spk_0: 0:00
Hello. My name is Melissa Hoffman. I'm a public health associate of the Medical Society of the State of New York. And I'm joined today by Dr Eugene Schiff, Dr Sarah Nosal and Dr Matthew Weissman. They're each speaking today on behalf of themselves. Dr. Schiff is director of adult and childhood vaccines that the Institute for Family Health and Works of the Stevenson Family Health Center of federally Qualified Community Health Center in the Bronx. Dr. Nosal is boarded in family medicine in clinical inform attics, serving as VP for innovation. Optimization in chief, medical information officer as well. A CE providing direct patient care in the South Bronx with Institute for Family House. Dr. Weisman is the site share of the Department of Medicine at Mount Signing Beth Israel and is an associate professor of both Internal Medicine and Pediatrics. The Icon School of Medicine at Mount Sinai. We will be discussing recommended vaccines for young adults. We will delve into vaccine side effects and complications and what people need to know about immunizations in this age group. My first question is what vaccines were recommended for young adults ages 19 to 26.
spk_2: 1:16
Hi, Melissa. Thanks. So much for having us. Vaccines are one of the greatest public health accomplishments over the last many decades and for young adults is a particularly good time to come in and see their doctor and get vaccines. I often, and I'm sure we all do, see adults who are newly out of school have insurance on their own for their first time and haven't seen a doctor in a while. And so it's great when they come in and they want to get their health affairs back in order. And vaccines are a really important part of that. They're safe. They prevent disease. And for young adults in particular, it's a great opportunity not only to protect themselves but because their immune systems are pretty robust. Getting young adults vaccinated in this age group is a really good way to help protect the older people there around their co workers, their Children or other Children they might see. And so it's really a great time to come in and assess what they need and then make sure they get it. Very few adverse effects for these kinds of vaccines and for a young adults who may be exposed to disease by traveling a lot or in their workplace. For with relatives there around, it really is important to get checked out and vaccinated. And I love it in particular when they come in for this visit. And they bring their tattered old yellow vaccine card from when they were a kid. Because all those vaccines they still count and they're still important. And in many cases, that data, even though it's for when they were two months old, is more reliable than any kind of blood test we could do at that point.
spk_0: 3:00
My next question is what vaccines are recommended for young adults ages 19 to 20. Fixed.
spk_1: 3:08
Thanks, Melissa, this is Sarah Noble. I really think about when young people, young adults are coming in sort of the core group of vaccines as flu, HPV and tetanus. The flu was really something that we're going to be getting every year, and so I think that could be one of the challenges for young adults is actually making sure they get in each year, and I do encourage young adults to think about timing if you are gonna make that annual visit, which we love to see you and help protect you during flu season. So particularly early on. So in the fall, when you can then make sure you're up to date on everything you need and not have to make another trip in, which can be difficult when you're young and starting your career, the next vaccine being HPV, which we really expect individuals to have received when they were younger. But if you have gotten into 19 to 26 you still haven't received the Gardasil HPV vaccine, this would be a really great opportunity to make sure we get that for you. And that will be a series of three shots that will be within one year and then, finally the tetanus shot, which most young people have received at around 11 years old. But they'll be due in this time period for their 10 year booster shot, which has all but eliminated tetanus because people are keeping up to date on it. And this will be the first opportunity for most to receive the T dap, which is a little different than the regular cuteness. So when we think of tetanus, normally we think of the vaccine that's really for we get a cut or a scrape, where we step on a rusty nail, where the pertussis component of tetanus is actually a coughing illness that we're able to both protect ourselves from. But particularly this is a time when people are starting families, their friends are starting families. They may be taking care of older parents, and the protesters can be really important to protect, invents pregnant women as well as the elderly. And so those are all sort of the core that we bring in. And at that time, there are additional recommendations for other vaccines as well for individuals that fall outside that typical group.
