Are vaccines the light at the end of the tunnel?

[TeeRick]

15 hours ago, markeb said:

 

Interesting question, honestly. Almost certainly the sequences are slightly different between the candidates, and almost certainly not to a point you'd expect any differences. I'm sure they've done every possible 21st century measurement of protein structure and conformation, and everything predicted a good to great conformation match between the fragment to the wild type protein. Maybe the segment folds differently in the body than in the lab? Maybe the virus actually undergoes a conformation change as it binds to the cell, and the others got lucky in a better match? Maybe the mRNA vaccines and the human adeno vector express a more appropriate (more or less?) amount of antigen? Or maybe Oxford snipped in exactly the wrong place for this variant that they couldn't have predicted?

 

Great time to be a molecular virologist/immunologist because this will give you something to study for awhile, and there might even be grants to fund it! Maybe not so great if you're actually trying to make a vaccine...

The mRNA vaccines were studied early mostly in the populations they were designed to treat.  I would bet now that their efficacy would not be 95% today in populations dealing with variants surging like S Africa.  Probably similar to the efficacy of the J&J vaccine in South Africa.  But the mRNA vaccine makers are already working on a S.Africa variant vaccine.  Not sure if they could do a head-to-head comparison  of original versus variant vaccine there.   But possibly prime-boost using original + variant.  In the future the mRNA vaccines would be perfect for mix and match (combination vaccines) using the mRNA's for multiple strains in the same shot.   A good example of multiple-strain vaccines (although bacterial) mixed in the same vial is Prevnar-13 (which was originally Prevnar-7).  Pfizer is already developing Prevnar-20.  These are all made as single types and blended together in the same vial.  Quite complicated to manufacture.  A blended mRNA approach for COVID would be much easier.

[AC Stew]

We received our 2nd Moderna jabs on February 02. I wouldn't dream of interjecting opinions on the science, but I'm reading here about taking OTC meds to help with vaccine after-effects.

 

Our experience: While in the waiting area (post vaccination), we were all briefed about the "possibility" of a more pronounced body response to this second vaccination. We were advised to avoid Tylenol (etc.) and just try to power through the discomfort. The nurse explained that those pain meds could "dilute" the immune response we want from the vaccine. Made sense to this layperson!

 

Yes, we got the fever, chills, headache, fatigue ... gone in a couple of days. Oh, and we were also advised to pass on the 5:00 PM glass of vino, for at least a couple of days. That hurt more than the shot!

[cangelmd]

34 minutes ago, TeeRick said:

I agree.  I don't see how taking ibuprofen before the shot will matter much.  Post-injection it takes several days to ramp up antigen expression and present it to the immune system.  And pre-treatment by taking an OTC anti-inflammatory drug will not down-regulate the immune response for days after.  The timing does not make any sense.  And for those with natural viral and bacterial infections of most types don't they recommend aspirin, Tylenol or ibuprofen to treat fever, aches and pains while your immune system is fighting these infections?

Exactly, but the CDC is a very conservative body, making recommendations for millions of people with millions of different situations. I pre-medicated, but recommended to my family to only post-medicate for symptoms. Despite taking q 6 hour anti-inflammatories, I woke up in the middle of the night after my second shot as soon as the meds wore off - my arm was very tender and I basically rolled over onto it and immediately woke up. I had a rather mild, but definite systemic reaction - all over body aches and a slight temperature rise - about 12 hours after that. I know of someone ( female, late 40s) who had temps to 103 and missed 2 days of work (OB-GYN who would not have been out unless truly incapacitated), so marked reactions do happen, but those are uncommon - out of 400ish physicians, NPs and PAs of varying ages closely affliated with my hospital, that is the only truly severe reaction I have heard reported, most people had the "achies" and it wore off quickly.

 

13 minutes ago, AC Stew said:

We received our 2nd Moderna jabs on February 02. I wouldn't dream of interjecting opinions on the science, but I'm reading here about taking OTC meds to help with vaccine after-effects.

