Good evening and welcome to our 45th season of Doctors on Call.

I'm Dr.

Ray Christensen, a faculty member from the Department of Family Medicine and Behavioral Health at the University of Minnesota Medical School in Duth.

I am also a family physician at the Gateway Family Health Clinic in Moose Lake.

I am your host for our season premiere tonight, immunizations, RSV, COVID, flu, and pneumonia.

This season, we will again be rotating hosts from the Duth Medical School.

These include Dr.

Ryan Harden, Dr.

Chris Aquadey, Dr.

Mary Owen, and myself.

Remember that the success of this program is very dependent upon you, the viewer.

So, please call in your questions tonight or send them in ahead of time to our email address askdsec.org.

The telephone numbers can be found at the bottom of your screen.

Our panelists this neing include Dr.

Maritt Kenudson, a pediatrician and pediatric hospitalist with Essentia Health, Dr.

Rachel Modal, a long-term care specialist with Essentia Health, and Dr.

Carly Udlin, a pediatrician and who also works in hospital medicine with Aspirus St.

Luke's.

Our medical students answering the phones this evening are Ella Miller from Lewon, Minnesota, Einisa from Duth, Minnesota, and Maya Orvis from Cross Lake, Minnesota.

And now on to tonight's program.

And just a reminder that this is a program 45 years.

It started with the founding dean of the medical school in Duth and it was involved and was worked with the medical societies of Douglas County, St.

Louis County, later St.

uh Lake Superior Medical Society and the Range Medical Society and it's on that basis that this program has continued at this point.

Welcome everybody.

Uh this is a great chance for you to uh help our public.

What I really like tonight is we have the gamut from little ones to older people.

We don't always cover children like I would like us to.

So this is great.

So thank you for coming.

Happy to having us.

So Dr.

Kudson, do you want to talk a little bit about your practice?

Yeah, I am a general pediatrician in uh pediatrics clinic in Duth and I also uh work part-time as a pediatric hospitalist at Essentia Health St.

Mary's Medical Center.

um uh St.

Mary's Children's Hospital and Dr.

Madall, same same question.

Yeah, I am a geriatrician and an internist at Essential Health.

I work part-time in primary care clinic and then also parttime in the nursing homes.

And Dr.

Oland, I knew I knew I would do that.

It's tricky.

Dr.

Edund, welcome.

Thank you.

Um same question.

Yes.

Very good.

Um I am also a pediatric hospitalist.

I work at um Aspirus St.

Luke's and so I see lots of newborns on the birthing center go to deliveries that kind of thing.

I don't right now do any outpatient pediatrics just in the hospital for now.

Well, the immunizations there's there's a lot going on.

We we see a lot on measles and a lot of other things.

I thought we'd start tonight with RSV because it's a new immunization.

It affects both ends of our age spectrums.

And uh where should we start?

Do you want to start with the elderly or we want to start with the young people?

Elderly.

We'll go with the elderly.

Yeah.

Uh RSV is a respiratory illness that can affect older adults and cause serious illness that results in hospitalization.

The vaccine is effective approved for those over the age of 75 and then 60 to 74. or if you have pre-existing health conditions.

It's just a one vaccine right now.

Um it's recommended for all almost all my patients since I only see those above the age of 65.

Um and it's been uh pretty well tolerated and great vaccine.

Dr.

Dudlin, you want to take the Oh, little ones.

Yeah.

So from the little one's standpoint, I I RSV the um introduction of the RSV vaccine in the last few years has made a huge difference in pediatric health um and pediatric health care.

So um RSV is one of the it is the leading cause of hospitalization in children especially um young children less than the age of two um tends to it's same thing with adults causes like a respiratory infection and when you're really really little the um it can cause babies to like pause in their breathing called apnea.

it can cause just significant respiratory distress to the point where babies have to be in the hospital.

Sometimes they have to be in the ICU um with breathing tubes and that kind of thing.

