An overview of some common vaccines that can prevent serious illness
Dr. Magda Sobieszczyk is the Chief of Infectious Diseases at NewYork-Presbyterian/Columbia University Irving Medical Center. Dr. Sobieszczyk is a clinical virologist and the principal investigator of the NIH-funded Columbia Collaborative Clinical Trials Unit which has been advancing the science of HIV and emerging infections like SARS-CoV-2.
Dr. Sobieszczyk joined Dr. Hyesoo Lowe on an episode of the Columbia Surgery Podcast Series: Conversations & Curbsides. The two doctors discussed vaccines such as the Covid, RSV, Flu, and Shingles vaccines, as well as who should consider each.
The following is a transcription of the discussion, and is lightly edited for context and clarity.
Jump to a Section:
Introduction
Dr. Hyesoo Lowe:
I'm delighted to be joined today by Dr. Magda Sobieszczyk, professor and chief of the Infectious Disease Division here at the Columbia University Irving Medical Center. Thanks for talking to us today.
Dr. Magdalena Sobieszczyk:
Great. Thank you so much for having me.
Dr. Hyesoo Lowe:
This is a very timely season, as the vaccine season is up and running. So just to talk about that a little bit, it seems like the flu vaccine, COVID, Shingrix or varicella, RSV, a lot of these are on the top of everyone's mind. I've also noticed in even my local pharmacy, a whole menu of vaccine options, including pneumonia and a variety of other ones.
Dr. Magdalena Sobieszczyk:
There indeed is a veritable potpourri of vaccines that's available, and it can get confusing!
Covid, RSV, And Flu Vaccines
Dr. Hyesoo Lowe:
So let's just start with the top-of-mind issues. Who is recommended to have the flu vaccine, COVID vaccine, and RSV? Let's start there.
Dr. Magdalena Sobieszczyk:
The way I think about it is that, especially with the updated COVID vaccine, anyone over the age of six months is eligible for the updated COVID vaccine.
For the RSV vaccine–which is also a new and exciting development because it's the first approved RSV vaccine, and there's been a lot of research in that field happening for decades–right now, the current recommendations are that the RSV vaccines are recommended for individuals above the age of 60 years old. And there really also is very much a conversation and shared decision-making between the provider and that individual above the age of 60 because there are special indications as to who would need it.
Dr. Hyesoo Lowe:
Can you quickly define RSV?
Dr. Magdalena Sobieszczyk:
That stands for “respiratory syncytial virus,” which is a virus that causes an upper airway pneumonia-like infection, like a bronchitis or a respiratory illness. And we often think about it like it's a common cold that comes and passes. It peaks in the late fall and in the winter season.
Dr. Hyesoo Lowe:
Thank you, so getting back to the other vaccines. Covid, RSV…
Dr. Magdalena Sobieszczyk:
And flu, good old flu vaccine, again, something that is recommended annually. The Flu vaccine that is updated every year, as we all know. That's a vaccine that's really recommended for pretty much anyone, sort of childhood and above, and especially for older adults.
But for people who are older and for little babies who have tiny airways where every little bit of inflammation can wreak havoc, it is very important. For older individuals and little babies, such an infection can be actually quite devastating. It can lead to respiratory complications, hospitalization, and severe pneumonia. So people who are older, people with a compromised immune system, and small infants.
Shingles Vaccine
Dr. Hyesoo Lowe:
Got it. And also for the Shingrix, which is the shingles vaccine, is that a similar thing, the older and the younger, or just the older?
Dr. Magdalena Sobieszczyk:
Yeah, so the shingles vaccine, it's really recommended for adults 50 years and older in general. But for individuals who have a compromised immune system, they're getting cancer drugs or chemotherapy or they're living with HIV, for those individuals, the vaccine can be recommended when you're 19 years old and up if you have a weakened immune system because of an illness or medications that people are taking.
Dr. Hyesoo Lowe:
Great. So that's very helpful to know. So flu and COVID, pretty much everyone is eligible and probably should. And then there are more specific recommendations for some of the other vaccines.
Yearly Covid Vaccines?
Dr. Hyesoo Lowe:
Do you think the COVID vaccine is going to be kind of like the flu? Every year, we know and accept the idea that we're going to get a flu shot. The same with the COVID, do you think?
Dr. Magdalena Sobieszczyk:
It's very much on people's minds, because people are a little bit sick and tired of yet another vaccine coming out. I think the way I think about it and many people think about it is that probably just because the virus, the COVID virus, SARS-CoV-2, mutates so much and so frequently, so it changes its appearance and escapes from under the control of the immune system, we will most likely need updated COVID vaccines on an annual basis.
