Caitlin Whyte (Host): This is Woodlawn Health Doc talk. I'm Caitlin Whyte. With me today from Woodlawn Hospital are the Director of Infection Prevention and Employee Health, Lyndsey Schrimsher and pediatric provider, Dr. Kevin Reyburn. We are talking all about vaccinations, pediatrics, and infection prevention.

Well I'll start with you Dr. Reyburn. Why are vaccines considered one of the most essential tools in public health?

Dr. Kevin Reyburn: They are considered essential due to the fact that they prevent illness rather than treat after you've already become sick. Many illnesses are not necessarily treatable after you become infected. And vaccines prevent that infection. And they've been used actually to eradicate some illnesses such as smallpox.

Host: And Lyndsey, what are the biggest misconceptions that you encounter about vaccines?

Lyndsey Schrimsher: There are a lot of myths about how vaccines are manufactured, tested, and distributed. I see a lot of these myths when I have conversations with employees about vaccination. So, one of the biggest issues that people report to me is that they believe that many vaccines contain aborted fetal cells or may contain DNA from somebody else or something else.

So, the reality of that situation is that viruses, in order to make a vaccine, viruses have to be grown or reproduced. And to do that, viruses have to reproduce inside of a cell. So, one of the necessary tools is that we have a type of cell that the virus will grow. Human cells work best because that mimics the real thing. Scientists figured out that they needed cells that were isolated from a sterile environment of the womb. This means that the cells would not be infected with other viruses, and the viruses that are produced in these cells would not be contaminated.

So in the 1960s, scientists took some cells from tissue from a fetus. Those same cells have been replicated and grown since then. When viruses grow in the cells, these cells are killed. Because in most cases, the new viruses burst out to be released. Once the virus is grown, it's purified. All of that debris is removed during the process, and there is no DNA remaining.

I like to compare this to picking fruit or picking blueberries/ if you think about it, this part of the process is similar. So when you're picking blueberries in an orchard, you might get some of the plant in there. You might get stems and leaves, or maybe even little pieces of branches in your bucket. You use the berries, but you remove all those other things. You wash them before you eat them, so that the pie only contains the blueberries. It's the same thing with vaccine production. While those other pieces might be involved in the growth, we filter them out.

Some vaccines have been engineered to grow in other types of cells, such as chicken embryos, which is why some vaccines can impact people with egg allergies. And so, we have different varieties available. There's a lot of beliefs that vaccines are not safe. The reality is that vaccines go through years of testing before approval. In the US, CDC and FDA monitor vaccines continuously to make sure that they're safe and effective. Some vaccines are developed quicker because they use existing technology and so they don't have to reinvent the wheel. Some of them take longer to develop because they have to grow those germs or reproduce those germs for several weeks and months.

And the most common one that I hear is that "I don't want to receive this vaccine because I've had one before and it made me sick," or maybe "I got the flu shot last year and it made me sick." Most side effects are very mild, like a sore arm or a low fever, and they go away within a day or two. These side effects are caused because your immune system is ramping up to fight that germ. Very few vaccines have the capability of causing infection, because they contain a germ that is either dead or weak, or maybe just parts of the germ. The only way you could ever actually catch the disease from a vaccine would be if you are a person who is severely immunocompromised and your immune system is not working as it normally should, which is why we ask you so many questions before we give you a vaccine because we want to make sure it is safe for you to receive it.

Host: And on that note, Dr. Reyburn, how do you address vaccine hesitancy among parents or patients?

Dr. Kevin Reyburn: The biggest problem I have now is the fact that parents get a lot of information from social media. And so, you're not just addressing one hesitancy or one misconception. There's multiple things. Everything from they don't want to get a vaccine because it has aluminum as a preservative in it to the fact that they can cause autism. So, you have to really drill down on what that particular parent is concerned about, and then try to work from there. So, there's not just one way or one thing we have to talk about.

I think the biggest problem that I've run into is that probably the biggest enemy of vaccines has been their effectiveness. Because 20 or 30 years ago when I first started in practice, there still was a generation of people that had family members or friends that had the particular illnesses or had died from the illnesses that we vaccinate against. And that generation pretty much has passed on now, so you don't have as much history to go by. I mean, we used to say, "Go home and ask your grandparent about vaccines." And most of the time, grandparents say, "Definitely get your vaccines. You know, your aunt died of small box or something." But we don't have that. So now, people don't see the effectiveness of the vaccines like they used to. That in itself is a hurdle that you have to get over.

A big hesitancy I do see is that they feel that if you give multiple vaccines at the same time, that they will hurt the immune system of the child. Again, trying to explain that we make about a hundred antibodies daily to different things that we're exposed to. And so, by giving the vaccine, we've probably given another 107 things that we make antibodies to that day.

