Quick article about vaccine adjuvants

Roxxsmom

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This little article is scientific in nature, but I wanted to share it here because it is relevant to Covid-19.

https://www.npr.org/sections/health...e-special-sauce-that-makes-some-vaccines-work

People often ask how, since there's still uncertainty whether people recovered from Covid-19 generally produce sufficient antibodies for long-term protection, how a vaccine could possibly work. The answer (aside from possibly administering multiple boosters) is adjuvants, which are molecules that significantly boost the immune response when one is exposed to an antigen. Adjuvants made a big difference in the efficacy of shingles vaccines, for instance, with the new vaccine producing 90% protection, even in the elderly (compared to the earlier vaccine, which my mother took, that only is about 50% effective, so she got to be one of the lucky ones who got shingles anyway). Unfortunately, only a few adjuvants are currently known, and they can be propitiatory (one down side of the for-profit sector being responsible for vaccine manufacture and development).

Because of adjuvants (and other technologies, such as being able to make vaccines with concentrated antigens), vaccines can actually provide better and longer-lasting protection than catching and recovering from an infectious disease "naturally." I am guessing the folks racing to produce a Covid-19 vaccine are hoping this will be the case.

Having said this, there are a few worries I have. Sometimes adjuvants can cause unpleasant side effects. I didn't experience more than a slightly sore arm and some mild fatigue for a day after my Shigella shingles vaccines, but some volunteers are reporting feeling mildly ill after the Covid-19 vaccine second booster. The other is that upon occasion there are issues or mistakes with new vaccines, and rushing them into development could mean we miss some of the longer-term or rarer side effects.

We have, in essence, on chance to get this vaccine right for a country as "flighty" and "volatile" as the US is with regards to vaccination. Some people won't get any vaccines ever, insisting that it's always safer to risk the disease. Those people are beyond reach, unfortunately, and the only thing you can really do is impose maximum quarantine for the duration of the pandemic if they refuse to comply. There are others, though, who will be vaccinated if they think it's "necessary" and if they are sure it is safe, but they skip vaccines for diseases they don't think of as serious (like influenza), or they question the need for boosters. They often express concerns about "overvaccination" or posit that getting a disease "naturally" produces stronger immunity or simply makes one's immune system stronger somehow (when they opposite may actually be true).

If the Covid-19 vaccine that first becomes available in the US does turn out to have issues, or to be less effective than we'd hoped, getting the "vaccine flighty" on board will be hard. Or heck, it doesn't even have to be our vaccine. If Russia pushes one even faster, and it turns out to be a disaster, that could make Americans shy of a very different vaccine, even if it's much safer.

This is a situation I am watching with interest and with concern.
 

mccardey

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I hope you'll keep us posted on this, Roxx. Especially with your clarifications of what the articles are saying. I do appreciate that.
 

ChaseJxyz

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So I actually have bad reactions to tetanus vaccine/booster and I skip out on getting that (and if I ever get into a situation where I NEED to get one, they're going to be doing it at the ER which is the best place to have a serious allergic reaction), but I still get my flu shot every year. I still have gotten all the other ones (fun fact: NH was the only state without any sort of vaccine registry, and my doctors growing up already threw out my files so I have no proof of it) and I'm going to get this once it comes out. There's a risk of injury, yes, but it's going to be way lower than the risk of death/serious harm from covid. Even if it only works for a year, that's better than what we're dealing with now. But This Whole Thing has really illustrated how much people aren't willing to minorly inconvenience themselves for the welfare of others.

I hope they really do what they did in Contagion (and what Gates wants to do) and make some sort of ID/certificate to prove you've been vaccinated so you can go to certain places (like sports or bars). It'll be interesting to see the anti-vaxxers have meltdowns on Nextdoor about the George Soros-funded Microsoft tracking chips (because Bill Gates doesn't have his own money?)

Thanks for sharing this + posting an explanation.
 

Roxxsmom

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So I actually have bad reactions to tetanus vaccine/booster and I skip out on getting that (and if I ever get into a situation where I NEED to get one, they're going to be doing it at the ER which is the best place to have a serious allergic reaction), but I still get my flu shot every year. I still have gotten all the other ones (fun fact: NH was the only state without any sort of vaccine registry, and my doctors growing up already threw out my files so I have no proof of it) and I'm going to get this once it comes out. There's a risk of injury, yes, but it's going to be way lower than the risk of death/serious harm from covid. Even if it only works for a year, that's better than what we're dealing with now. But This Whole Thing has really illustrated how much people aren't willing to minorly inconvenience themselves for the welfare of others.