That's why we're not really calling it a booster anymore, because a booster kind of gives a boost to the person's existing immunity from a previous vaccination. Updated vaccines are a little bit different in that they're expected to provide protection against the currently circulating viruses and variants, helping the body build a new response to those variants, so that we would get it on an annual basis, kind of like the flu, as you mentioned.
Dr. Hyesoo Lowe:
That's helpful to distinguish. I have patients and I hear in conversations people counting their COVID vaccines. "Oh, I've had two. Oh, I actually had three. And oh no, I had four," but we don't really count flu vaccines. We just assume we're going to get the updated vaccines.
Dr. Magdalena Sobieszczyk:
That's a very good point. Exactly.
mRNA Vaccines
Dr. Hyesoo Lowe:
While we're talking about the mRNA vaccines, it's been a few years now, so can you give us a short summary on how it's going with mRNA vaccines? Have there been any surprises, anything going on with updates on that front?
Dr. Magdalena Sobieszczyk:
Thanks for that question, and actually I want to take a moment and remind us what the mRNA vaccines are about, how they're different from traditional vaccines that we've been using for decades.
The way I think about it, and tell my patients about it, is that many traditional vaccines use either a weakened or dead virus, the dead version of the actual virus, to stimulate an immune response to the infection. It really takes time to develop such vaccines, and it's quite expensive. In contrast, the mRNA vaccines use a genetic code.
It's a laboratory-made genetic code, not real genes, a genetic code to tell the body, instruct the body to make proteins that then train the immune system to make antibodies and make T-cell responses. So the result is you can make these vaccines much easier because you keep the structure of the mRNA vaccine and just exchange the message that is being delivered to the immune system. And that can be swapped more easily. It still does take effort. It's done extremely carefully in a controlled fashion, but easier than the traditional vaccine development.
And this mRNA technology has been really around for a long time, so much so that a lot of people have devoted their scientific careers to working on mRNA vaccines. And also very recently, two scientists, Katalin Kariko and Drew Weissman, who invented the messenger RNA technology, received the Nobel Prize in medicine, an incredible accomplishment for science and for the field.
So there is a lot of excitement about the potential of these mRNA vaccines, especially in the last couple of years, and how to use them for other infectious diseases like HIV, malaria, influenza even. And even for non-infectious diseases, like for cancer, and even it's been talked about to be developed for environmental and food allergies. Those are all still in the research phase.
But I'm mentioning this because in the last three years, there's been so much safety data and so much information gathered about mRNA vaccines through the COVID experience. There's a lot of momentum and a lot of impetus now behind the development of mRNA vaccines, not only for COVID but for other entities. So that's actually quite important.
Vaccine Safety
Dr. Magdalena Sobieszczyk:
You also asked what else is new? One thing I always discuss with my patients, because the question comes up, is the safety of vaccines and how safe they are.
I want to point out, and I tell my patients, that the CDC is collecting a lot of information on vaccine safety, both from clinical reports from large clinics and from tracking vaccine safety from insurance claims. And essentially, they've accumulated information from millions of people across the US about what their experience has been with COVID vaccines and if there are any safety signals. This is almost real-time data that's being accumulated.
I can highlight one aspect of this safety data that's been very reassuring to date, because millions of people, billions of people have received the vaccines. One question that sometimes comes up is about something called myocarditis, which was noticed early on. It's an inflammation essentially of the heart, and muscle around the heart.
It was an observation reported early by the CDC about a rare occurrence of myocarditis that happened often after the second injection of the Pfizer or Moderna COVID vaccines. And most of these myocarditis events happened in teens and in young adults. The majority of them were mild, and cleared up on their own without any issues. But they were noticed. They were again picked up by this surveillance system.
There are recent updates from the surveillance system that really have shown that the risk of this myocarditis overall is really, really quite, quite low and nothing compared to the risk of getting this myocarditis or inflammation of the heart after COVID infection.
So again, thanks to this massive amount of information that's been collected, we can now tell and say that any potential small risk of an adverse event from a vaccine is really completely balanced out by, and pales in comparison to, what would happen if people got COVID, again making us confident about the safety of these vaccines.
Dr. Hyesoo Lowe:
It's very helpful to know that. And I think nobody wants to go back to the time when too many people had the COVID infection. We all know what that led to, which was a lot of bad outcomes.
So now that a lot less people are getting Covid or the fact that it's much less severe in many cases are certainly steps in the right direction.
FURTHER READING
- Columbia Surgery Podcast Series: Conversations & Curbsides
- Working with the Community to Improve Public Health Outcomes
- Getting Clear on Common Covid Vaccine Side FX