spk_3: 5:04
Thank you, Dr No. So this is Eugene Shift the Tita. You were just talking about that. We can also mention that that's really important to be offering to pregnant women who often fall between this age group 19 to 26 or a few years younger or older, and that should be given in the third trimester of pregnancy between 27 to 34 weeks of possible. So, in addition to the regular 10 year booster for the T DAP about the yellow cards, sometimes I have patients that come in that don't have a yellow card or coming from out of the country out of state. And it's really not clear when they're showing up in our office for the first time ever what vaccines they've had before or if they've even had any. I had a patient who was home schooled in Georgia and had never had a single vaccine in his whole life who was about 25 years old. So I was really challenging in that point, trying to see what I could do for him to make sure he was protected against our routine childhood illnesses. So the couple other vaccines that recommended to be caught up for Children and young adults with the measles mumps rubella vaccine. We've had a lot of measles outbreaks recently in New York state and New York City and globally, even though the New York epidemic seemed to be subsided. There's a lot of measles being transmitted and could potentially be re imported into New York, So there's a measles, mumps and rubella vaccine that we don't know if our patients have had that before. It's usually am recommended, especially before they travel. We'll go back to school or work in the health care setting that we give them that there's a several others that we might mention here. Just so people are aware, even though they're not part of the routine recommendations for people that age. These would include the hepatitis A vaccine, which we usually would give an early childhood, but in case it hadn't been given or if we don't know if it's been given. There's some outbreaks of hepatitis A these days amongst homeless people, people injecting drugs and also the concern for anyone who's traveling internationally to make sure that they're up to date on their hepatitis vaccine. Usually we're tryingto immunize all of our Children, but sometimes that doesn't happen, and we still might want to think about it. For people coming in from 19 to 26 young adults, the meningitis vaccines routinely given at ages 11 to 16 and we'll talk about that a little bit more in a separate podcast. But these are things to think about, especially for college students in the settings of meningitis outbreaks in college. And there's some changes in the guidelines related to those that have come up, and we'll talk about those in a little bit more detail or later. Hepatitis B vaccines, pneumococcal vaccines. There's a few different types of those that my worth discussing with your doctor when you go in. In addition, Tau, host of other travel vaccines, which we would have to really Taylor based on where people are traveling to. But there's other vaccines that were worth talking about any for people, depending on where they're going to that we now have, including Ebola, Rabies, Japanese encephalitis collar anthrax. And the key point is to come in well before you're going to travel so that some of these vaccines can be discussed in our clinic. We don't even stock a lot of these special trouble vaccines, so we would want to try to find a place that has them so you could be protected before you go abroad. And people are going away for all sorts of reasons that have some of these infections spreading good resource to turn to. For travel vaccines,
spk_2: 8:02
there are lots of good online resource is that we often turn thio, and sometimes people don't realize that if they got vaccinated in New York that they can look up their vaccine history or we can look up a vaccine History online?
spk_3: 8:17
Yes. And I think we're going to talk a little bit more about the impact of the vaccine registries and the electronic medical records that keeping better track of which vaccines patients already have had or may need. And sometimes busy Doctor may not realize exactly of all these hosts of shots which ones would be do are important as to provide as a preventative measure. And in that case, we're getting better and better clinical just decision support so that it can be more likely that your health record may alert your doctor which shots you need. It still has some kinks that we're working out. But more and more, this is work We're going in the next decade so that everyone will know including your providers. Which of these shots you maybe do for based on your age and what you've had before haven't had before.
spk_0: 8:57
Thank you so much, Doctor knows. So Dr Weissman and Dr Chef, we're gonna move on to our third question. And that is, are there certain vaccine preventable diseases that young adults are more susceptible to?
spk_2: 9:11
I think it depends on what the circumstances are of those young adults and certainly people who are living in close quarters like in college dorms were particularly concerned about certain things, like meningitis. For people who are homeless people, in particular areas where there might be an outbreak of on infectious disease, like measles or whooping cough, which is part USCIS, or in neighborhoods where a lot of people are unvaccinated. It's particularly important for people to get vaccinated, because when we count on that herd immunity, when we count on everybody else's vaccines to help protect us, that's really conditional on the idea that other people are getting vaccinated when other people in the neighborhood aren't vaccinated, particularly important for somebody to get vaccine. I think about that also, with tetanus in particular, because there is no hard immunity around tetanus and so making sure as we've mentioned before and as we mentioned on some of our other podcasts the importance of getting tetanus vaccine and I think it's Dr Schiff mentioned, Texas is particularly important in pregnancy, so that's a particular condition for lack of a better word, a particular situation where it's really important to be in touch with your provider and making sure that you're getting all the vaccines you need for lots of different circumstances, brother. Chronic illnesses For people who are traveling for all kinds of risk factors, people who are health care workers in the military, particular living situations. The best advice is really to go see your doctor and trying to sort out for your particular circumstance. What vaccines are best for you
spk_3: 10:51
and these routine vaccines. This is Dr Schiff again, are very interesting and tetanus, for example, that we mentioned. It lives in the soil. It's endemic, and that's why it's recommended to continue protecting against tetanus. The protesters component, which is part of that teed up, is why we give it, ah, mothers in the third trimester so that the immunity passes done to the baby before they're able to get their own vaccines as a young child, influenza, a lot of cases of influenza, and even this year, more cases of influence a be on the vaccine, while not 100% effective, is the best thing that could be done to prevent complications from severe influenza, both for the people who are vaccinated as well as for other community members so they may pass it to HPV vaccine, I think, is often a very common sexually transmitted infection. So for young adults that may be exposed for having more partners than people younger or older, that's a consideration for getting the HPV vaccine in particular.
spk_1: 11:44
And in addition, I really think that besides that, there are some circumstances where you're more vulnerable. You're also in one of the best places to still have a robust response to vaccination. And so if we have missed opportunities for some of these routine vaccines, or we're just getting those that are due now that really the younger we are, we know that are vaccines will be more effective. And so this is a great time to make sure you're protected. And
spk_3: 12:08
it's critical that we sort of emphasized that people get coming at this age because they may not be required to anymore, like they were when they were in school or when they're starting college or every year in New York City in New York state. But it's still so important to get these vaccines the ones that are recommended, especially if they have getting them before,
spk_2: 12:24
right, that's a great point. I mean, I see 20 something year olds all the time and seen a doctor since they were in high school, So it's a great opportunity to encourage people to really come in and get checked out.