I hope they really do what they did in Contagion (and what Gates wants to do) and make some sort of ID/certificate to prove you've been vaccinated so you can go to certain places (like sports or bars). It'll be interesting to see the anti-vaxxers have meltdowns on Nextdoor about the George Soros-funded Microsoft tracking chips (because Bill Gates doesn't have his own money?)

Thanks for sharing this + posting an explanation.

Individual sensitivities or allergies are another reason why it's so critical for those who can be safely vaccinated to do so. Not with Tetanus so much, since that's not a communicable disease the way measles, influenza or Covid are. But with communicable disease, those few who can't be vaccinated safely (or whose bodies don't respond adequately to a vaccine) are at risk if people who can safely be vaccinated choose to abstain.

I'm a bit concerned that Fauci reassured Americans that a Covid-19 vaccine will very likely be available here by the end of 2020. First of all, that's not a time frame everyone agrees with. The trust the American public has in our experts and public institutions was fragile to begin with, and it has been greatly damaged by the slow and inconsistent response to the pandemic. People trust Fauci, but that might change if the vaccine is not ready by then, or if it turns out to have problems.

Secondly, that doesn't mean everyone can or should get the vaccine right away. With any vaccine that becomes available during a pandemic, health care workers will need to get theirs first, followed by the most vulnerable. But the faster you can get a critical portion of the population vaccinated, the sooner we will know how well it works to stem the outbreak.
 
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MaeZe

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So I actually have bad reactions to tetanus vaccine/booster and I skip out on getting that (and if I ever get into a situation where I NEED to get one, they're going to be doing it at the ER which is the best place to have a serious allergic reaction), but I still get my flu shot every year. I still have gotten all the other ones (fun fact: NH was the only state without any sort of vaccine registry, and my doctors growing up already threw out my files so I have no proof of it) and I'm going to get this once it comes out. There's a risk of injury, yes, but it's going to be way lower than the risk of death/serious harm from covid. Even if it only works for a year, that's better than what we're dealing with now. But This Whole Thing has really illustrated how much people aren't willing to minorly inconvenience themselves for the welfare of others.

I hope they really do what they did in Contagion (and what Gates wants to do) and make some sort of ID/certificate to prove you've been vaccinated so you can go to certain places (like sports or bars). It'll be interesting to see the anti-vaxxers have meltdowns on Nextdoor about the George Soros-funded Microsoft tracking chips (because Bill Gates doesn't have his own money?)

Thanks for sharing this + posting an explanation.

If that reaction occurred when you were a child you might want to check in with an allergy or infectious disease doc on this. There are many reasons for doing so.

CDC: vaccine contraindications

Scroll down to the last page:
TABLE 4-2. Conditions incorrectly perceived as contraindications or precautions to vaccination (i.e., vaccines may be given under these conditions)

Anaphylaxis and GBS within 6 weeks following a dose of a tetanus-toxoid containing vaccine are exceptions.

Kids often react to the pertussis component of a pediatric DPT, not the tetanus component. And a lot of vaccine reactions, even severe ones are not absolute contraindications to subsequent vaccines.

If you are not fully vaccinated against tetanus and you experience a tetanus-prone wound you'll need TIG (tetanus immune globulin). If you are indeed unable to get another tetanus vaccine, you need a plan in place for when you should seek out TIG and where you can get it. It's not readily available in every ED because it is rarely needed.

And what about your diphtheria vaccine? It isn't easy to find a diphtheria vaccine not combined with tetanus. It must need to be special ordered. I don't even know the timing of boosters for that since we always give it with tetanus as a Td.

All things to think about after the quarantine is lifted. See a specialist.
 
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ChaseJxyz

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If that reaction occurred when you were a child you might want to check in with an allergy or infectious disease doc on this. There are many reasons for doing so.

It happened as an adult. My father also has bad reactions, and he ended up with multiple ER trips because of tetanus-prone wounds and it was quite a debacle every time. I have a lot of allergies, including food allergies that appeared as an adult. My plan was to get my food allergies re-tested this summer during down time between surgeries, but all of that has gone out the window so...who knows. It's definitely a thing that I get asked about by all my various doctors and they're all aware of it.
 

