Speaker 1: 0:03

Welcome to the Healthy Matters podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's your host, Dr. David Hilden.

Speaker 2: 0:20

Hey everybody, it's Dr. David Hiin, your host of the Healthy Matters podcast. This is episode 23 and we are gonna talk all things vaccines. To help me out, I have Dr. Kate Hust. She is the medical director of the Internal Medicine Clinic here at Hennepin Healthcare in downtown Minneapolis, and a colleague of mine as an internal medicine physician. Kate, thanks for being on the show

Speaker 3: 0:40

With us. Of course. Thanks for having me. Happy to be here.

Speaker 2: 0:41

So let's dive right in. Covid 19. I hear there's a vaccine for that. So you're the medical director of clinic, you've seen quite a bit and been actually instrumental in getting as many, forgive the way I say it, needles in people's arms over the years, especially since uh, a little bug called the Coronavirus, uh, um, mutated a few years ago and morphed into Covid 19. The vaccines for Covid 19 are in the news constantly. Give us, if you could, Kate, what is the current state? What is the current vaccine that we're asking people to get?

Speaker 3: 1:12

Yeah, so Covid vaccines have been in the news for the last year and a half and I know a lot of people are tired of hearing about it frankly, but it is important to pay attention to now because we have a new one, which I know is hard for some people to imagine. But if you think about it, we had an atlas, the roads got updated, we need a new map. And so we have a new the Covid Bivalent vaccine that is designed really to protect against Omicron, which is the version of Covid that's been floating around for the last six or eight months.

Speaker 2: 1:37

So that's what this new one isn't, but okay Doctor, there you go again. You're saying we got another one. Another one. We're gonna have a new one in four months. We're gonna have one four months after that. We're gonna have another one every six months. I think vaccine fatigue is probably actually gonna be a real

Speaker 3: 1:51

Thing. I think that's fair. We're we're used to as participants in the healthcare world getting a certain schedule of vaccines. We think about things like the TNA shot. You get one every 10 years, you forget about it by the time you have to get another one. Mm-hmm<affirmative>, this is a little bit more like a flu shot. You know, we get a different flu vaccine every year because we change it to try to predict what we're gonna need to protect us over the given season. Well, we have a new one in four months. I think it's unlikely. I have not yet found the crystal ball for Covid or the last two years. Mm-hmm<affirmative>. But is it something that's gonna be a part of our lives maybe annually going forward? It certainly could be. It's the nature of how viruses work. They just figure out how to do what they wanna do and a vaccine is what we can do to try to prevent them.

Speaker 2: 2:29

So just some real practical information right here at the beginning. This new vaccine protects against what?

Speaker 3: 2:36

So the new vaccine, which we refer to as the Bivalent booster, is available both from Pfizer and Moderna. And it prevents against additional strains of covid compared to what our initial covid vaccines were. So it really is protecting against Ohn BA four and BA

Speaker 2: 2:50

Five. And who should get that vaccine?

Speaker 3: 2:52

So this vaccine is for everyone ages 12 and older. Pfizer for 12 plus Moderna for 18 plus who has gotten their primary series. So individuals who have completed their initial vaccines, as long as it has been two months since their last covid vaccine, they're good to go. Doesn't matter if you've already had one booster or two boosters, as long as it has not been a bivalent booster and it's been at least two months since your last shot, you should get this booster.

Speaker 2: 3:17

What if you've already had covid? How long should you wait before you get your booster, your bivalent booster is what I'm saying? Yeah,

Speaker 3: 3:23

Right. So that's a great question. So there is not any medical reason why you have to wait a particular time. What happens when you get covid is that your body produces some of its own antibodies. It is essentially gotten a vaccine just by getting the illness. So you have your own protection that will probably last for up to about three months and be quite similar to what the vaccine would do. So you don't have to rush out and get the vaccine if you feel more comfortable getting that vaccine right away. As long as you have recovered from your covid and are out of your quarantine period, it's safe for you to get it. But you also have a little space if you wanted to wait up to three months.

