For the Love of Health

Vaccinations 101 with Dr. Marci Drees and Dr. Stephen Eppes

• ChristianaCare • Season 2 • Episode 3

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Did you know that in 1796, Dr. Edward Jenner created the world's first successful vaccine? Since then, vaccines have greatly reduced diseases that once harmed or killed babies, children, and adults. But people all over the world still become seriously ill or even die from diseases that vaccines can help prevent. Which is why it's important to stay up-to-date on vaccinations.

On this episode of For the Love of Health, ChristianaCare Chief Infection Prevention Officer, Dr. Marci Drees, and Associate Infection Prevention Officer, Dr. Stephen Eppes join us to explain the necessity of continuing to discuss vaccinations as a whole, especially outside of outbreaks and pandemics.

Marci Drees, M.D., MS, is the Chief Infection Prevention Officer and hospital epidemiologist for ChristianaCare. Dr. Drees serves as a councilor on the Board of Trustees of the Society for Healthcare Epidemiology of America (SHEA), and previously served as SHEA's liaison to the CDC's Advisory Committee on Immunization Practices (ACIP). She is board certified in internal medicine and infectious diseases.

Stephen Eppes, M.D., is the Associate Infection Prevention Officer and Pediatric Infectious Disease Specialist at ChristianaCare. Dr. Eppes is also Co-Chair of the Immunization Coalition of Delaware.

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Speaker 1

But I think what we forget is that vaccines are one of the great public health accomplishments of the 20th century.

Speaker 2

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. And now here are your hosts.

Speaker 3

Hello everyone, I'm Megan McGerman.

Speaker 2

And I'm Jason Tokarski. Welcome to another episode of For the Love of Health brought to you by Christiana Care.

Speaker 3

As far back as the 1700s. Vaccines have greatly reduced diseases that once harmed or killed babies, children and adults.

Speaker 2

But people all over the world still become seriously ill or even die from diseases that vaccines can help prevent, which is why it's important to stay up to date on vaccinations.

Speaker 3

Joining us today for an episode we're calling Vaccinations 101 are Christiana Care's Chief Infection Prevention Officer, Dr Marci Dries, and Associate Infection Prevention Officer, Dr Stephen Epps. Marci and Steve, thank you both so much for being here today. Thank you for having us.

Speaker 4

Pleasure to be with you.

Speaker 3

So obviously the three of us specifically have talked about vaccinations a lot over the past few years, specifically about COVID-19. But why is it so important that we continue to discuss just vaccination as a whole?

Speaker 1

Obviously, the COVID-19 pandemic was this extraordinary event that our country went through and suffered through, and vaccines were a big part of that, for better, for worse. I mean obviously for better overall. But it became, unfortunately, very politicized. But I think what we forget is that vaccines are one of the great public health accomplishments of the 20th century. Millions and millions of lives have been saved by all the standard routine vaccines that we recommend every day.

Speaker 4

You know, in 2019, the World Health Organization listed the top 10 threats to global health. Vaccine hesitancy was number eight. I think if they relisted them now, vaccine hesitancy would rise in that list because of COVID and when we had lockdown in March of 2020 and going forward a few months after that, immunization rates plummeted because doctor's offices were not seeing patients except for real emergencies and things like that. So rates went way down. And bear in mind that you know we had just come off of the worst measles we'd ever had in this country in recent memory in 2019. And public health authorities were afraid that, you know, with plummeting rates of immunization, we would have a resurgence of vaccine preventable diseases like measles.

Speaker 2

According to the CDC, there have been more than a dozen outbreaks of measles reported this year alone. I thought that wasn't really a thing anymore. How is measles back? Are there any others that we thought were gone but are back again now?

Speaker 4

Let's start the conversation with Europe, and Europe is having a huge problem with measles right now, as are other parts of the world. So what has happened is that you take a non-immune person in the United States either they didn't have measles, didn't have vaccine, whatever they fly on an airplane to somewhere else in the world, encounter measles, bring it home with them and then can spread it in their community. If you have a highly immunized community, it won't be much of an outbreak. If you have a less immunized community, you'll see a lot more, which is what happened in Illinois a few months ago.

Speaker 1

Yeah, and I think measles is the most concerning disease because it's probably the most contagious disease that we know of. So if you have 10 people in a room who are not immune to measles and you put a person with measles in there, nine of those people will get measles and measles will linger in the air for a long time and remain contagious. We always say can go out the door and down the hallway and infect people. You know you really need a high community immunization rate of 95% to really protect the community from measles outbreaks and I think overall in this country we still have that. But there are definitely pockets of communities that don't believe or, for whatever reason, don't get measles immunizations and so when one of these people you know, one of these people that traveled and come back, you know, hit one of those communities, it can really, it can really explode and other diseases too polio Polio has almost been eradicated.