Roxxsmom

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MaeZe makes some good points, especially about the immuno globulin for people who have potential tetanus exposures without being current on their vaccine.

And Tetanus vaccines are also often combined with Pertussis DTaP), which is very communicable as well, and especially dangerous to infants and young children. I don't know if it's possible to get pertussis vaccines on their own, but it might be.
 
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MaeZe

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MaeZe makes some good points, especially about the immuno globulin for people who have potential tetanus exposures without being current on their vaccine.

And Tetanus vaccines are also often combined with Pertussis DTaP), which is very communicable as well, and especially dangerous to infants and young children. I don't know if it's possible to get pertussis vaccines on their own, but it might be.
In the US, as far as I know, it isn't currently being manufactured.

We give Tdaps to anyone over the age of 7. If a person reacts it's almost alway to the pertussis component. Those folks get a Td.

Just a bit of trivia: For kids we give the D and P, those are higher doses. But they are two components adults tend to react more strongly to. So adults get d and p.

Used to be we gave DPTs to kids and Tds to adults. The 'a' stands for acellular and it lessens the reaction to the pertussis component so kids now get TDaP and adults get Tdap.

We have to rely on herd immunity to protect kids from pertussis. That's true anyway because the most dangerous time for a pertussis infection is in infants and they are not fully immune until they've had that 4th dose of vaccine at 18 months.

There's not a lot of diphtheria in the US but there is in other parts of the world. Someone not immune to diphtheria should consult a good travel medicine clinic before traveling to countries where the infection is endemic.
 

Roxxsmom

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In the US, as far as I know, it isn't currently being manufactured.

We give Tdaps to anyone over the age of 7. If a person reacts it's almost alway to the pertussis component. Those folks get a Td.

Just a bit of trivia: For kids we give the D and P, those are higher doses. But they are two components adults tend to react more strongly to. So adults get d and p.

Used to be we gave DPTs to kids and Tds to adults. The 'a' stands for acellular and it lessens the reaction to the pertussis component so kids now get TDaP and adults get Tdap.

We have to rely on herd immunity to protect kids from pertussis. That's true anyway because the most dangerous time for a pertussis infection is in infants and they are not fully immune until they've had that 4th dose of vaccine at 18 months.

There's not a lot of diphtheria in the US but there is in other parts of the world. Someone not immune to diphtheria should consult a good travel medicine clinic before traveling to countries where the infection is endemic.

This is interesting.

Maeze, I get the vaccine every ten years that has tetanus, pertussis and diptheria. I have a friend who actually got pertussis in spite of being vaccinated (and it was a joy, let me tell you, even though she had a relatively mild case and was treated early). Is it recommended to get the pertussis vaccine more often? Is there a down side to getting the tetanus vaccine more frequently too, since they come together? Or was this friend just one of those special people who doesn't get a good immune response to that vaccine?

Incidentally, there is a Bordetella bacteria, Bordetella bronchiseptica, bacterial strain that dogs get, which causes a disease called "kennel cough." It is rarely fatal in healthy adult dogs (causes them to have coughing fits where they cough up this foamy stuff) for a couple of weeks, but it can be more serious for younger puppies or frail dogs. It spreads like wildfire in boarding facilities, which is why they require a vaccine for it. But the vaccine for the dog strain of Bordetella only provides good protection for six months to a year. There is also a canine coronavirus which is primarily intestinal, and a feline intestinal coronavirus as well. Interesting that they would be intestinal infections when they are enveloped viruses, but coronaviruses seem to be mostly respiratory and mucosal spread in humans. They have vaccines for these infections in dogs and cats. The one in cats occasionally results in a very serious disease called feline infectious peritonitis which is generally fatal and involves many organ systems beyond the intestinal tract. But it generally doesn't progress to this condition in most cats. I think it is certain strains of feline coronavirus that differ in particular mutations.

Anyway, the reason I mentioned this, aside from the weirdness of how somewhat related viral and bacterial agents can different diseases in other animals, there is some thought that there are different strains of the human coronavirus that have been found, and they may differ in virulence and in their route of infection and in which organ systems they affect. It appears that all the SARS COV-2 get into cells via the ACE-2 receptor. Different human coronaviruses (I think there are seven identified total that are known to infect humans, SARS COV 1 and 2, the one that causes MERS, and four "common cold" strains. They have different entry pathways into cells. I just read an article about this in Science.