So, it's a really significant serious illness in little babies and um accounts for a huge number of the hospitalizations across the country.

I think 60 to 80,000 babies tend to be admitted each year with RSV.

and um the so bringing the new RSV vaccine.

There's two ways that babies can um benefit from getting this vaccine.

Either the moms when they're pregnant are going to get the vaccine or there's another type of immunization which is um it's not exactly a vaccine.

It's like a monoconal antibbody.

So it's kind of like a it's like an infection sponge I think about it.

Um and babies can get this immunization in the RSV immunization in the first week of life.

And both of those have been shown to have huge benefits in terms of like decreasing a the number of kids being infected also like um the number of kids who are admitted to the hospital and the number of kids who end up in the intensive care unit with this infection like to the order of I think um 80% fewer like infections have been noted 80% fewer hospitalizations for these kids and then 90% fewer kids ending up in the ICU.

So, that's a huge a huge game changer for little little kids who um haven't even gotten a chance to get out the gate.

Put me out put me out of a job.

RSV is is fantastic vaccine.

Well, it's good because RSV those of us I take care of elderly people more and we stumble around as to how we were going to use it and I think we've got three or four years under our belt.

So, I think we're getting a good feel for it.

Merritt, I can't help but go back and just measles has been bugging me again.

Yeah.

I grew up back before 57, so I I had it.

Um, what's so bad about measles?

Why should people get the immunizations?

It's a great question and a question that we're getting a lot of um in our clinics and hospitals and um family and community members asking a lot about measles.

Um the typical protection as far as vaccines that are recommended just to kind of start with that basis is um two uh two immunizations.

One at uh between 12 and 15 months of age and then the other between four and six years old.

And those two immunizations together give about 97% protection from measles um infection and uh and illness.

So that's like pretty astounding protection.

Um however with declining immunization rates over the last several years or you know decade or so um there it's uh there tend to be pockets of communities that are um you know under that I think 95% threshold that you really need 95 97% threshold that you need for the community immunity and so then it spreads very quickly um to the order that even if you are breathing the same air within I think two hours that was um someone who had measles was there before you.

Even if you're not there at the same time as them, if you're not immunized, you could um very likely get sick with measles.

So, we're seeing big outbreaks.

Um we have the highest number of measles cases over 3,000 this year already.

Um and already four measles deaths um this year, which is the highest in, you know, decades.

It was declared eliminated from the US in 2000 and now it's coming back.

It was It's so infective.

Yeah.

You just have to breathe it.

Rachel, how does this affect adults?

Measles.

Is there a problem with the older adults now, too?

Uh, not that I have been seeing.

No.

And most of my patients have been immunized.

As far as I'm aware, it's not something I've seen in our long-term care facilities.

They're before 57 if they're like me.

So, yeah, they had it.

Why why is Canada before 70?

So here it's before 57.

I think Canada you if you were born before 70 you don't need the humanization.

I don't have an answer.

I don't know.

I thought maybe you might have it.

So this is a common common concern.

Um, and I'll I'll preface it in that I grew up at the end of the polio season or the polio times and uh knew that my parents knew people that had had polio and early in practice I'd taken care of a few people that had had polio also and also when I first started practice H flu was out there and that first year we had like about five H flu menitises immunizations came for both of those.

I will tell you that that first polio shot hurt like heck because I had it.

Took a week to walk again.

But uh thank God for parents that just drug us in there.

Those diseases have been have been basically taken away.

So whoever wants to bite on this, why do we need vaccines for diseases we don't see very often anymore?

I mean I can speak at least initially to that and then would love your opinions as well.

Um, I mean diseases that hadn't been seen in so long because people are not immunizing as much as they used to, we're seeing them again.

So, uh, if we don't have the community immunity or her immunity, things come back.

So, measles, like we just discussed, like I have taken care of children with measles within the last five years.

This was at a former job in Minneapolis.

And I mean, it's awful.

They're not, it's not just a fever and a rash.