spk_3: 12:35
Oftentimes, his family physicians will see these young parents coming in along with their Children, either both at the same time or accompanying the other. So it's it's an opportunity to discuss vaccination and why it's important for the whole family.
spk_0: 12:47
Thank you again. We're gonna move on to the fourth question. How do doctors decide if a patient might need additional or different vaccines than other people my age?
spk_1: 12:58
I think that all of us, when a patient comes in, we're looking at them really specifically individually. There are nice plans that help us know for a typical person coming at us at a particular age what vaccines they might need. But individual clinical circumstances might make it appropriate for us to consider some of the vaccines that not everyone else in that age group is receiving. I would tell you this is a common time where we start to identify people who have maybe drinking a lot more than they perhaps realized or presented. Her was captured in their past visits, so people who are alcoholics are recommended to actually get some additional vaccinations of new McCorkell to prevent pneumonia. Individuals who are men who are having sex with men are really recommended to make sure they've had already has Children or to receive the hepatitis A hepatitis B and consider it HPV, particularly there under 26. This would be the right time toe complete it. We talked quite a bit about pregnancy and the importance of several vaccines during pregnancy, also as we're planning pregnancy. So in that time period, when someone comes in, you're writing them for prenatal vitamins. And they said, Oh, we were really excited. We wantto conceive in the next year. This is a great opportunity to make sure the other vaccines, particularly mumps, measles, rubella, have beer up to date, which are not vaccines. We normally given pregnancy, and we've discussed the importance of giving flu and teed up in pregnancy. We talked a lot already about those entering college and the choices we would make their and certainly anyone who has been in those populations, like Dr Chefs, patient who was maybe homeschooled or in a particular religious community that didn't vaccinate at some period in their life or missed out on some key vaccines that as young adults, they often present on already to receive appropriate vaccines and make sure that they're protected. Then there are just other clinical conditions in general that where were medically more vulnerable people who have asthma, smokers, liver disease, heart disease, some people who have different problems with the fluid around their brain or have had leaks of that fluid. People have different kind of implants HIV cancers, all the kinds of things you think about. Obviously, those individuals have some additional vaccines that they may need, or we should make sure that they've already received. And
spk_3: 15:11
I would just say, For some people, there's more and more people on different medications that can suppress the immune system for various reasons either his treatment or after a transplant so they may warrant special vaccines. And also there's people who are pregnant or who have some immunocompromised conditions for which live vaccines, which you know there's just a few of those, including the measles, mumps, rubella and varicella vaccines that are still being used. But they wouldn't be indicated in those populations, so it would be worth checking before getting all of these, whether they're needed, whether they recommended or whether their country indicated in some certain circumstances.
spk_0: 15:45
Thank you. We're now moving on to the fifth and final question that that is. Should young adults continue to have their immunizations tracked in the registry? Why is it important that they do? So
spk_3: 15:57
I guess I can talk a little bit about the vaccine registries in New York City. We have what's known as the citywide immunization registry, and I've been using that for many of my patients who are 0 to 18 years old. And it is required at most clinics and pharmacies and hospitals and other places. Rip poured all shots given to Children to the registry, now in New York, stayed for adults after they turn 18. It requires consent in order for that to be reported to the registry. But it's probably worth having those shots reported for any patients benefit, so that if they've already gotten a vaccine, they don't have to get it twice, and we can have the most accurate information possible, and we can also use the registry in some ways to outreach patients who need vaccines but haven't had them. Some of them are these vaccines that we've talked about already. And another cases. The registry may even have more information about you and be ableto have certain tools like text messaging and other tools, which we can use as a population to see how we're doing in terms of our vaccine rates. Measles, for example, which was spreading last year. If 95% of the population is protected against measles, that's considered necessary for herd immunity. So the registry can help tell us where we are at and what percentage more patients should be getting thes vaccines so it can be used both on the public health authorities as well as in an individual patient. Patients can access the registry themselves and so compare INTs of Children. So the registries air sort of changing quite quickly and trying to integrate them to the pharmacies, to the the hospitals, the clinics, so that more people have access to the accurate information that chairman, which vaccines people might need
spk_2: 17:30
and separate from the registry. I often ask people just get all of their records from everywhere and bring them to me so we can keep a total list of the some of what they got his kids and in high school and college and but the pharmacy or wherever. And if we can kind of collate all that information, it just makes it easier for everybody.
spk_0: 17:49
Thank you again, Doctor. No soul. Dr. Schiff and Dr Weissman. I appreciate the time that you spent speaking about vaccines for young adults. Please be sure to listen to all of the other vaccine related podcast that missing has posted.