Speaker 2: 3:57

So what do you seeing in your clinics here in Minneapolis, Kate, and I know people are listening to this from all over the country, but here in our part of the country, what are you seeing? Are people lining up to get the bivalent one? We don't hear about it as much in the news as the other ones. What do you see in as far as what people are willing to do? I

Speaker 3: 4:16

Would say I've seen the full range. There are certainly individuals who are just not sure what to make of yet another vaccine, understandably, they're a little bit tired of covid. Most of them, we have a conversation about what it means. They think about it. It's not something that has to happen immediately. So I encourage'em to think about it, come back, call'em, make an appointment, do it at your pharmacy when it feels right for you. I have lots of patients who were thrilled that they happened to be in clinic the first day we had'em available. I have other patients who missed that window by about a week and we kept a list of their names. So we call back and say, Yep,

Speaker 2: 4:48

They came in a week before it out. Got,

Speaker 3: 4:49

Yeah, we got, yeah, we've got'em now. And so I've seen, I've seen everything in between and there are some individuals, like you mentioned, who had covid this summer and just wanna wait a little while, wanna wait til it's closer to the holidays until things are a little bit more settled and then they'll go ahead and get that vaccine. So

Speaker 2: 5:02

Kate, have you found this to be true? I am having in my clinic, at least zero problems getting people to get the bivalent one because number one, you already had to have received the first primary series. And so people are like, well of course I'm gonna get that. So it seems like a different world than two years ago when we were having to educate people about the yes or no, should I get the vaccine? Now people are sort of divided into their camps already. Either they got the first series so they're willing to get the bivalent one or they never got the first series and nothing's gonna change their mind. Is that where we

Speaker 3: 5:33

Are? I think there are certainly lots of people that fall in those two camps. Kind of the, I didn't want the vaccine before. I've done okay since that time. So I don't know that I wanna do this again. There are people who have said, Yep, I've gotten that vaccine as soon as I could get it all along. And they will probably forever be the people up the front of the line to say, Yep, it's time for that flu shot, it's time for this vaccine. I'm gonna get it. I would say I have also seen a group of people who got their primary series, got their initial vaccines, maybe got their booster. They're not opposed to getting the bivalent vaccine, but they're kind of giving a little bit of thought. They maybe wanna time it right compared to what events they have coming up so they don't get sore or they're providing the most protection before they spend time with their family at the holidays. So there certainly is a divide and then kind of a spectrum in between. I think having these conversations still with patients, when I have folks come in who have not been vaccinated at all, I still offer to have the conversation, Have you had questions? What have your concerns been? We can't give you the bivalent booster without doing those initial vaccines first. But those initial vaccines are still providing importance coverage

Speaker 2: 6:34

And better late than ever. So that, that leads me into a probably the million dollar question that you hear a lot in out in the community. Here I am, I've never gotten covid and I also never got the vaccine. You, you got your vaccines, you got all your boosters and you got covid a couple of times. So we all know somebody like that who, somebody who got the vaccines and still got covid. And then there's always somebody out there who's feeling a teeny bit smug who'd never got any of it, didn't get vaccinated and didn't get covid. We, What do you say to that?

Speaker 3: 7:01

We all have those I think. I think that's where we tie, take a step back and think about what is the purpose of vaccines really? Vaccines are designed for a population. Vaccines are designed to take care of a whole city, a whole country, a whole group, not specifically to take care of an individual. So there's always gonna be one person whose experience is a little bit different, for better or for worse. We also need to remember that vaccines, especially the covid vaccines are to prevent serious illness. They're to prevent you from dying from covid or having to spend weeks in the hospital. They're not designed to prevent the covid that is two days of the sniffles and kind of twiddled in your thumbs waiting to go back to work after quarantine is over. And so I think that's where we kind of get lost is that there are lots of people who have been vaccinated and have had covid, but a lot of people who haven't had to go to the hospital, they haven't died because of the covid and that vaccine relationship. So, so there will, there will always be people who said, Nope, I'm not interested, I didn't get sick. And I tell this patients great, I'm, I'm glad that you have been lucky enough Yeah. Not to be sick or you have been sick and you've been okay or that your family members have been that. Okay. And that's an individual decision. It's my job to give you some information and help you make an informed decision, but I can't tell you what to do.