If you look at one of the newer vaccines that we have, which is the rotavirus vaccine that was originally produced for use in Africa because the number one cause of death in children under 12 months of age in Africa before that vaccine came out was rotavirus from dehydration. And it was so effective in Africa. Then they started to use it throughout the entire world, and that's just been in the last 10 years.

Host: Well, knowing all of that, Dr. Reyburn, what is the schedule that parents need to be aware of when it comes to these vaccines?

Dr. Kevin Reyburn: I usually break it down into what I call the infant vaccines, which are the vaccines that they get at two, four, and six months of age. And then, the toddler vaccines, which they get at 12 and 18 months and then, after that, their kindergarten vaccines. And that's kind of how I explain it to the parents so they can understand. And if you break it up into that pattern, they can remember when they're supposed to get them at that point in time.

At two months of age, a hepatitis B, which is a vaccine that prevents a viral illness that causes liver injury. And people that get hepatitis B, about 50% become carriers. And then, of those carriers, there's a certain percentage of those that develop liver cancer. So, it's one of the vaccines that you can get that helps prevent cancer.

There's the rotavirus that vaccine that I was just talking about, that's an oral live virus that they get at two and four months of age. And then, there's a diptheria, tetanus, and pertussis, which diptheria is an infection you can get in the lungs, tetanus is lock jaw, and pertussis is whooping cough. And that one, they get at two, four, and six months as infants.

And then, there's two vaccines that we get for meningitis. One called Haemophilus influenzae type B, which I don't know why they called it an influenza, because it's not a virus, it's a bacteria. The other is strep pneumococcal vaccine. And that, they get at two, four, and six months as infants, and those both prevent meningitis. The other is polio. The nice thing is they've now combined polio, the hemophilus influenza, the DTaP, and the hepatitis B into one shot. And so, you only have to get two pokes at the visits now rather than five like we used to.

Then, at 12 months, they get the measles moms rubella and varicella vaccine, which is a little bit different than what they'd gotten before because it's a live virus vaccine. And that vaccine can cause a rash and fever about 10 to 14 days after the shot, not at the time of the vaccine. And it is very effective, you get about 95% protection after just one shot. You don't have to get multiple ones because it is a live virus. There's a hepatitis A, which is a diarrhea illness. Again, it can cause liver injury and hepatitis that is given at 12 months. And in 18 months, you get boosters of the diptheria, tetanus, pertussis, Haemophilus influenzae, and the pneumococcal.

Lyndsey Schrimsher: So, there's been a lot of discussion around vaccines in the news lately due to some changes that have occurred in the Department of Health and Human Services, which is who oversees the CDC or Center for Disease Control. Within the CDC, there is a committee called the ACIP, and they go in and they review evidence and they make recommendations to the CDC based on professional opinion and the evidence and the research that is out there.

Well, this committee recently made some changes and they made some significant changes to the schedule. And because of that, it has caused some controversy. Many professional organizations like the American Academy of Pediatrics, which is, you know, who our pediatricians are going to follow pretty closely, many of these organizations have publicly disagreed with some of these changes. And so, it's caused some confusion for parents, because now it's who do we listen to.

At the end of the day, I would recommend that you go with what your provider or your pediatrician recommends. They know your child best. They know what your child's risk factors are. They know what is circulating in your community at the time. They know what you should be concerned about, where you live, and work and go to school.

 If you do ever want to look at this information at yourself and see what those recommendations are, one thing that you can do, and a lot of people don't realize this is you can actually go on to the internet, Indiana Department of Health, and they have adult and pediatric vaccination rates in your county, state, and even school corporation. So, you know, this is something you may want to look at when you're trying to decide, "Do I want to vaccinate my child with whatever vaccine?" You can kind of look and see how prominent is it in your school system or in the area that you live.

Host: Of course. And Lyndsey, what role does herd immunity play in protecting our communities as well?

Lyndsey Schrimsher: So, herd immunity occurs when people are immune, usually through vaccination, so that a disease can no longer spread easily. This protects our vulnerable groups. So, examples of some of our vulnerable groups, infants who are too young to be vaccinated. Most infants do not get their first MMR vaccine—the measles mumps, rubella—until one year, which means for that first year of life, they are unprotected. So if your child is going to daycare, or maybe you're taking them to the grocery store, and somebody who is unvaccinated against measles or mumps or rubella is at the grocery store, your infant could be exposed or infected.

People who have weakened immune systems are another vulnerable population. So, this might be somebody who has cancer and is receiving chemotherapy. It could be something with HIV. It could be somebody who just has a lot of chronic illnesses that can weaken your immune system. And you can't spot these people by looking at them. You do not know what the immune status is of the person behind you in line.

