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Dear Dr. K;

Dear Dr. K;

I recently read something about micro needles and vaccines.  Is that anything similar to my getting my flu shot intradermally?

Actually yes, it is.  As you know, the traditional and standard way to administer most vaccines (including Covid) is intramuscular; that is, injecting the vaccine fluid into a muscle.  The vaccine is then processed by migratory immune cells in the blood vessels and lymph system.  Obviously, this method works well. 

But the dermis of our skin actually contains 1,000 times the density of immune cells than our muscle.  This leads to a much more efficient response by our immune system.  An individual gets an as good or better antibody response by “skin vaccination” and it requires a smaller volume of the vaccine material. 

Until the advent of micro needle research, the only other way to do this was by a single needle intradermally: aka your flu shot.  3D printing has allowed the production of micro-needles.  The chip itself is about the size of a small fingernail and contains 60 tiny needles on one side.  The vaccine material is applied to these tiny pain-free needles and dried.  So, all that needs to be done is to press the small chip against the skin for a minute and then remove it.  Current research using this technique has led to a 50-fold increase in antibodies compared to intramuscular dosing. 

Since the vaccine is dry and “pre-loaded” it could be mailed to our homes and self-administered.

Vaccines after 65 — who and what for?

Vaccines after 65 — who and what for?

Dear Dr. K: I recently heard that there are certain vaccines that are recommended for adults. I thought I got all my necessary vaccines as a kid.

Not to pick on you, but I can tell by your question you didn’t read last month’s newsletter. In that issue I discussed influenzal vaccine (flu shot) which is recommended on a yearly basis. The vaccine is given yearly because it is a different shot each year, in order to address the new viral strains that emerge.

The tetanus/diphtheria (TD) vaccine is needed every 10 years throughout life. A new spin on this recommendation is that once during adulthood the TD should include pertussis (TDap).  The “ap” stands for acellular-pertussis, which is the new, improved whooping cough vaccine. This new recommendation reflects a resurgence of whooping cough illness in adults, due to waning immunity from our childhood vaccine.

Pneumococcal vaccine (pneumonia shot) can be taken by all adults, but is felt to be essential for persons with respiratory disease (COPD and asthma), heart disease, kidney disease, liver problems, diabetes, HIV and asplenic patients (persons who have lost their spleen). If the first vaccine is given before age 65, then a second vaccine is recommended after five years. If the initial vaccine is given after age 65, then no further shot is needed.

Herpes zoster (shingles) vaccine is recommended for all adults 60 years or older. Even if a person has already had shingles, the vaccine is still recommended.

Meningococcal vaccine (meningitis) is recommended for all young adults attending college. It is also recommended for mature adults with asplenia, HIV; and those who travel to endemic areas and for military personnel.

Hepatitis A vaccine is recommended for travel exposure, gay men, people with liver disease, and people with daycare exposure.

Hepatitis B vaccine is recommended for gay men and for heterosexual people who are not in a monogamous relationship. It is also recognized for all healthcare workers and for public safety personnel and for family members of patients who have chronic hepatitis B infection.

My aging immune system…and flu shots

My aging immune system…and flu shots

 Dear Dr. K: I read that since I’m 68 years old I won’t get as good immunity from the flu shot as a 30-year-old. Am I wasting time by getting vaccinated?

The complete and total answer to your question is “No.” However, let me elaborate.

The issue at hand is immunosenescence, or aging of the immune system. Just like other parts of our body, our immune systems age. It is for that reason that persons over age 50 are more likely to get shingles and to die from influenza. We (I can say that since I’m over 50) also are more likely to get bacterial pneumonia, urinary tract infections, meningitis, gastroenteritis and tuberculosis.

Because of these risks, it makes it all the more important to take preventive steps to bolster our immunity.

People over 65 get only 56 percent of the protective effect of flu vaccine and only 65 percent of the protective effect of the pneumonia vaccine, as compared to young people. Still, that 56 and 65 percent improvement is better than 0 percent.

There has been intense research on the aging immune system, especially with the wave of baby boomers enlarging the elderly population. One unexpected finding was that in addition to increased risk of infection in people over 50, there is a specific infection that by itself can actually speed the senescence of the immune system. The culprit is a virus called CMV – Cytomegalovirus.

As it turns out, this dastardly virus reduces the helper T-cell lymphocytes which are so important in building good immune function. CMV is in the family of herpes viruses and once you’re infected, it stays with you life long.

Since CMV is fairly common, there is intense research into finding a way to prevent its immunologic mischief.