Speaker 2: 8:13

You said that so well, Kate, that was really well said because I usually say something snide like, Yeah, I haven't been in a head on collision yet and I still wear my seatbelt and I'm glad there's an airbag. You know, you sort of get tired of of giving the nice rational response. That was wonderful. I love the way you did it. I also like what you said about we do it for the population. We were back. Remember that, you remember when we first rolled this thing out and we were talking about should we make hospital employees get it? Should we, should we make it a requirement of employment? And by the way, we did and I'm glad we did. Yeah. Um, but remember those first few days it was like this is the way we're gonna get through this thing. Uh, not necessarily that person A or person B isn't gonna get, get covid still, but that this is the, the way our community and the collective good is going to be advanced. Do you remember those first few days when we got that thing? Yep.

Speaker 3: 9:01

And I think that's the hard part about what, what we've seen over the last year and a half or two years with Covid is that really we are for better for worse think used to thinking about ourselves as individuals or thinking about our nuclear families. And that's important because we're all important to our family members, our loved ones, those with whom are connected. But what a pandemic and a big kind of health crisis really thinks about is a whole community, a whole population of people. And so when we think about vaccines, the aim of vaccines always was how do we take care of this group of people and how do we try to make sure that everybody does as best as we can together? Rather than saying, Hey Hilton, you've gotta do this. It doesn't matter what you say or think really is about framing. How do we support one another through this? It's the same thing with wearing a mask that it's not about you don't feel well or you feel fine, it's about everybody else that you're spending your time with.

Speaker 2: 9:50

Yeah. And I know we're not talking about masks, but that brings up a good point. Long before Covid, if you went on the public train in Bangkok, Thailand or in Tokyo, Japan, people would have masks on because the person that wasn't feeling well that day would wear a mask. It's more about the collective good, isn't it? Yeah. Before we get off of Covid, uh, I wanna bring up just uh, maybe some kind of rapid fire questions about the vaccine. People are worried about safety. Is it safe?

Speaker 3: 10:15

I think it is safe. We can never predict who's gonna have what type of complication or what type of reaction. I know what we hear about people are worried about is, gosh, I got the Covid vaccine and I felt terrible. What the vaccine is doing is giving us a test drive our bodies when we're sick with a virus or an infection, we get a fever because if you turn the heat up, that virus can't reproduce. It doesn't like the temperature that hot, we get shaky because again it's like virus living in an earthquake. So all these are things that our body does to create an environment that's not hospitable to this infection growing. When we get a vaccine, especially vaccine like the Covid vaccine, that really turns on that immune response. Your body's practicing for what it would do when you got sick and that's why it happens. It's not the vaccine is making somebody sick, but is your body's practicing? Certainly there are people who have had allergic reactions to a covid vaccine just like we see people who have allergic reactions to any number of other things out there. So there are people who the risk maybe isn't worth the benefit based on their their own medical conditions, but in general I believe they're safe.

Speaker 2: 11:14

Question two, they're made of Mr. mRNA. That's the genetic material. I don't wanna put genetic material in my body, it's changing my dna. True or false?