And then, there are some people who do not respond well to vaccines, and it might be a medication that they have. It might be a blood disorder that they have. Older adults tend to have decreased immunity over time. So, it's not just about protecting ourselves, it's also about doing what we can to protect those people in our community who don't have that inherent immunity already. When enough people are vaccinated, germs can't travel as easily because they're not going to have as many people to latch onto and be carried throughout the community. Herd Immunity has historically helped control diseases like measles, polio, diptheria, and rubella, which is why we don't hear a lot about them any anymore.

Host: Great. And Dr. Reyburn, I'd love to know how COVID-19 changed conversations around routine childhood vaccinations.

Dr. Kevin Reyburn: It made it much more difficult for me. When the COVID vaccine came out, they were overpromised and then it underperformed. And then, when it became mandatory and there was a big political divide between people on when you're told to get something and you have to, or else you lose your job or something, then people became suspicious.

I can definitely say that was a flection point on immunizations in children. At that point in time, I was able to probably talk maybe 99% of all my patients' parents into getting vaccines. After that, I suspect, and I don't have the numbers, but it's definitely dropped, I would say maybe two-thirds now that don't want to even get vaccines, convinced that they're safe and they will get them. But it definitely made my job a lot harder, to put it that way.

The COVID vaccine actually, when it came out, because there was not a lot of information about it beforehand, I did not necessarily recommend to all my patients. We would talk about if there was high-risk family members or the patient was high-risk, we would get it. But on normal children, because we had seen the illness in lots of kids, we didn't go ahead and vaccinate all the kids that did not have a high risk to it because they seemed to tolerate the illness quite well. And I think we only ended up having two children during the whole pandemic admitted to the hospital for symptoms related to COVID.

Host: And Lyndsey, for adults, which vaccine should they be aware of to stay up-to-date?

Lyndsey Schrimsher: Vaccination is not a one-size-fits-all, especially when it comes to adults. Some people are going to have higher risk for certain illnesses based on their work environment, their home setting, their occupation, their health history, and even their age. So, you know, typically, immunity decreases with age because your body has less of those fighter cells, less of those soldiers. So naturally, older adults are going to have more recommendations.

Some of the big ones out there is the influenza vaccine. I think everybody should consider the influenza vaccine, even if you figure you are a healthy person. Think of the people that you live around and work around, you know, maybe your parents, your grandparents. RSV is another vaccine that is newer and is very exciting, because RSV is something that typically impacts older adults and can have some pretty severe consequences. And that is a newer vaccine that has come out. So, a lot of people are very excited for that one, and I would recommend that for older adults. There are also vaccinations for pneumonia. That can be really great, especially if you have an underlying respiratory condition. Maybe you have really severe asthma and you always have your whole life, you're more susceptible to pneumonia, and older adults, of course.

And then, shingles is another one that a lot of older adults will get because we've all had chickenpox, whether it was the vaccine or we got it from another kid and when we were in school. That virus can stay in your body and can reactivate later in life if you become immunocompromised. So, shingles is something that impacts people pretty heavily. So, I do recommend that shingles vaccine.

And the other ones really kind of depend, like I said, on your work setting. I work in healthcare so, you know, there are some vaccines that we recommend for healthcare workers that maybe aren't necessary for other people. Hepatitis B vaccine is really great if you are at risk for exposure to bloodborne pathogens. Hepatitis B is our most common bloodborne pathogen. Also, hepatitis A or if you are in an area where you may have contaminated water or contaminated food sources, you travel a lot, hepatitis A can be great as well. So, like I said, it really depends on your work environment, and this is why it's so important to discuss these risk factors with your provider.

Dr. Kevin Reyburn: The other vaccine that just recently they've come out with some studies on is the shingles vaccine. And it's been shown to decrease the rates of dementia in older people due to the decreased inflammation and also decreased strokes. So, the shingles vaccine's very important also.

Host: Thank you. And Dr. Reyburn, just wrap it up for us. What is one thing you wish people understood about vaccines that they don't?

Dr. Kevin Reyburn: That they have been around for over a hundred years. They've been used extremely effectively And that, like I'd said earlier, their effectiveness has been probably the biggest downfall of why people don't want them because they are so effective that they don't see the problems that can occur when people stop getting vaccines.

In Japan, because of the pertussis vaccine and that had a whole cell organism, there was higher fevers and seizures with it. And so, they had stopped vaccinating. And within a three-year period of time after they stopped vaccinating for whooping cough, they had a large amount of infants that died from whooping cough. So, it doesn't take long when you don't vaccinate for these illnesses to come back.

Host: That was Dr. Kevin Reyburn and Lyndsey Schrimsher. For more information, please visit our website at woodlawnhealth.org. If you enjoyed this podcast, please check out our entire podcast library for other topics of interest. I'm Caitlyn White. And this is Woodlawn Health Doc talk. Thanks for listening.