Vaccination
Dear Doctor: Older Person Wonders If It's Possible To Receive Too Many Vaccines
DEAR DR. ROACH: It seems as if the number of recommended vaccines increases every year, especially for us in the "over 65″ crowd. It's hard to imagine how the immune system can keep up!
Is it possible to receive too many vaccines, or at least too many within a given time-frame? Thanks. -- M.T.
ANSWER: Don't underestimate the work that your immune system does for you every day. You are always exposed to millions of antigens, which are specific parts of foreign material such as bacteria, virus, food, dust and pollen. We get exposed to tens of thousands of new antigens daily. Our immune systems work to fight off potential invaders and almost flawlessly ignores what it recognizes to be parts of ourselves.
Because vaccines only use a tiny part of the relevant bacteria or virus, the antigens that your body learns to respond to are just a tiny fraction of what it normally "sees" in a day. A typical modern vaccine contains 1-69 antigens, compared to vaccines from the 1940s that contained thousands of antigens.
I have had patients get as many as 30 vaccines in a single day (when they were in the military) without any problems.
DEAR DR. ROACH: My husband is 89 and taking amiodarone. He had a heart attack and is taking iron infusions for anemia. He was diagnosed with prostate cancer. His PSA level is over 300 ng/mL, but his bone enzyme level was normal.
What do you think about him getting the Lupron shot? His kidneys were failing, but they are now functioning at 50%. -- Anon.
ANSWER: A PSA level over 300 ng/mL suggests advanced prostate cancer, but I expect him to be recommended for a CT scan to see how extensive the disease is, as well as a biopsy to confirm the diagnosis. Just because his bone enzymes aren't high doesn't guarantee he doesn't have prostate cancer that has spread to the bones.
Most of the time, in a man with a PSA level that high and biopsy-proven prostate cancer, X-rays and bone scans are done to determine the severity of the involvement of the bones, which can be common with advanced prostate cancer.
I am also worried about the possibility that he has locally advanced disease, meaning that there might be a large amount of the tumor in his pelvis. If the prostate cancer is large, it can block drainage of urine, leading to kidney failure. I'm very concerned that it might be the cause for his kidney failure, whose function can be completely or partially restored by a procedure such as a drainage tube. This allows urine to flow without pressure.
If he indeed has advanced prostate cancer, treatment with a medication like leuprolide (Lupron), which blocks production of testosterone, is a very standard treatment that can improve both his length and quality of life. Most people with medical conditions such as heart disease tolerate this therapy well. However, there is a lot more that you and your husband need to be sure of before being able to make an informed decision.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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Researchers Identify New Antibodies That Could Improve Flu Vaccines
For most people, coming down with influenza — more commonly known as the flu — is not a major health issue. They will feel sick for four to seven days, then symptoms will subside.
However, there are populations where the flu can cause more serious health concerns, including older adults over the age of 65, pregnant people, children under the age of 5, and people with certain medical conditions such as heart disease, diabetes, and asthma."
This is why groups like the Centers for Disease Control and Prevention (CDC) in the United States and the European Centre for Disease Prevention and Control recommend people get an annual influenza vaccine, especially those in high risk groups. A recent CDC health advisory warned that current vaccination rates against respiratory viruses are low in the U.S.
Because influenza viruses are always changing, influenza vaccines are changed yearly to protect against the strains predicted to be the most prevalent during flu season.
Additionally, influenza viruses are very diverse. For example, influenza A viruses, which contribute to seasonal epidemics each year along with influenza B, can be further divided into various subtypes before eventually being classified as individual strains. The flu vaccine works better for certain strains and is less effective against others.
Now, researchers from the University of Pittsburgh have identified a new class of antibodies capable of combating multiple flu virus subtypes.
Scientists believe this new research — published December 21 in the journal PLOS Biology — could help develop a flu vaccine with broader protection across different strains.
According to Dr. Kevin McCarthy, assistant professor of microbiology and molecular genetics at the Center for Vaccine Research at the University of Pittsburgh and senior author of this study, although antibodies provide the strongest protection against flu virus infection, the virus continually evolves to escape them.
"Multiple co-circulating flu subtypes make it difficult to get a match between circulating viruses and components in vaccines," Dr. McCarthy told Medical News Today.
"The antibodies in our study are capable of blocking multiple flu virus subtypes at once."
Although all approved influenza vaccines train the immune system to make antibodies against the flu virus for future encounters, he explained that the influenza virus evolves to evade these antibodies, which is why updated vaccines are needed.
"The antibodies we identified demonstrate that the hurdles to making improved vaccines that resist year-to-year changes may be lower than previously believed. We also highlight that specific vaccine manufacturing processes may introduce errors that may 'distract' the immune system from achieving an optimal response."