Speaker 3: 11:22

I dunno if I can give an easy true or false there, but I will say that the new vaccines, so the mRNA vaccines, which are things like the Pfizer and the Moderna co vaccine are not changing your dna. MR. A is something that is part of our bodies. It essentially is given your body the instruction manual without your body having to write it itself. It's saying, Hey, here's the map, here's what you do now you don't have to figure it out on your own. I think the other good news in Covid vaccine is over the last couple months the Novavax vaccine was approved in the US that is built in the the traditional vaccine way. It is not quite as readily available everywhere, but it is available. So if you're interested in a vaccine that fits with all the vaccines you've been getting since you were a kid, talk to your clinic about

Speaker 2: 12:03

That. Thanks Kate. We've been talking about the COVID 19 vaccines with Dr. Kate Hus, internal medicine physician and medical director of the internal medicine clinic here at Hennepin Healthcare in downtown Minneapolis. When we come back we're gonna talk about some more vaccines. So stay with us.

Speaker 1: 12:18

You're listening to the Healthy Matters podcast with Dr. David Hilden. Have a question or a comment for the doctor, become a part of our show by reaching out to us at Healthy Matters at HC m e d.org or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 12:43

And we're back talking to Dr. Kate Hust about vaccines influenza. Dr. Hus, we're back into the fall at least when we're recording this episode and we're back to the flu vaccine. What's the flu story for this season in your crystal ball?

Speaker 3: 12:56

The crystal ball

Speaker 2: 12:58

The last few years have been pretty good, right?

Speaker 3: 12:59

Yeah, so, so it will be very interesting to see what happens this year. The last few years we haven't had big flu seasons largely because we've all been married wearing masks. Yeah,

Speaker 2: 13:07

We haven't come within a mile of each other. Exactly. No one can get

Speaker 3: 13:09

Sick. Exactly. We haven't been around, we haven't kind of been in the mulu of people sharing their germs. We expect that we'll see more flu this year simply because we're all out and about a little bit more the flu vaccine every year, regardless of covid or anything else that's happening in the world, we base in the US on what's happening in the southern hemisphere. They get winter before us, they get flu season before us. So we try to model what's happening here based on what's happening there. Kinda use our best prediction about what's gonna come. That's why we get a new flu shot every year cuz we see which versions of the flu are common someplace else. Try to design our flu vaccine to best protect against those viruses. What we've seen in the Southern hemisphere is that the flu season has started a little bit early in places like Australia. So there's some concern that flu season will start a little bit sooner in the US than does normally. Usually we would see it probably December into winter. There's some thought that it could start as soon as Halloween.

Speaker 2: 13:59

In my experience, people who have not yet had the flu and I've never had the flu in my life, at least I don't think I have, don't realize it hits you like a Mac truck. I've had patients tell me they, they can practically tell me the hour their flu hit. I was fine at breakfast doc and at lunch I couldn't, I was fatigued and coughing and I had a fever. So it comes on kind of rapidly and, and they're miserable. So once they've experienced that once it, it's no, it's no trouble getting them the flu shot next

Speaker 3: 14:26

Year. The nice thing about the flu shot is we have different options. We also kind of think about the flu shot as people age and their risk changes. So individuals who are older, 65 and above, the risk of them having a serious illness from flu is much different than it is for somebody who is 18, 20 40. And so individuals who are 65 plus actually get a slightly different version of the flu shot than the rest of us. Something that has an additional strain and a little bit more potency to help just give that little little bit of extra protection. So it's important to make sure, especially if you're 65 plus that you are getting that correct flu shot for

Speaker 2: 14:56

Your age. That's a great bit of advice. I'm glad you mentioned that. So summarize flu vaccines for us, uh, Kate, if you will, for the, for the people in the back who should get it, when should you get it?

Speaker 3: 15:05

So everybody can get the flu shot. We'd recommend it really starting from infancy and above. If you're 65 plus, you should make sure you're getting an especially designated flu shot that has a little bit better potency to provide extra protection. The flu shot usually becomes available sometime in September and the flu vaccine season really will run through February, sometimes later into the winter. Oftentimes it's okay to wait I would say into October, November because we expect peak flu season to come December and after, and there may be a little bit of protection that wanes over time if you get it first thing in September. But also it's a, it's a personal risk benefit thing. If you have big family activities in the fall, get that flu shot before you're going somewhere where you might be exposed.