 

Our experience: While in the waiting area (post vaccination), we were all briefed about the "possibility" of a more pronounced body response to this second vaccination. We were advised to avoid Tylenol (etc.) and just try to power through the discomfort. The nurse explained that those pain meds could "dilute" the immune response we want from the vaccine. Made sense to this layperson!

 

Yes, we got the fever, chills, headache, fatigue ... gone in a couple of days. Oh, and we were also advised to pass on the 5:00 PM glass of vino, for at least a couple of days. That hurt more than the shot!

Yeah, that has changed since December/early January. I don't know that there is any solid science yet behind either approach. My bias is that a fever of 103 needs fever reduction to allow rest and healing, but I might try to power through lesser symptoms. Naps, naps are good.

[TeeRick]

37 minutes ago, cangelmd said:

Naps, naps are good.

I use this advice pretty much every afternoon!  Thanks for your medical opinion here!😀

[biguntx]

I'm no expert on immunology but I can't wait for my vaccination on Thursday!

 

I also feel very fortunate.

[UnorigionalName]

2 hours ago, TeeRick said:

I agree.  I don't see how taking ibuprofen before the shot will matter much.  Post-injection it takes several days to ramp up antigen expression and present it to the immune system.  And pre-treatment by taking an OTC anti-inflammatory drug will not down-regulate the immune response for days after.  The timing does not make any sense.  And for those with natural viral and bacterial infections of most types don't they recommend aspirin, Tylenol or ibuprofen to treat fever, aches and pains while your immune system is fighting these infections?

 

NSAIDS are anti-inflammatories and hence blunt the immune response.  The goal of pre-medicating is blunting the day after side effects.  While the serum antibody levels don't begin rising for a while, the important b and t cell activation stages occur in the first few days, hence the symptoms.

 

It's a difficult issue because there's not that many studies done, because honestly there wasn't much interest before.  Again, I am not an immunologist or virologist, and this is not my area of expertise, so take this with a grain of salt and skepticism and not as advice:

 

To my understanding, there is data in the pediatric literature that shows pre-medicating with NSAIDS decreases the end result serum neutralizing antibody concentration.

 

However, there is also data in the pediatric literature that shows that pre-medicating with NSAIDS has no significant effect on efficacy of select vaccines.

 

Also the clinical trials (pfizer/moderna) did not routinely pre-medicate, but they did not screen for NSAID use before or after the vaccine (I am unsure if they gave any guidance, maybe one of the members who participated in the trial can elucidate this point).

 

So hence the CDC guidance makes sense: Don't pre-medicate. Don't feel guilty about it afterwards if you are miserable. If you are taking NSAIDS for another condition, don't stop.

[TeeRick]

1 hour ago, UnorigionalName said:

 

NSAIDS are anti-inflammatories and hence blunt the immune response.  The goal of pre-medicating is blunting the day after side effects.  While the serum antibody levels don't begin rising for a while, the important b and t cell activation stages occur in the first few days, hence the symptoms.

 

It's a difficult issue because there's not that many studies done, because honestly there wasn't much interest before.  Again, I am not an immunologist or virologist, and this is not my area of expertise, so take this with a grain of salt and skepticism and not as advice:

 

To my understanding, there is data in the pediatric literature that shows pre-medicating with NSAIDS decreases the end result serum neutralizing antibody concentration.

 

However, there is also data in the pediatric literature that shows that pre-medicating with NSAIDS has no significant effect on efficacy of select vaccines.

 

Also the clinical trials (pfizer/moderna) did not routinely pre-medicate, but they did not screen for NSAID use before or after the vaccine (I am unsure if they gave any guidance, maybe one of the members who participated in the trial can elucidate this point).

 

So hence the CDC guidance makes sense: Don't pre-medicate. Don't feel guilty about it afterwards if you are miserable. If you are taking NSAIDS for another condition, don't stop.