Speaker 1

There's really only a couple of countries in the whole world that still have wild type polio circulating. But we have had several years ago there was a case of paralytic polio in New York, again an unvaccinated person, and that's only the tip of the iceberg because polio often is asymptomatic. So that one case probably represented hundreds of actual cases.

Speaker 4

Marcy mentioned 95%, which is the number that you have to have to keep a disease like measles from spreading. Well, this past school year, the CDC always looks at this. This past school year, 93% of kids entering kindergarten were vaccinated. In the UK it was 85%, so that's just not enough. That's why we will continue to have measles until we get more people immune.

Speaker 3

So, from a vaccine hesitancy perspective, I know a lot of it has to do with COVID, but what is your message to anyone listening right now who's in that boat, who's hesitant to get any vaccine?

Speaker 1

COVID is unfortunate in that we keep needing to have these boosters. You know, even once a year is OK, but sometimes even more than once, and people just got fed up with having to always go back and get additional doses. And obviously that's not the norm for every vaccine. Measles is completely different. Ninety seven percent of people will have immunity after two doses of MMR and that will last their whole life. And that's because the measles virus just doesn't change like the COVID-19 virus does.

Speaker 1

And I think you know, in many ways vaccines have been a victim of their own success, right. So people have not seen cases of paralytic polio. Most people have never seen a child get a severe case of measles or die from measles. And even things that are more common like flu or respiratory syncytial virus, rsv you know they're common but still the average person doesn't probably know a person who died from the flu or an infant that died from RSV. So people kind of lose. They see, you know they see potential risk. That's all over in the media and they don't see all the benefit because we're not seeing those diseases. You can't see something that's not there.

Speaker 4

So in a 20-year period of time. In the United States and this was published not too long ago it was estimated that 731,000 lives were saved by vaccines in 20 years. In other words, if we didn't have vaccines, in that 20-year period of time 731,000 kids mostly kids would have died, and the World Health Organization just published a couple of weeks ago that in the last 50 years 154 million lives were saved globally by vaccines and you know I hope these numbers will have some impact on people's thinking.

Speaker 4

But to address your question, megan, you know people should talk to their doctor if they're vaccine hesitant. I mean, it's been shown over and over again that that conversation with your doctor is the most powerful thing to enable people to get vaccinated.

Speaker 2

By and large, the biggest reason people don't get vaccinated is concern about side effects, I believe. So are there any opportunities for myth busting here that we can do to help take away that side of hesitancy?

Vaccination Efficacy and Safety Overview

Speaker 1

No one would come up here and say a vaccine never has a side effect, right? So every vaccine has potential side effects. But I think what people need to recognize is that you know, for the most part, many of these, you know the common side effects are, you know, having a sore arm for a couple days. Some people have a robust immune response and so they feel kind of feverish or sick for a day or two, but then they're fine. So that is common. But these really serious side effects are extremely uncommon in the sense, you know, depending on which one we're talking about, about, on the sense of you know one or two per million doses given and again, people focus on that because that's something you can see, you know, that you hear about and they don't think about you know, for every million doses given, okay, you might have one or two people that have a side effect, and I empathize with those one or two people. But at the same time you're preventing often hundreds or thousands of illnesses, hundreds of hospitalizations and often hundreds of deaths for that same number of vaccines. So we aren't very good at estimating risk. You think about how many people are scared of flying but will drive anywhere in their car, even though we know that driving is higher risk. It's kind of the same thing. It's not something that the human brain is good at, but it's just something we have to keep emphasizing. One thing I think that often gets misinterpreted is what they call vaccine effectiveness. So every year and this mostly comes up around the flu vaccine, also a little bit for COVID is every year they publish like how effective did we think the flu vaccine was this past season? So unfortunately it's always retrospective, we never know in real time. But often you'll hear, oh, the flu vaccine was only 40% effective or 50% effective, and I think people misinterpret that as oh, it's only going to work half the time, so why should I bother? Right? So when we think about vaccine effectiveness, we're actually thinking about a population. So in a population of vaccinated people, if the vaccine effectiveness is 50%, we would see half as many cases of flu as we would in the same population were they not vaccinated. So it actually is, even a 50% effectiveness rate is actually pretty good in terms of reducing kind of population level disease.

Speaker 1

And then the other thing you know with, specifically with COVID. You know we remember when those COVID vaccines first came out and they were 95% effective. Like everyone was floored at how effective they were. And now you know, for the most recent booster last year, it was closer to 50%. Has the vaccine gotten worse? No, what's changed is that the population now has a lot of pre-existing immunity.