Speaker 2: 15:46

Yeah, those are good tips. I've had a lot of people actually say, I'm gonna wait until mid-October to get it and I go, go for it whenever you wanna do it, but just do it in September, October and that's the, that's your timeframe. But even if you didn't get it then India in for some reason get it in November. Get it whenever you can. Exactly. But make sure that you get it. So let's shift to, okay, can I tell you a story, Kate, in my clinic last week, I had a guy that I put three shots in his arms, or I'll be honest, I didn't put the shots in his arms. I, one of the skilled nurses, um, gave him three shots. Uh, but I ordered three shots and two of'em were the ones we've talked about. He got his bivalent covid vaccine and he got his flu shot. He also got the shingle shot. And so, uh, let's talk briefly about that one because that one is one that people they ask a lot about, but also shingles is relatively common, but this isn't usually one of the life threatening things, but it's so common and people do ask about this one a lot. Who should get the shingles shot and why?

Speaker 3: 16:38

So the shingles virus for people who don't really know or aren't sure what shingles is, is that when you're little and you have the chicken pox, the chicken pox virus goes to sleep in one of the nerves in your spine. I

Speaker 2: 16:49

Tell people that and they go, Ew. Yeah.

Speaker 3: 16:51

And later in a period of stress in your life it might wake back up and it gives you a painful rash that goes just in one little line around your body looks like a belt on just one side of the body. But it can happen anywhere. It can be real painful and folks sometimes have that nerve kind of terrible pain for months if not longer after the rash. The shingles vaccine can help prevent against shingles, but what it's actually really good at is decreasing the risk for what we call posturpedic neuralgia or that pain that comes after getting shingles three or four years ago. Now we have a new shingles vaccine called Shingrix. It's two doses and

Speaker 2: 17:26

It it's the one to

Speaker 3: 17:26

Get and it's the one to get. It is better than the prior version at preventing both shingles and those long-term side effects. So if you were vaccinated for shingles in the past, it's worth talking to your doc and see if she would do it again. But the new Shingrix vaccine is indicated for anybody 50 years of age and older. And it's a series of two vaccines. The first one, whenever you get it, the second one at least two months after, you don't have to start over. If you've waited six months or a year, you just get that second shot when

Speaker 2: 17:51

You can. I have seen so many people with posturpedic neuralgia and you just don't want to get it. That is the number one reason I'm glad you said it that way, is you really don't want to get that pain, which can go on for months or even longer, even lifelong in a small subset of people. Um, so that's, uh, the shingle shot, otherwise known as zoster. The vaccine is the Shingrix vaccine. It's a two shot series, second one's two months after the first. Everybody over age 50 should be, uh, getting that one. Let's move to briefly pneumonia. Pneumonia is huge and we don't, we don't talk about pneumonia much. People aren't like deathly afraid of pneumonia. You don't hear people coming in saying, Oh my goodness, I might get pneumonia. And yet tens of thousands, maybe hundreds of thousands of people get pneumonia every year and there are very effective vaccines. Can we talk about that

Speaker 3: 18:39

One? Yeah, of course. And, and this is something that has changed very recently. We've had for several years a vaccine we call Pneumovax or Pneumococcal 23 Valeant that is designed to prevent against 23 strains of the infection that caused pneumonia. We then later had another one called Prevnar or PCV 13 and many individuals received both in a certain sequence depending on which one you got first. We now have a couple new versions that are gonna replace those that if you've had both of those other two pneumonia vaccines, you don't need another one. If you've had only one, you might need another one. But these are newer versions that are again gonna help prevent against the big pneumonia that puts people in the hospital. It again, may not prevent all pneumonia, but it's designed to prevent the big pneumonia that puts you in the hospital with a breathing tube there for weeks and get in real sick.

Speaker 2: 19:25

So to cap this section off Kate, who should get the pneumonia shot?

Speaker 3: 19:29

So if you're age of 65 and above, you should make sure you have all of your pneumonia vaccines updated. If you're younger than age 65 and have other chronic health conditions, talk to your physician or your clinical team and they'll help make sure you have the right vaccines.

