[Music] good evening and welcome to doctors on call I'm Dr Peter nalen professor and head of the Department of Family Medicine and biobehavioral health and Associate Dean for Rural medicine at the University of Minnesota Medical School Duluth campus I am your host for our program tonight on infectious disease and immunizations the success of this program is very dependent on you the viewer so please call in your questions or email them to ask at wdse.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Ken rip a family medicine physician with the dmh rater clinic in Cloquet Dr Harmony Tyner an infectious disease specialist with Saint Luke's infectious disease Associates and Dr Dylan Wyatt a St Luke's emergency medicine physician our medical students answering the phones tonight are Walker Lair from Monticello Minnesota and Nehemiah Olson from International Falls Minnesota and now on to tonight's program on infectious disease and immunizations Dr rip the first question is for you and that's about the importance of pertussis in the tetanus booster for adults why is it there what we found is that uh for adults it's important to keep up on your pertussis because as you get older you can get very sick from where you found that patients who end up in the ICU with bad pneumonias there's a percentage of them had pertussis and we we didn't really think we thought of it more as a young person disease and so by vaccinating the whole population we can just sort of keep it tamped down a teenager getting pertussis they can get very sick too and so now we boost them at around seventh grade and that helps protect them into adulthood and then continuing to keep that protection is a great idea thank you Dr Tyner congratulations to you for the recent publication of your research in Jama the Journal of the American Medical Association with your research involving more than a thousand participants can you tell us a little about why this research was undertaken and what it's shown yeah so we've been lucky enough to work with the CDC on a prospective cohort study which means we've watched about 7 000 people across the country over time since the beginning of the pandemic and this most recent research was looking at the effect of vaccination on preventing the different strains of covet as you may have heard there's different types of covid so Delta and Omicron and we would observed that the vaccination was able to reduce the degree of symptoms for each variant the effect was a little less in Omicron which really kind of brings home the importance of this new bivalent vaccine which has a specific component of it which is more effective against Omicron but we are still recruiting so if you are a Frontline worker or someone who works with people face to face we would love to have you consider swapping your nose every week for us terrific well uh Dr Wyatt for you we're hearing the initials RSV what is it and why is it important in this season in your emergency practice well it's a respiratory Sensational virus on any normal year it would be something that we just call a cold or something like that colloquially but it is more specifically a respiratory infection that really can hit younger children and very elderly quite hard this year from what we have seen throughout the rest of the country um and even now down into the cities the levels of RSV we're seeing in the population is quite high and we're also now in our emergency room starting to see increasing levels of it in more what I would describe as sort of socially mobile kids the three to seven-year-olds that are kind of out and about and interacting with more people throughout school they usually do quite well with it but the problem is that they can then pass it on to younger and younger children less than two and then less than six months are associated with a lot more severe disease and so we want to make sure we can try and keep it away from those kiddos if we can if you're offering an RSV test to a patient or talking to the family how do you describe the test to them very it's previously before covid it was a little more challenging about the oh we need to swab your nose why are you putting something into my nose but now we're all fairly familiar with the idea of a swabbing test for that and thankfully there's actually testing that exists for both covid flu and RSV so we've been utilizing that great deal because the symptoms can overlap and sometimes especially in a little bit older kids it can be harder to really identify yes this is covered yes this is RSV purely based on symptoms due to the overlap thank you Dr Tyner a caller wants to know what is the most common infectious disease you see or treat in your practice ah most common oh that's such a good question we see everything the variety is what makes it so much fun and so interesting but I think the most like common things are common and I think the most often things we see are bacterial infections and viral infections but we aren't often called for viral infections unless it's HIV or hepatitis C probably staph or strep infections and staff and strep are the two number one germs that cause a lot of skin infections lung infections Bone and Joint infections so I think that's the most common but there's such a great variety thank you Dr rip a viewer wants to know what's the best way to minimize side effects after an immunization um that's a good you can we used to tell people to you know pre-medicate with something before the shot and we realize that that blunts the immune response and our whole idea of giving a shot is to get your immune system to recognize a virus or so that if it sees it it kills it quickly and if you get a sore arm or feel a little under the weather after shot that means that your body's doing what it's supposed to do which is having that immune response and so you're generating a good a good immune response to that vaccine once if you're having those feelings then you could use some Tylenol or Ibuprofen to try and you know lessen those but you don't want to take it before the shot you want to have a clean slate so that your body can generate a nice immune response thank you Dr Wyatt in the emergency practice do you see Travelers