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Dear Dr. K; Any good news on Covid vaccines?

Dear Dr. K; Any good news on Covid vaccines?

The answer is yes: they are working well and luckily the foibles are generally mild.  Globally there are eleven different vaccines currently in use, but so far only 2% of the world’s population has been vaccinated.  We need to do better, including vaccines that don’t have elaborate requirements for transport or refrigeration.  Another 251 vaccines are at some stage of development including 60 that are entering human trials.  Let me tell you about some of the very promising ones. 

Vaxxinity Pharmaceuticals has created a vaccine using proteins from the Corona Virus spike protein that are the ones that allow the virus to attach to and invade human cells.  Another company, Novavax, has also developed a spike protein vaccine but theirs is directed to the entire protein, not just the “latch-on” portion.  Both vaccines are very promising and early trials indicate they will work against corona variants. 

Vaxart Pharmaceuticals had developed on oral vaccine that uses the common cold virus (adenovirus) to carry pieces of the corona virus through a hybrid technology.  Johnson and Johnson and AstraZeneca use the same technology in their injected vaccines which work very well. 

There are two big advantages for an oral vaccine.  One is that it is easily administered, not requiring refrigeration.  The other is a dual protection mechanism.  Oral vaccines, uniquely, provide both “blood stream” protection (as do all injected vaccines) but also mucus membrane protection.  Oral vaccines lead to antibodies being present on the mucus membranes of the nose,

mouth and lungs as a first line of defense against the virus.  Historically there was a similar segue for polio vaccines from Dr. Salk’s injected vaccine to Dr. Sabin’s oral “sugar cube” vaccine.

Another advantage of Vaxart is that it elicits an immune response to both the spike protein and the N protein on the Corona virus (Johnson and Johnson and AstraZeneca only elicit spike protein antibodies).  This may be important for mutant variants because they alter the spike protein much more rapidly than the N protein. 

Valneva Pharmaceuticals is using a killed whole virus vaccine with two adjuvants (substances that enhance immune response).  Several killed virus vaccines are already in use (made by Sinopharm, Sinovac and Bharat Biotech) but they do not include the immune booster adjuvants. 

Inovio Pharmaceuticals uses a DNA vaccine that is injected just under the skin with multiple tiny needles and then zapped into cells via a handheld wand that releases a split-second pulse of electricity.  From there the cells produce the spike protein which cues an immune response.  No other vaccine uses this delivery system.  So far, patients report much less discomfort from the vaccine and also fewer side effects.  Since the vaccine consists of only DNA and saline it can be stored at room temperature. 

Priming the immune pump – deposits to the health bank

Priming the immune pump – deposits to the health bank

My paternal grandparents had no indoor plumbing. When I visited them as a child I was put in charge of bringing in water for coffee and breakfast oatmeal. I would run to the well and pump hard — with no result.

Then I’d remember the priming glass of water kept inside. Pouring it in the pump first always led to bountiful water.

The dramatic aspect of priming happens with many vaccines, which is one reason many are given as a series. Examples are DPT and polio. Priming also can occur with the flu vaccine, even though each year’s vaccine is different.

The reason I bring this up is because in the past few years many people — who previously received annual flu shots — have chosen not to.

What the media fail to report is that it is precisely that older population who have received flu shots over many years, who have the best chance of getting better “bang for the buck” via priming from all their previous vaccines.

And the strategy the CDC (Centers for Disease Control and Prevention) is now considering is to give two identical flu vaccines in the same season, with the first one being the priming dose for the second.

Q – Tips; sleep deprivation and vaccines

Q – Tips; sleep deprivation and vaccines

• Sleep deprivation can lessen the immune response to vaccines, report researchers at UCLA. In a controlled study they found that restricting sleep to four hours per night for five days led to only a 50 percent response to vaccination. Take-home message: If your or your child are sleep-deprived put off getting your childhood or adult vaccines until you are well-rested.
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.