They have pneumonia.

They might get brain swelling.

Um and yeah, I mean we we need to keep vaccinating to keep the level of protection so that these illnesses don't don't spread again.

I can't remember when I was growing up.

I know we all got measles.

I don't remember how ill we got.

I lived on the farm.

You never saw anybody else.

So you just never knew, right?

But I believe that the young people when they get it, there's there's a lot of lot of pathology that can happen with measles.

There certainly can.

And and that's one of the things that when you were thinking about like diseases that we choose to vaccinate against or that that the and efforts are going into providing like vaccines for like we know kids get sick.

I think on average uh like young kids in kind of preschool school age kids will get a feebal illness like every I want say they they quote like every 3 to six weeks.

So just expect your kids going to be like snotty and sick through most of their early childhood.

Best of luck.

And um and that's that's part of being a kid and we kind of all know that.

But there are diseases like you know hand foot and mouth is one that really like bothers people like it gets a lot of publicity but it really does just cause a fever and rash and then you're kind of better after a little while and then um but something like measles and some of like vericella and stuff there are actually some really sever.

Yeah, chickenpox.

Exactly.

Um there are actually some really significant side effects or not side effects but there are some really significant outcomes that can come like um brain swelling like you said and that brain swelling doesn't even just have to happen during the time of the infection like later in life you can get something called pansclerosing and sephilitis which is basically just a terrible brain um attack later in in a child's life um secondary to having had measles as a as an early child like there can be permanent nerve damage hearing loss with um vericella and so there are kids who measles looks just the same as like a hand foot and mouth.

Like, oh, you get a rash and a fever, but these are actually really significant illnesses that cause um death and disability in kids.

And so, a lot of kids get measles and they get better and they get fine.

But then there's the measles deaths that we've already seen.

And as the numbers in the community increase, we're going to start seeing more of those kind catastrophic complications.

Rachel, the word vicella came up and got me thinking about chickenpox.

And Mhm.

So where are you with shingris and yes and her with shingles and so on.

Yeah.

Uh your chance of getting shingles um increases as you get older as our immune systems get weaker.

Um all of older adults have been exposed likely in some way to vicella when they were younger and so it's a virus that reactivates.

Shingri is an amazing very effective vaccine.

It's two doses uh taken two to six months apart.

Um it's over 90% effective at preventing shingles and then I think over 85% at preventing post-traetic neuralgia which is the really awful nerve pain that everyone complains about when they get shingles.

And shingles is not fun for anyone who gets it.

I think it's a vaccine that can make if you did get it less severe.

And so it's it's definitely worthwhile.

So shingles can affect the eye too.

Can it also affect internally uh like a menitis or an infection inside not just superficial and I don't have the answer to that.

It just it seems like I've stumbled across that once in a while.

Well, I know.

So shingles is is um like an infection or a presentation that older adults will get like as a reactivation of this herpes virus which is called vicella.

And so um when you get a primary for sure you can have uh like um vericella like chickenpox and sephilitis and actually there was re really recently like within the last few months we've had a patient who had was vaccinated for vericella but had a breakthrough case basically because her immunity is decreasing people are still getting exposed to it.

So this individual ended up getting um chickenpox as like a young adult and currently has um severe complications.

Has um hearing loss is not able to swallow like one side of his throat not swallowing well.

He's lost his voice.

Um he's having significant complications from the veracell itself.

So once you have chickenpox it kind of lives inside you in your nerves.

And so when it's reactivated it becomes shingles.

So, if it's reactivated enough and your immune system is suppressed enough, I do think that it would cause I I don't know this for sure, but um I think that like if it becomes basically a full-blown reactivation of chickenpox, then you could have some significant complications.

The other thing that uh is very disastrous for the elderly is the pain.

And I've lost patients just because of the pain.

It's just nasty.

Merritt, um question from superior.

Can a child get multiple vaccines at one time or should they try to spread them out?

It's a great question.

We It's very It's topical now.