Speaker 2: 19:40

Great tips. Okay, now let's go to something that's in the headlines a lot. Monkeypox, should we be worried about that and what's the deal with that vaccine?

Speaker 3: 19:48

So we've been lucky that Monkeypox has not created Covid round two as far as the pandemic and the numbers in most cases are tapering off. There is a vaccine that's available for particular groups of people who are at increased risk to contract monkeypox or for people who have been exposed to someone with Monkey ppo. So it is available, it is not something that everyone needs to get. If you have concerns about your risk to contract monkeypox or that you may have been exposed, talk to your healthcare provider and they'll help connect you to a vaccine if you need

Speaker 2: 20:14

It. Perfect. That wraps that one up nicely. Now before we go, let's do some rapid fire questions about vaccines in general. Ready?

Speaker 3: 20:21

Sounds good. Ready?

Speaker 2: 20:22

Can you get autism from the measles vaccine? No. One down. Question number two, can you get multiple vaccines on the same day?

Speaker 3: 20:31

Yes, you can get many vaccines on one day. There are a few instances of vaccines that we call live vaccines that are made in a slightly different way that you can't always mix, but it is safe to get multiple vaccines at one time and your healthcare team will make sure you're getting the right combination.

Speaker 2: 20:44

Next question. What if I had an allergy or I have allergies to other things? Can I get most vaccines?

Speaker 3: 20:50

Most individuals who have allergies to any number of things can safely get almost all of our vaccines. If you've had particular allergies or reactions with vaccines in the past, it's always good to talk to your clinician about that. Then they can talk about how those things might cross react and if you could have a reaction to the new vaccine.

Speaker 2: 21:04

Last question. Are you getting rich from all these vaccines? Doctor?

Speaker 3: 21:08

I sure am not

Speaker 2: 21:09

Me neither. Well, that about wraps that up. Um, we have been talking with Dr. Kate Hust, internal medicine physician here at Hennepin Healthcare with me in downtown Minneapolis. She is also the medical director of the Internal Medicine Clinic at our downtown clinic and Specialty Center. Dr. Hus had a great deal to do with the early rollout of our clinical cares to people in 2020 during Covid 19. And I know she wouldn't say that, but I do wanna say it. Um, to set up clinics, to test people, to help set up clinics, to get people vaccinated, to get information out to our diverse patient population. Dr. Hus was instrumental in getting a whole new clinical system set up. So I just want to throw that out there. And thank you so much for that,

Speaker 3: 21:52

Kate. Always happy to help answer questions and help people feel better.

Speaker 2: 21:55

Thanks for that. And also thanks for doing this podcast and getting some solid information out about vaccines. Glad to be here. And I want to thank you listeners for joining us on this episode. We've learned a lot about vaccines today. I hope you'll tune into our next episode when we will be talking about breast cancer prevention and treatments with a surgeon who specializes in breast cancer, all in honor of Breast Cancer Awareness Month. It's gonna be a great episode, so please join us and in the meantime, be healthy and be well.

Speaker 1: 22:24

Thanks for listening to the Healthy Matters podcast with Dr. David. Hi. To keep up to date with the latest in healthcare and your health, subscribe to this podcast wherever you get your podcasts. For more information on Healthy Matters or to browse the archive, visit our website@healthymatters.org. And if you have a question or comment for the doctor, email us at Healthy Matters at hc m e d.org org or give us a call at six one two eight seven three talk. To catch all the latest from Dr. Hilden and the Healthy Matters Podcast, follow us on Twitter at Dr. David Hilden. Finally, if you enjoyed this podcast and would like to support us, please leave us a review and share the Healthy Matters Podcast with your friends and family. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered by John Lucas At Highball Executive Producers are Jonathan Kato and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your personal physician if you have more serious or pressing health concerns. Until next time, be healthy and be well.

Speaker 4: 23:32

Sh.