is going to hurt tomorrow. I don't like patients to have any surprises. I want them to know what to expect so they can make a choice that's informed.

So for tetanus, yes, your arm is going to hurt. Are you going to feel unwell? No, you're not going to feel sick, you're not going to have a fever, but your arm is going to hurt,because our immune system is responding. So in many ways we can celebrate. Yes. I am not going to be getting tetanus, but I won't need this vaccine for another 10 years.

Other vaccines like the shingles vaccine, which is Shingrix, which is needed two times for adults over age 50, that vaccine, one in four, so that's 25 percent of patients are going to have possibility of either your arm hurting or being under the weather, feeling like a low grade fever. Not feeling well. So you can plan that. You're not going to do that before you go on a great trip. And then for the COVID vaccine, it is really half of the people that have that side effect of not feeling well, having fever for some people. What I would say, even for the COVID vaccine, which I think of all the vaccines, has the highest rate of half of the people having a side effect; the very severe side effects of COVID are about at least 18 times more common if you get the actual illness. So remember when we're giving a vaccine, we're giving one little piece of a part of virus or a part of a bacteria that's not alive to train our immune system to hone in and be able to see that and kill.

But if you get the whole illness, you're going to feel much more unwell. And so anyone who's had a friend who's gotten shingles is pretty.

Yeah, they're very eager to get the vaccine versus to get the illness. Yeah. 

Host: You mentioned the CDC, are there other places where people can find reliable information on vaccines, especially with so much misinformation out there?

Wendie Grader-Beck, MD: Yes, I think that you want to be looking at the medical organizations that are based on the highest level of research and expert guidelines. And so the American College of Physicians is a very important resource for adult vaccine recommendations and every year they will put out an update for that. And there's even little videos you can watch. The American Academy of pediatrics, also has clear guidelines, and you can look on their website as well to see the latest guidelines for your children. 

Host: Do you have any key takeaways for our listeners on this topic, adult vaccines?

Wendie Grader-Beck, MD: I think the key takeaway is that we love to wake up and feel good and do whatever it is we have planned. And it's when we have unexpected illnesses that we are not happy. So this is all about prevention. This is all about waking up and getting to do what you love to do. So vaccines are a wonderful way to protect ourselves and prepare ourselves. So I think adults love to be prepared. So here's an opportunity.

Host: Well, thank you so much, Dr. Grader-Beck for joining us today. This has been very educational and helpful. We appreciate it.

Wendie Grader-Beck, MD: Thank you so much for having me. It's been a pleasure.

Host: Of course. Again, that's Dr. Grader-Beck. And for more shows just like this one, go to umms.org/podcast and on YouTube. Thank you for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media.