It's a Yeah, it's a question a lot of parents are asking.

I think you know we hear among friends or other people or social media or the news like should we be giving them one at a time or should we be doing combination vaccines and we have really great evidence that shows that um you don't have any more you know side effects or bad side effects um if you give things as a combination um in fact you lower the number of times that the child might then be subjected to having fever and pain um if you do it kind of all at once.

So, we do recommend kind of going by that schedule and using the combination vaccines.

It's actually something I was learning more about recently because so many people have questions about ingredients in vaccines that when you use a combination vaccine, it allows you to actually use less of the um you know the adguants and the stabilizers and some of the ingredients people are worried about.

So, um, not that we have any proof that those are detrimental at this point, but if it's something you're worried about, actually, you're going to get a lower amount of those things if you do use a combination vaccine where you're getting um, you know, more of the diseases protected against in a single shot.

And in the adults in the past, generally, we spread them by about two months.

So if you you get a whole bunch of them today, whole bunch of shots today, say a COVID and a flu shot or you had the spread by a couple of months, what what's the latest thinking on uh the spreading out of shots or versus getting them all the same day?

COVID and flu are safe to get together.

I usually recommend to get them together.

I if you're due for a, you know, multiple at once, usually in the fall, I recommend kind of spacing them out a little bit, but not usually a couple months.

shingles I do recommend giving some time that sometimes can have more side effects associated with it um and doing that one by itself.

So you you opened it up.

Talk about flu shots.

When should they get them?

How good is it this year?

What's happened in the southern hemisphere?

How's it going to work?

Last year it was useless.

Yes, that it's true.

It changes year to year.

I It's important to get every year.

Um, now is a great time.

Weather's getting colder.

It's flu and cold season.

Um, it's going around.

Patients are are getting sick again.

So, I say anytime kind of like in this like early early fall is a good time to get the get the flu shot.

How long is a shot good for?

The flu shot is good for the season.

So, so six months, yeah, something like that.

And another thing to think about is that it does take uh four to six weeks for your immune system to really build up a good response to that flu shot.

So you want to get it yesterday, last week.

So because we're entering that cold and flu season.

So if you're exposed the day after, like if you're going on a big cruise and you get the flu shot the day before thinking you'll be protected, you could still get the flu while you're on the cruise and then it's like, "Well, the flu shot didn't work for me."

Yeah.

And another thing to think about timing at least with um infants is uh the American Academy of Pediatrics does recommend all infants six months and up um and all children get a flu shot.

However, for parents to keep in mind that the first um the first winter season that a an infant goes through um you do need two doses of the um of the flu shot.

So your first dose you would get on day one and then you need your booster um flu vaccine about four weeks later.

Um and same thing with co vaccines um need multiple doses at first season.

So don't put it off too long because to get the baby's full immunity um for influenza or covid you you really need multiple you know booster doses and your t the time for your body to build the immunity after the vaccine to be protected.

Just another comment.

Does my I want you to make a comment on this because I think it's a good one to make.

Does my child still need vaccines if they are generally healthy and rarely get sick?

Yes.

Yes.

Uh no questions.

Hands down.

Yes.

Um, we and I think it's I think it's really important and I think that this is like a a very um it's a big concept I think right now in like social media and everything is like you're taking all your vitamins, you're getting good sleep, you're staying hydrated, you're getting enough protein and fiber, you're doing all of these things.

And so you can check the list and be like my family does a fantastic job taking care of ourselves.

like we eat kale salad and um you know we are like a strong and hearty people but even strong and hearty people can get sick and they can get infections.

And then the other thing that's really important to think about, your family may be very strong, very resilient when you get to these kinds of infections and you may be very strong, but um keeping these infections, the numbers of them low so that other people who are less strong or less able to fight off infection are also safe.