 

Yes we discussed previously here on this thread post#2570 on Jan 28th. 

I do not ever remember guidance on pre-medicating (or not) with other vaccines.  I know that certain medical societies and organizations have cautioned about steroids in certain compromised patient groups,  but not OTC anti-inflammatories.  The post I refer to has the link to the CDC language.

[mdcelebrity]

2 hours ago, UnorigionalName said:

 

NSAIDS are anti-inflammatories and hence blunt the immune response.  The goal of pre-medicating is blunting the day after side effects.  While the serum antibody levels don't begin rising for a while, the important b and t cell activation stages occur in the first few days, hence the symptoms.

 

It's a difficult issue because there's not that many studies done, because honestly there wasn't much interest before.  Again, I am not an immunologist or virologist, and this is not my area of expertise, so take this with a grain of salt and skepticism and not as advice:

 

To my understanding, there is data in the pediatric literature that shows pre-medicating with NSAIDS decreases the end result serum neutralizing antibody concentration.

 

However, there is also data in the pediatric literature that shows that pre-medicating with NSAIDS has no significant effect on efficacy of select vaccines.

 

Also the clinical trials (pfizer/moderna) did not routinely pre-medicate, but they did not screen for NSAID use before or after the vaccine (I am unsure if they gave any guidance, maybe one of the members who participated in the trial can elucidate this point).

 

So hence the CDC guidance makes sense: Don't pre-medicate. Don't feel guilty about it afterwards if you are miserable. If you are taking NSAIDS for another condition, don't stop.

Tylenol is not an NSAID.  Do those of you who know about this stuff think Tylenol would be okay if symptoms occur?

[TeeRick]

10 minutes ago, mdcelebrity said:

Tylenol is not an NSAID.  Do those of you who know about this stuff think Tylenol would be okay if symptoms occur?

Here is the CDC language which includes acetaminophen too.

From the CDC:

Antipyretic or analgesic medications (e.g., acetaminophen, non-steroidal anti-inflammatory drugs) may be taken for the treatment of post-vaccination local or systemic symptoms, if medically appropriate. However, routine prophylactic administration of these medications for the purpose of preventing post-vaccination symptoms is not currently recommended, as information on the impact of such use on mRNA COVID-19 vaccine-induced antibody responses is not available at this time.

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

[Arizona Wildcat]

4 hours ago, TeeRick said:

I use this advice pretty much every afternoon!  Thanks for your medical opinion here!😀

2nd dose coming up in 10 days.  Think my regular lunchtime routine should work fine 

#1 1/2 sandwich with a few chips and fruit

#2 1 bottle dark beer - preferably porter

#3 recline with a good book and enjoy beer

#4 finish my beer after my nap

[cruise kitty]

during the blinded phase of the Pfizer trial, our site did not make any recommendations about pre or post acetaminophen or ibuprofen, however, for my unblinded  crossover phase vaccine last week they recommended no pre shot meds, & to avoid post meds for 2 days if possible...  Had a post tax call from the study lead Nurse last night, & she was quite pleased I had powered through the immune reactions without taking anything (except wine, of course :) )

[larry_s_taco]

2 hours ago, TeeRick said:

 

Yes we discussed previously here on this thread post#2570 on Jan 28th. 

I do not ever remember guidance on pre-medicating (or not) with other vaccines.  I know that certain medical societies and organizations have cautioned about steroids in certain compromised patient groups,  but not OTC anti-inflammatories.  The post I refer to has the link to the CDC language.

Tee Rick, what do you think about anti-inflammatory effect of daily 81mg ASA? I can't  imagine that it would have any effect on traditional vaccines, but the mRNA is so new I'm just throwing it out there. 

[markeb]

1 hour ago, larry_s_taco said:

Tee Rick, what do you think about anti-inflammatory effect of daily 81mg ASA? I can't  imagine that it would have any effect on traditional vaccines, but the mRNA is so new I'm just throwing it out there. 