with illnesses and what are some of the common infectious illnesses that Travelers encounter so here in Duluth not as much um where I did my residency in New York far more so um to the point of covid very early on which was a new thing at that point here it's more of those sort of respiratory illnesses and RSV flew covid that usually it's someone on a flight from somewhere else they may be from Duluth traveled somewhere and came back and they just picked that up on the flight the most common thing that we'll see can I interject that infectious disease actually has a Travel Clinic so we actually see return Travelers who've gone strange places and come back with really weird things so we've actually seen Dengue and hookworm and other fascinating things do you see patients in the Travel Clinic before they travel yes so we give them a lot of recommendations about vaccinations to get if you need to have yellow fever or Japanese Encephalitis vaccination will give recommendations on that specific to where you're traveling and also things to avoid for example drink bottled water or wear masks or other things that wouldn't make a whole lot of sense but like altitude sickness a lot of different things you wouldn't necessarily think about and like emailing yourself a copy of your passport so you have access to Internet and you don't just have a copy that's lost somewhere so you know practical things too but thank you and uh Dr rip the meningitis vaccine is it working is it reducing the incidence of meningitis yes we're seeing yes so we're now routinely vaccinating uh uh at the seventh grade and before graduation high school we try and get our our high schoolers vaccinated as they begin to go out in the world and mingle with other adults young adults that's when we see these little outbreaks of meningitis and if we can capture those people we have seen a decreased rate of meningitis and there's now a second meningitis shot as well so that's very encouraging Dr Tyner what are some instances when you might actually consult to stop antibiotics rather than to start them that's such a great question so oftentimes when people are admitted to the hospital they're sick and one of the things that can cause the greatest risk of morbidity or mortality dying or being really sick from something is oftentimes an infection and sometimes it ends up being something else for example congestive heart failure or a stroke or something else but it doesn't it's not obvious at the time so as we go through like the workup sometimes it ends up not being an infection even though we oftentimes will use antibiotics to start with just to be careful and just to be sure but oftentimes we can pull those back if we've kind of ruled it out or ruled something else in as someone if I can just add on as someone who is often the prescriber of many of those broad spectrum antibiotics um especially in people who are very very sick a lot of the markers that we would use for infection such as white blood cell counts can be elevated in any kind of stress and so those can seem falsely elevated we can have symptoms just due to General severe illness that can imitate those kind of infectious processes or perhaps there is a small infection going on but it's not the main problem and one that needs to be addressed with the suite of a sort of larger stronger set of antibiotics that we often utilize in the ER you uh have heard of the news stories of floods and people being sick after hurricanes Etc what's your advice or alertness about the flesh-eating bacterias what are you what are you looking for in patients who may be concerned about this you just cheered flesh eating bacteria so in in hurricanes it's Unique because they oftentimes have exposure to certain pathogens we don't necessarily have here so vibril vulnificus is one example of things that can cause the quote unquote flesh eating bacteria but here's something that's interesting and maybe I shouldn't I don't want to worry anybody but most bacteria can eat flesh but um not in the traditional sense like the really rapid ones um if people are concerned about that there's really two types of things we think about there is necrotizing fasciitis and it's usually caused by one of two things one is either you get a wound and you have a history of diabetes and that can cause a really terrible looking wound or group a strep the strep throat germ if you have a very sore spot on your body or you're feeling sick that's something that can be assessed for and there's pretty classic things we look for but I wouldn't necessarily be worried about the classic flesh eating bacteria it's not really that common generally speaking thank you Dr rip a viewer from Proctor wants to know after enduring viral pneumonia for about two weeks what might be the next things to consider so are they still sick yes I think so so if you have a viral pneumonia it can it can damage the lung tissue and then you we you can get what's called a super infection meaning you can get a bacterial infection that is able to then break in and start a different kind of infection so if they're still sick you need to go back in because sometimes we do say okay it was virus now it looks like it's moved down to a bacterial pneumonia and you might need antibiotics so thank you Dr Tyner a caller from Tower Minnesota wants to know what are some of the negative side effects of the coveted vaccine to watch for the covet vaccine is very similar to other vaccines we really haven't seen a lot of severe side effects overall out of proportion to any other vaccine and those are usually soreness at the injection site sometimes people have a fever afterwards for 24 to 48 hours and sometimes you'll have muscle aches and joint pains but those things are usually pretty brief rarely people can be getting sick at the point of time where they get a vaccine and kind of it might seem like that's making them sick but really no different than any other vaccine so if you get a flu shot or a polio vaccine like anything you would get can cause the same types of symptoms okay so most are asymptomatic or have symptoms for 24 hours that rapidly resolve yes okay thank you Dr Wyatt If a patient presents suspecting that they've