Speaker 1

When those vaccines first rolled out, nobody was immune to COVID. That's why we saw so many hospitalizations and so many deaths. So the vaccine had a lot of opportunity to give people that protection. Now most people have had COVID or they've been vaccinated multiple times, and so there's really a high level of pre-existing immunity in our population, which is great. That's why we're not seeing as many severe illnesses now, but we do still see some. So when we say that the latest COVID vaccine is 50% effective, that's on top of that existing immunity. So it's not that it's. You know we're not taking a naive population anymore. We're really taking a population that already has a lot of immunity and making it that much better.

Speaker 4

And the other thing to point out is the CDC has this catchphrase that they rolled out this past respiratory season, that they rolled out this past respiratory season wild to mild. So meaning that even if you don't prevent an infection, you take it down a few notches so that patients aren't getting really sick, admitted to the hospital, admitted to the ICU or dying and you turn it into a mild illness. So if that 50% effectiveness number for the flu could be kind of reinterpreted, think about all of the mild illnesses that occurred instead of the wild illnesses.

Speaker 2

Are there any ways that those side effects are tracked, and how reliable are those methods for that?

Speaker 4

Safe does not equate to risk-free. Everything has risks, like Marcy said, but vaccines are safer today than they have ever been because of the many steps from somebody having the idea for a vaccine to putting it into experimental use and then finally into use in the community Many, many steps rigorously overseen by various regulatory authorities, and so that's why we can be confident that our vaccines are safe.

Speaker 1

Yeah, and I would just add to that that vaccines are held to a higher standard than many other medications. Because you think about, like you know, the latest greatest cancer drug. You know they're giving that to people who are already sick. Vaccines are given primarily to healthy people. The risk tolerance of side effects for a new vaccine is much lower than for a new drug because it is given to healthy people. The risk tolerance of side effects for a new vaccine is much lower than for a new drug because it is given to healthy people and often given to a broad swath of the population.

Speaker 1

So the standards are very high and there are a ton of different surveillance systems that look for expected or unexpected side effects. So, for example, there is a program called VAERS, the Vaccine Adverse Event Reporting System. Now, that's just a voluntary reporting, so anyone a doctor, a patient, a parent, anyone can report what they think is a vaccine adverse event. So, for example, if you had a vaccine and the next day you got in a car accident, you could submit that into VAERS and they will take it. Obviously we don't think biologically that that vaccine had anything to do with a car accident, but it accepts those. So it's a good way to kind of detect if there's an early signal, if all of a sudden, oh we're seeing a lot of cases of something that we weren't expecting.

Speaker 1

But it has no way to prove causation because it's completely a voluntary system. The CDC and the FDA take those reports and investigate them and obviously try to determine if they think the vaccine's involved. And it's a good way to see if is there a safety signal that we need to investigate further In the clinical trials. Obviously there's a lot of safety monitoring, but until you give the vaccine to millions of people, you're not going to detect those really rare side effects. So they have systems that then look systematically at whether or not there are safety signals and they look for specific things based on which type of vaccine they're looking at. They can use statistical power then to actually say does this vaccine seem to have a causative effect or not? Is it statistically significant? And if it even starts to have a signal that's maybe not significant, they'll dive into that deeper and do further investigation.

Speaker 4

One has to be careful about Dr Google because if you start searching for side effects or just randomly put in the name of a vaccine, you're going to come up with websites or chats or places where people will put their own anecdotal experience or the anecdotal experience of Uncle Fred or whatever. That usually is not scientifically based and that may be heart-wrenching and you feel sorry for Uncle Fred, but don't make your medical decision-making or your decision-making for your child's health based on things that you might find on Dr Google.

Speaker 3

So where should people be looking then?

Speaker 1

The ACIP is probably the expert, and they delve into these vaccines in excruciating detail. So if you really want to delve into it, all their meetings are recorded. All the slides are available, it's free public access and they will go through everything ad nauseum, more than most people would ever want to know.

Speaker 4

My advice if people want to know good, reliable information about vaccines is go to immunizeorg, which used to be called the Immunization Action Coalition, immunizeorg. This partners with the CDC and it's useful, I think, both for health professionals and laypeople, with the most up-to-date scientific information very user-friendly, very easy to navigate the website and it's your one-stop shopping for any information about vaccination. I'd also make available Immunization Coalition of Delaware. It has a great website. It's not password protected, it's free. It has some Delaware specific information, but also links to national information as well. People should go there.

Speaker 2

Vaccinations are a lifelong process to keep up with. There's a certain maintenance to it, so we'll be linking in the show notes to a more complete schedule of when people should get what. But let's focus on some of the big ones and go stages of life here. What are some of the top vaccinations you'd recommend for children and teens?

