Amanda Wilde (Host): Once your immune system knows how to fight a disease, it can give you lifelong protection. Vaccines teach your immune system how to create antibodies to defend against disease. In this episode, Primary Care Physician, Dr. Christine Baker, breaks down which vaccines are essential at each stage of adulthood.

 This is WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Welcome Dr. Baker. Thanks for being here.

Christine Baker, MD: Thanks so much for having me.

Host: I did mention adults in my introduction here. Can you give an overview of why vaccines are important for adults?

Christine Baker, MD: Vaccines are very important for adults. Most important is protection from hospitalization and death. Second, on a very practical level, vaccinations provide protection from illness. And in the US this provides protection from days missed from work, days spent on the couch with high fevers and chills, and then of course, protection from spreading the disease to our loved ones and those who are most vulnerable.

Host: So it decreases danger for yourself and others and enhances protection for yourself and others. But let's look exactly at how vaccines prevent diseases and in other words, how do vaccines actually work?

Christine Baker, MD: Vaccines were developed really in response to smallpox in the late 1700s. And I'm going to just say a little bit about that story because it kind of illustrates beautifully how vaccines work. So at that time, there was an English physician, Edward Jenner, who observed that milk maids who were women whose full-time job was to milk cows that they who had contracted cowpox, which was a mild disease.

So they had gotten cowpox from milking the cows that those women had protection from getting the disfiguring and deadly disease smallpox. So he did something that would've broken a lot of medical ethic rules today, but was probably appropriate at that time. He injected a small boy with material from a cowpox sore, and then some days later exposed that same small boy to smallpox and the, the little boy didn't get sick.

It's really the same simple idea that we use for vaccines today. We expose our immune system early to a non-deadly particle that mimics a disease, and that's the vaccine. And then when we're exposed to the real disease, our immune system is ready.

Host: And so you may get a milder form of the disease or not get it at all.

Christine Baker, MD: Yep, exactly.

Host: I always think of vaccines as something we get when we're kids, but let's talk about when adults should get vaccines. From, let's talk about when you're beyond childhood vaccines, what are the first vaccines you might get as an adult, and why would you get them?

Christine Baker, MD: I sort of break it down into a few groups within adulthood. So age 19 through 49, we think of updating your tetanus booster. So that's what you get if you step on a nail, get bit by a dog, need stitches, so that's the tetanus vaccine, which is also paired with the whooping cough component, so then it becomes T DAP.

And then also recommend yearly flu shot and COVID boosters. For this age group, they tend to be a little more adventurous and do traveling, so it's important to remember travel vaccines if they're going to be going out of the country to somewhere where there's high mosquito populations, they might need yellow fever depending on what the travel conditions are like at that time. So that's sort of 19 to 49. And then ages 50 to 64 we'll layer in Shingrix, which is a two-part vaccine series to prevent getting shingles and the pneumonia vaccine to protect from getting pneumonia. 65 and over, we think about also adding in RSV, which is a vaccine to protect from respiratory as well.

I will also say that there's some flexibility within these guidelines. So if you have a patient who is immunocompromised, basically somebody whose immune system isn't working at a hundred percent, whether it's due to cancer, whether it's due to certain medications that they're taking; those patients sometimes can get some of the vaccines earlier. There is some flexibility and you look at it sort of on a patient by patient basis.

Host: So how can patients and healthcare providers work together to weigh the risks and benefits of vaccines?

Christine Baker, MD: I think that's a really good question because there's so much discussion now nationally about vaccines. I think the most important thing is taking the discussion on an individual level. I feel like each person is different. A lot of people really want to be protected with vaccinations, and so we'll go through what is appropriate and available for them.

And then I have other patients who really feel like they do not want vaccines due to religious reasons or severe allergies they've had in the past. I feel like that also needs to be acknowledged and respected. So I would say it's a decision and a discussion. I have the advantage of a lot of years of experience, so I can kind of help lay out the risks and the benefits and how that kind of fits in with that patient's clinical picture.

Host: You make me wonder how the conversation about vaccines has evolved over the past decade and since the pandemic. Can you talk a little about that?

Christine Baker, MD: I do think that it has evolved. I think during COVID, we experienced a lot of patients who really were pro-vaccine and wanted to get the vaccine, and then there was this whole other patient population who felt like they did not want to get the vaccines for personal reasons. So I feel like there's some suspicion of vaccinations now, which in some ways is unfortunate. And I have found that what's important with patients is to accept each person's viewpoint, kind of lay out what we know and what we don't know, and then together sort of come to a decision. I feel like the trust that the patient has with the physician, for me is, is the most important thing.

Host: So you're a team with each individual patient.

Christine Baker, MD: Yes.

Host: Well, Dr. Christine Baker, thank you so much for these insights and providing clarity on adult vaccines.

Christine Baker, MD: You are welcome. It was my pleasure being here today. Thank you.

Host: To learn more about WakeMed primary care, visit wakemed.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Amanda Wilde with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.