had a spider bite how might that be related to an infectious disease presentation that's that's a fascinating and fantastic question so a bit rarer in our area spider bites but as during the Summers there can certainly be incidences where we encounter spiders and can have bites usually the spider bite itself depending on the spider variety most spiders are not venomous even if they do bite and if they are venomous they don't cause a lot of damage usually in those cases what will actually cause the swelling the injury and the sort of redness around a potential bite is a superimposed bacterial infection from the bacteria that live on your skin the normal bacteria that are in our environment and on our skin are then put into a place where they shouldn't be under the skin from the bite itself if there's any concern about that a big red swelling areas I'd encourage people to come and get it double checked on because it can be a little tough to differentiate between if it's just the bite or if it's a bacterial infection sometimes Dr rip besides covid what are some other infectious diseases you wish the public knew more about this caller wants to know um common things are common so uh influenza you know so now if you haven't gotten it yet go get your flu shot because they're trying to get everyone protected and we're we look to our South like Australia is having a very difficult time with influenza and it's going to come our way it's already in the Southern United States and it's going to come our way and so now Now's the Time to get protected tetanus shot and then if you're if you're of the right age or have the right diseases in pneumococcal vaccination the the curve that we were able to show when we started to vaccinate with pneumococcus we've just been able to wipe really radically reduce the number of pneumococcal cases that we see by vaccination our hospitals don't have the patients with pneumonia like we used to 30 years ago because of pneumococcal vaccinations so go into your primary care doctor make sure your vaccines are up to date thank you Dr Tyner if a patient is sick in the hospital and offered a flu or pneumonia vaccine should they get it depends on what they're sick with if they're there with a broken ankle yes if they're there with something else that's causing similar symptoms to what the vaccine could cause I would wait until they're better so if you're there with an infection I would wait till the infection has resolved generally speaking there are some exceptions but generally speaking I'd wait till you're you're better another question from a viewer Dr Wyatt we hear about antimicrobial resistance is this something the public should be worried about worried No cognizant of yes um it is something that is a sort of steadily building concern in that anytime someone takes an antibiotic the goal is to eradicate a bad bacteria if one does not complete the course of antibiotics which is a very common reason why this resistance is growing or if there are some other factors involved that bacteria can sort of put up defenses against those bacteria the antibiotics from The public's perspective what they need to be concerned about is just making sure you take the entirety of your course of antibiotics and generally speaking when you are taking antibiotic and afterwards try to take some kind of probiotic supplement as well that can reduce the risk of those kinds of bacterial infections thank you Dr Wyatt this question is about or pardon me Dr Tyner this question is about monkey pox and why it's a particularly severe in uh critically ill patients in the critical care units why monkeypox is worse in critically ill patients um or is it worse in critically illness I don't know that it is worse so the vast majority so monkey pox itself is an infection that's transmitted by contact it's not one that's resting it's not a respiratory transmission Etc it's transmitted by contact at this moment in this current outbreak of monkey pox it is primarily in seen in people who have had sexual contact and largely in our population of men who have sex with men that's not exclusively there but the vast majority well over 90 percent that's the case I have not yet seen those people in the ICU but there is a chance that those infections could make them sick enough to be in the ICU it's unlikely you'll get that infection while in the ICU so um I would say if you are at risk of getting monkey pox the reasons described there is an effective vaccine out there and I recommend a senior provider for it okay thank you for that and uh Dr rip is there actually a diagnosis or workup called fever of Unknown Origin yes and that's when I would be calling Dr Tiner so occasionally we'll run to a patient who just has a fever and it can be just a spiking fever daily or every few days and they just get this high fever or they'll be a consistent fever and the primary care doctor or the ER doctors looked and looked at the common causes and we can't find a cause and a lot of times that's when we call Dr Tyner up and we say boy do we got a great case for you and sometimes they'll do a huge work up and they'll find something very exotic I had one gentleman who had brewer's yeast so cool and then I had another a friend of mine who we worked up and worked up and we could never find a cause and just went away Dr Tyner suppose you're evaluating a patient with a wound on their ankle and it's just not healing could it be infectious or how might you approach it yeah it could be infectious I will say that by the time I usually see somebody they've usually had multiple courses of antibiotics and there's usually other risk factors whenever I see a non-healing wound I usually think about underlying infection possibly infection of the bone however I would say the vast majority of non-healing wounds tend to be related to circulation whether it's venous circulation or swollen legs or simply not having enough blood flow in arterial circulation so I would be really thinking hard about their circulation Dr Wyatt is covet increasing the incidence of lung disease is covet increasing the incidence of lung disease in the post so covid infections have been associated with an increase in lung damage I have