And so one of the most important pieces of getting your kids vaccinated is to think about not only your children but other children in the community, other adults in the community, grandparents, elderly in the community.

um kids like specifically um kids with suppressed immune systems or anybody with a suppressed immune system where so um I actually had a patient in uh several years ago in um when I was in residency who was a four-year-old boy being treated for cancer and he was doing well with his cancer treatment but he got RSV um which is a common this was before the RSV vaccine really came out RSV and this kid actually ended up in in the critical care unit, ended up having to have a breathing tube, ended up having to have he ended up with a tracheosttomy um because he got RSV.

So, he was very very sick and nearly died because he got a very common infection that he was not able to fight off.

So, if you think about kids like this kid's family, to lose your kid who's fighting cancer and doing like this hard, horribly, you know, brave thing to then die of a newborn like of a of a common cold, it's kind of horrifying.

So, how do we reestablish that conscience in our society because it's been lost to some extent?

I think that that is there's actually a lot of research specifically going into how do we talk about these things in a way that is meaningful to people because we there's kind of a butdding of heads between like the scientific community and like health gurus and and various other people in different political arenas.

And so I I think just talking about it, reminding people about the fact that there are other people out there to think about and people who um who need your help and protection and to do the neighborly thing, especially in Minnesota.

I think that that can catch on like do the neighborly thing.

We're motans.

We're taking care of each other.

I hope that we can regroup after our current the way the way we're handling things from the CDC at the present time.

It's very frustrating.

Um I've already had shingles, so I still need the shingles shot.

Yes.

Why?

Because you can it can still be reactivated um as a virus and so getting shingles does not prevent you from getting shingles again in the future.

And so I still recommend it.

I was going to mention too um some of the resources that might be helpful for families um that I submitted to you know have displayed here today.

Um some of them are more uh pediatrics focused but you can see on the screen um there's the bottom two that probably address pretty much all um all vaccines for adults and children.

So, if there are um things that you're wondering about, what is the, you know, scientific community recommending versus CDC recommending, um these are some of the ones that um I'm using in my practice and recommending for patients and parents that I take care of um to get really evidence-based information and answer all the questions that people have, whether it's ingredients, spacing, timing, um yeah, the diseases themselves.

So, yeah, those are uh on the screen there.

Thank you, Rachel.

This lady just had a hip repair.

Uh how long does she need to wait for her flu shot and COVID shot?

Uh it is safe to get them now.

I would get them now before she leaves, right?

Yeah.

Yeah, I would think that would be yesterday.

Yesterday.

What vaccinations would you recommend for a one-year-old who has recurrent fevers?

Um, that's a great question.

I would say, uh, you know, there's probably when you go in for the visit, you know, have a detailed conversation with your child's provider, whether that's family practice or pediatrics, and that person who knows the history can help figure out is this, you know, virus after virus types of fevers or is this a periodic fever syndrome or is there something else infectious causing fevers?

I mean, there's just it's hard to say, you know, exactly what I it would be a one-on-one conversation, at least if I saw this child in my clinic.

But, um, if there's not something underlying that has been identified at this point, um, that would be some type of immune suppression, it's probably safe to get them.

Um, and, you know, just have close counseling about what side effects that that child might experience, which do include fever.

Um, but, um, that's usually limited to a day or two.

Yeah.

especially if that's could maybe be more vulnerable or more at risk for some reason that we haven't yet uncovered.

They should definitely get all of the recommended vaccines up until that point and then probably a more thorough work up.

This has really been a great show.

I've got to cut it off.

This is one we could have gone longer.

I'm sure we could have.

I want to thank our panelists, Dr.

Merritt Kudson, Dr.

Rachel Modto, and Dr.

Carly Udland.

Maybe I'll get it right.

and our medical students uh volunteers Ella Miller, Eye Nisca, and Maya Orvis.

Please join me again next week for a program on men's health and prostate cancer when our panelists will be Dr.

Timothy Kafal, Dr.

Ben Marsh, and Dr.

Paul Tonkan.

Thank you so much for watching.

Have a great night.

Get your immunizations.