The dog and cat coronaviruses have their own different entry pathways into canine and feline cells from the human corona strains, but it does appear that SARS COV-2 can occasionally infect felines (possibly dogs but evidence is shakier). At least there are a few documented cases, though it appears to be mild in cats. It also causes a milder disease in the monkeys they infect experimentally to test vaccines and so on. There are all kinds of weird bits of information about this virus, though, such as people with type A blood being more likely to experience severe symptoms, and possibly other factors that influence severity of the infection too. It's a weird puzzle, and hopefully the pieces are starting to be assembled in a more coherent way that will lead to better treatments.
 

MaeZe

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This is interesting.

Maeze, I get the vaccine every ten years that has tetanus, pertussis and diptheria. I have a friend who actually got pertussis in spite of being vaccinated (and it was a joy, let me tell you, even though she had a relatively mild case and was treated early). Is it recommended to get the pertussis vaccine more often? Is there a down side to getting the tetanus vaccine more frequently too, since they come together? Or was this friend just one of those special people who doesn't get a good immune response to that vaccine?...
First the type A blood risk might not have been a reproducible result.

But on to the vaccines. No adults got pertussis vaccine until 2005 when an acellular formulation was developed that adults could tolerate. Before that, age 7 was the oldest we gave pertussis vaccine to. They got DPTs.

In 2005, it was recommended every adult get the Tdap (with exceptions). Soon after, it was recommended for kids at age 11 and older. Teens and young adults were where outbreaks of pertussis began showing up as everyone's immunity waned.

The vaccine is not one of our most effective vaccines. We rely on herd immunity to protect infants and others for whom the vaccine failed.

Pertussis is also known as the 100-days cough. It is miserable. Though some teens had milder cases.

In 2015, the CDC had not yet recommended we give a Tdap with the 10 year booster for tetanus. I said to heck with that, if I gave my patients Tds, I'd have to come back when the CDC made the recommendation and revaccinate everyone before they needed their 10 year tetanus booster. So I started giving Tdaps for the 10 year booster. I'm sure I wasn't the only one. CDC finally recommended we use Tdaps for the 10 year booster last year.
 

Roxxsmom

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On a different note regarding vaccines, Putin has announced that Russia has a vaccine. In fact it's been tested on a handful of people, and the odds of it being safe and effective are practically nil at this point. Putin lies like my cat on a stack of homeworks I am trying to grade (in the pre-covid era, when homeworks were actual papers for my cats to lie on--now he lies like my cat on a keyboard). Nothing he says is trustworthy, and he's certainly capable of pushing a crappy vaccine through and treating his own people (even his own kid) like guinea pigs.

But the timing of this does make my inner paranoiac tingle. What if it's not Putin's own people who are the intended guinea pigs? What if it's really meant as bait for a "deal" with Trump, so the latter can "promise" a Russian vaccine if only he is re-elected? Or what if it wasn't originally intended that way, but Putin decides pursuing a deal with the US re a largely unproven vaccine is a great way to give Trump a boost, or at least to sow more discord and mayhem and eventual American mistrust of our own vaccine efforts?

There are a bazillion ways such a plan could backfire, of course, so I'm reasonably sure I'm just being paranoid. But chaos and discord are Trump's thing, and it's what Putin wants for our country. And Trump has already shown that there is no depth to which he will not stoop, and our system has shown itself singularly incapable of holding him accountable for anything.
 

MaeZe

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Any and everything you speculate is likely to be fodder for Russian trolls and bots interfering with our election regardless.

I don't think Trump's handlers would let him make such a foolish assertion as to promise a Russian vaccine if only he is re-elected. Trump's putting billions into two different US vaccines anyway. I'm pretty sure he's hoping for release of one or both of those vaccines in time to save his ass. I can't see it influencing many people to change their votes.
 

Roxxsmom

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That's the problem, really. There are so many others who want to stir things up.

There aren't as many undecided voters as there were at this point in 2016, and given how divisive the idiot in the Oval Office is, I suspect something would have to be really out there to shift people who have already committed one way or the other. But it's scary, because every time it seems like he's done the worst thing imaginable, Trump says, "Hold my beer."