not seen any research specifically about increased incidences of asthma or things of that nature there certainly has been I believe it was a few months ago a study that showed a decreased oxygening and kind of um like a vital capacity the ability of the body to really get in and get in full amount of air and oxygen in people post covet infection and that can last for quite a while you've heard of long covid that could be one of the symptoms of that but I haven't specifically heard have you heard of that any increase in asthma um anything of that nature I've heard a lot of it increased a lot of things like the cardiovascular disease but um specifically lung disease I know those can be scarring but not anything else unique there was a study that looked and they did a pet scans on people post coven they could find microscopic circulation issues so probably tiny blood clots and so if you talk to athletes who have had it a lot of times there is this prolonged recovery and then they get back so that's a good if you're you know that's why I encourage younger people especially all younger people but a lot of parents don't think that their kids oh they don't need that covet shot but if they're in sports they want to be active it is it is protective of the lungs in all of the rest of the body so and I will say we don't know yet we still truly do not know yet in the long term right covert's been here for to three years and not that long it could be that there are issues in the long term and from what we've seen thus far a lot of the issues we know about are mitigated to a significant degree by the vaccination right uh would one of you begin talking about the effectiveness of the newest covet booster and then others could chime in well we know that the news covered booster has increased efficacy against the currently circulating strains which are kind of known as Omicron the old vaccine had some activity but it really wasn't robust against Omicron and the new vaccine really does have much better activity against Omicron again we'll always know more after the fact but right now it seems like that's the best thing to do to protect yourself okay and this is about vaccinations and timing we have a few questions about that I'll start with um this one from a caller in Duluth why do we often get two vaccines at the same time is there any benefit to spacing them out if you give we see this a lot in kids where we know that we can give multiple vaccines at the same time and they'll all work if they're given at the same time now if you give one vaccine and then you give the vaccine a week later that second vaccine might not work as well so that's why we have that spread between vaccines so so if you're getting shots multiple shots at the same time it works but if not you need to give a I I tell people you know a six six to eight weeks between the shots so because giving vaccines are complicated now because some shots you can get in the clinic and some you have to go to the pharmacy now and so it's a little bit messy for certain vaccines at least in my world I think there's also a practical component as well of just the lesser amount of times that you're having to go to a place come in get the alcohol swap put in there and actually get the shot and then of course the period afterwards where you're sort of recovering from there from cochlea a caller asks I've had covid do I wait two months for my flu shot for your flu shot no I would go for it as soon as you feel better go for it there is some data from the CDC if you've had covid to wait three months for your covid shot and that's just thought to give you an increased boost of of antibodies however it's not dangerous to get your coveted shots sooner I would recommend it waiting until you've recovered they say about 10 days till you recover from your your covet infection but it's there's no harm in getting it right after you're infected and Dr Wyatt besides the tetanus shots that you might prescribe in the emergency room are there any other immunizations that you offer in the emergency room setting tetanus is most commonly given one for a long time we were also doing coveted vaccines for anyone who had a hard time getting there or who was like you know what I just I'm here for a different reason but I'm ready let's do it um I believe those are the two that we have available I oh yes of course and rabies although when it comes to that can get a bit complicated if people are having a bite that's confirmed from different kinds of animals but we do do rabies um as well okay and a quick question um how might antibiotics help acne so as the teenage skin changes from thin skin to thicker skin the pores get longer there's certain bacteria that then start to develop Under the Skin and the antibiotics can help lower that count of bacteria Under the Skin and also May the antibiotics we use have natural anti-inflammatories to them so it takes some of the inflammation out of the skin as well okay and then briefly should a caller be concerned about whether they do or don't have symptoms after a coveted vaccine no no it seems like you develop a reaction even if you don't have symptoms afterwards it's just some people experience that more systemic symptom but it seems like you still have antibodies if you didn't have symptoms after your vaccine and then another quick question Dr rip the pneumonia shot who gets it and when anyone over 65 should get an ammonia shot if you are under 65 and have certain disease States so diabetics bad lung diseases patients who have chronic medical illness heart disease should talk to the doctor about getting a moon shot and that and there's now a new there's some new Pneumonia shots that are even better well I want to thank you all for a very interesting and uh rapid round of active questions from our viewers I'd like to thank our panelists Dr Ken Ripp Dr Harmony Tyner and Dr Dylan Wyatt and our medical student volunteers Walker Lair Connor Olson and Nehemiah Olson please join Dr Mary Owen next week for a program on stroke and other neurologic problems when her panelists will be Dr Erica Cohen Dr Vikram jadav and Dr Jonathan Schultz thank you for watching good night foreign [Music] [Music] [Music]