Speaker 4

All of those vaccines that you'll see on the table are important, critically important. But if I could focus on three, I think I would choose MMR, and partly for the reasons we've already just said that you know our rates went down concomitant with the pandemic and we know that we've got to get those rates up in order to protect the entire community. So everybody should get their MMR, which is given at one and then again between four and five years of age. The second one I highlight is HPV vaccine, which protects against human papillomavirus, which causes cervical cancer and throat cancer. I think a lot of people don't realize this, but of all the vaccines that we give to pediatric patients, that's the one that probably saves the most lives. It doesn't save their life today or tomorrow. It saves their life 30 or 40 years in the future, when they make it a cancer related to HPV.

Speaker 4

And the third one I'd call out would be meningococcal B vaccine, very underutilized. It's worth pointing out that group B meningococcus, which is a big cause of meningitis, is the most common one, and this is the vaccine that is so underutilized and for adults.

Speaker 1

Yeah. So adults will to some extent depend on your age and then also depend on if you have any other underlying conditions. But if you're a general healthy adult, obviously you're recommended to get your flu shot every year. And this is probably the most underutilized vaccine in kind of the young adult population, because people are like, oh, I never get the flu or you know, if I get it it's no big deal deal. You know, and I think if you ever have had the flu, you know you're probably not going to end up in the hospital if you're young and otherwise healthy. But you will feel pretty bad for, you know, two to five days you might miss work, you might miss school, it's and it's like you know it has very little risk. So why not protect yourself if you can't? And I would say the same for the COVID-19 vaccine.

Speaker 1

The other population I want to speak that is young and healthy, are pregnant women. We now have four vaccines that are recommended specifically in pregnancy. Two are flu and COVID that I just recommended, and they're recommended specifically for pregnant women because as women advance in their pregnancy and get into their third trimester, you know you are at increased risk for respiratory illnesses, particularly flu, particularly COVID and we have seen deaths in healthy pregnant women from both of those diseases. And then you get the additional benefit of you passing your antibodies on to your baby so that your baby is protected in the first few months of life before they're able to be vaccinated. The second two are given not to protect the mother, necessarily, but to protect the infant. The first one is Tdap. We've been giving that for many years. That's tetanus, but most importantly pertussis or whooping cough. Again, babies, young infants, are extremely vulnerable to pertussis and there is no way to vaccinate them directly. So vaccinating that mom later in their pregnancy will give that antibody to the baby.

Speaker 1

And then the new one is the RSV vaccine respiratory syncytial virus. So this one, you have two options. One is to vaccinate mom during pregnancy, again, kind of later, 32 to 36 weeks, give those antibodies to that baby. Rsv is the leading cause of hospitalizations in infants and a leading cause of death in infants, and this is only given during kind of going into RSV season so that those antibodies will be there when the baby needs it, kind of going into RSV season so that those antibodies will be there when the baby needs it. The second alternative is there's a monoclonal antibody called Nersavimab that's given to the infant right after birth, again during RSV season, or if they're born outside of RSV season, which around here is October to end of March, then they would get that kind of in the next fall going into it. So four vaccines for pregnant women potentially.

Speaker 1

The other vaccines to think about is as you age. So the first one is the shingles vaccine when you turn 50. If anyone's ever had shingles, it's the chickenpox virus, but instead of a whole body itchy rash, it presents often as a very painful rash in one part of the body. It could be across your side, but it could be in your ear. Affecting your eye can be severe and pain can last for months. So it's certainly worth preventing. And then the other big time point really is 65 years of age. When you think about your pneumococcal vaccines.

Speaker 1

There's an RSV vaccine, which is actually at 60 or above, that you can think about. This is a new vaccine. It just came out in 2023. This past June the CDC changed their recommendation to advise that everyone 75 and older get the RSV vaccine, because there is strong data that that's very protective as you, as you're that age or older, and then between 60 and 74, it's more of a risk based recommendation If people have specific risk factors so for example, advanced chronic kidney disease, diabetes that has kind of end organ damage like amputations or eye disease or kidney disease, heart disease, lung disease things that we know increase people's risk if they were to get RSV that they would end up in the hospital. So hopefully this year it will be a little bit more clear. Last year only about 25% of people that were eligible for RSV vaccine got it, so I hope that people will be much more clear this year whether they are or aren't recommended to get that one.

Speaker 3

Marci and Steve, thank you so much for your time At time of recording this. We're rolling right into respiratory illness season, so I know our listeners will see you across all of our platforms in the coming weeks. Thanks so much. Thank you across all of our platforms in the coming weeks. Thanks so much. Thank you, and we'll have more information on all things vaccination in the show notes for this episode.

Speaker 2

And don't forget to subscribe to For the Love of Health on Apple Podcasts or Spotify. And you can watch the video version of For the Love of Health on Christiana Kerr's YouTube channel.

Speaker 3

We'll be back in two weeks with another great conversation.

Speaker 2

Until then, thanks again for joining us.

Speaker 3

For the Love of Health.

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