— Dr. Kevin McCarthy, senior study author
For this study, Dr. McCarthy and his team focused on finding a new to neutralize a small change found in some H1 flu subtypes that affect the sequence of building blocks that make up hemagglutinin — a type of protein that binds receptors on red blood cells to initiate the early stage of a viral infection.
According to scientists, while certain antibodies can stop H1 and H3 flu subtypes, they are no longer able to when the hemagglutinin is modified.
Using blood samples, researchers uncovered a new class of antibodies capable of destroying certain H3 flu strains and certain H1 flu strains with or without the hemagglutinin modification.
"We have two major findings," Dr. McCarthy reported.
"First, it appears that some humans can produce strong antibody responses that block infection by multiple influenza subtypes. A proper series of exposures is likely required but the barriers to achieving these responses are lower than we anticipated. With this information, improved vaccines can be designed and tested in the laboratory."
"Second, some types of vaccine production like growing vaccines in eggs can introduce changes that misdirect antibodies from their intended targets, the viruses transmitting between people," he added.
"Transitioning away from egg-grown vaccines, for which there are already alternatives, would minimize this issue."
MNT also spoke about this study with Dr. David Cutler, a board certified family medicine physician at Providence Saint John's Health Center in Santa Monica, CA.
Dr. Cutler said the discovery of a new type of antibody to protect against influenza offers promise to reduce the disease and death caused by various flu viruses.
"Whereas some viral diseases, like smallpox, polio, and measles, have either been eradicated or markedly reduced in their impact by vaccines, influenza continues to kill thousands in this country every year," he explained.
"What has made influenza more difficult to prevent is the rapid mutation of the virus, especially at certain sites, designated hemagglutinin and neuraminidase. These sites give the flu virus its classic designation, such as H1N1, or H3N2. Presumably, antibodies (that) latch onto more sites (that) have less variation could be more widely effective in protecting against the flu. This is the promise offered by this new class of antibodies."
— Dr. David Cutler, family medicine physician
Despite the positive potential for this research, Dr. Cutler cautioned there are many limitations to the promise that finding this new class of antibodies produced by vaccines will lead to the eradication of influenza.
"Flu vaccines have never been more than about 50% effective in preventing serious illness or hospitalization," he added.
"But certainly, there is room for improvement in flu vaccine development and administration. The same is true of other serious viral respiratory infections like COVID and RSV."
Dr. Cutler also said there are limitations in terms of people not believing they need to be vaccinated and that simply having antibodies against a virus does not necessarily mean that you will not become infected or ill from that virus.
"There are many other components of the immune system (that) aid us in warding off infection in addition to antibodies," Dr. Cutler continued.
"We are a long way from understanding all the complexities of the immune system which determine why some people acquire infections while others don't despite having similar vaccine and disease histories."
"Goals for future vaccine research include making them more effective at actually preventing infection, making them more resilient to mutations in viruses, and getting people more receptive to vaccine administration to prevent serious illness, hospitalization, and death," Dr. Cutler added.
Pharmaceutical Companies Target The African Market For Vaccine Production
Vaccine production has become particularly important, especially as a new pandemic is anticipated by various experts. German pharmaceutical company BioNTech has announced that it has reached a key milestone in establishing its first vaccine production center in Africa in Rwanda, aiming to enhance access to messenger RNA vaccines on the continent. BioNTech has set up a production unit in the Rwandan capital, Kigali, to manufacture vaccines against various diseases in Africa. Built from recycled shipping containers, the unit covers an area of 35,000 square meters. Construction is expected to be completed by the end of the year, and production should commence next year, according to the German biotechnology manufacturer, which, along with the American Pfizer group, rapidly and successfully developed the world's first authorized COVID-19 vaccine, generating billions of euros in revenue for the two companies. The $150 million project in Rwanda began in June 2022 and aims to avoid Africa's total dependence on imported vaccines, as happened during the COVID-19 pandemic. "Initially, the consensus was that messenger RNA vaccines should not even be administered in Africa. It was said to be too complicated for our health systems," said Rwandan President Paul Kagame during a ceremony attended by European Commission President Ursula von der Leyen. "When we embarked on this adventure to manufacture these vaccines on the African continent, we were told it would take at least 30 years. That was completely wrong. This is possible and necessary," he added. BioNTech plans to hire approximately 100 locals when the plant is fully operational and train them to manufacture a variety of new vaccines using messenger RNA technology. Rwanda will then distribute the vaccines to the 55 member countries of the African Union. The first COVID-19 vaccine plant in Africa was launched in April 2023 in Cape Town, South Africa, a country leading the fight for equal access to COVID-19 vaccines, with the support of the World Health Organization (WHO), South African biopharmaceutical company Biovac, biotechnology company Afrigen, and the South African Medical Research Council.
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