 

Neither he nor I are physicians. What I can tell you is my physician told me in reference to a steroid, which would be much more anti-inflammatory, was they were recommending their patients continue. But the steroid is a key component of my treatment. Some groups (chronic pain management, for instance) are suggesting a temporarily cessation of steroids, but I've not seen anything on suspending any NSAIDS. Hopefully cangelmd can pitch in with what they're doing. And low dose aspirin is used in part because it doesn't suppress the "good" activities in the GI tract but does slightly suppress coagulation.

[phoenix_dream]

I am not a physician either, nor any type of medical professional for that matter.  I'm just a person that generally is considered sensible by those who know me.  I think the bottom line is - right now they just do not know the impact of these medications, either pre or post.  So the most logical recommendation is to avoid them.  Taking them ahead of time really makes little sense anyway, so that should be easy to avoid.  Taking them after I think should be a discussion between a patient and his/her physician and should likely depend on what side effects are experienced.  If I have a low grade fever, some mild body aches - I will certainly tough it out.  If I end up with a 103 degree temp like someone mentioned, I think I would check in with my doctor about taking at least a low does of ibuprofen or something similar.  I will find out next Wednesday -when I get shot #2 of Pfizer.   i was lucky to finally find a vaccine, even though due to the insane way my state is handling things I have to drive 2 1/2 hours to go get it.  Worth every mile IMHO.

[cangelmd]

5 hours ago, Arizona Wildcat said:

2nd dose coming up in 10 days.  Think my regular lunchtime routine should work fine 

#1 1/2 sandwich with a few chips and fruit

#2 1 bottle dark beer - preferably porter

#3 recline with a good book and enjoy beer

#4 finish my beer after my nap

I recommend a nap both before and after lunch 😉.

I also took a warm relaxing bath, but YMMV

[cangelmd]

2 hours ago, markeb said:

 

Neither he nor I are physicians. What I can tell you is my physician told me in reference to a steroid, which would be much more anti-inflammatory, was they were recommending their patients continue. But the steroid is a key component of my treatment. Some groups (chronic pain management, for instance) are suggesting a temporarily cessation of steroids, but I've not seen anything on suspending any NSAIDS. Hopefully cangelmd can pitch in with what they're doing. And low dose aspirin is used in part because it doesn't suppress the "good" activities in the GI tract but does slightly suppress coagulation.

First of all, anyone on chronic steroid therapy should never alter the dosage of their steroid therapy without consultation with their physician. Abruptly stopping or even reducing corticosteroid treatment can have life threatening consequences. Not stuff to fool around with talking to me on the inter webs, please.

Anyone who is on chronic immunosuppressive therapy of any sort should consult with their provider about how to proceed. Those I know want their patients to get vaccinated safely and effectively, some MDs who see lots of complicated, immunosuppressed patients (oncologist, rheumatologists) may already have some general guidance for patients on their websites. 

Anything else I could say would be speculative and unhelpful. Ask your doc how to proceed, and if you get a green light for the vaccine, get vaccinated as soon as you can!

[markeb]

2 minutes ago, cangelmd said:

First of all, anyone on chronic steroid therapy should never alter the dosage of their steroid therapy without consultation with their physician. Abruptly stopping or even reducing corticosteroid treatment can have life threatening consequences. Not stuff to fool around with talking to me on the inter webs, please.

Anyone who is on chronic immunosuppressive therapy of any sort should consult with their provider about how to proceed. Those I know want their patients to get vaccinated safely and effectively, some MDs who see lots of complicated, immunosuppressed patients (oncologist, rheumatologists) may already have some general guidance for patients on their websites. 

Anything else I could say would be speculative and unhelpful. Ask your doc how to proceed, and if you get a green light for the vaccine, get vaccinated as soon as you can!

He’s recommended getting the vaccine and driving on with the treatment. And absolutely consult your own physician is the best advice. 
 

Actually meant it to be an example, but somehow left out the fact they recommended I get vaccinated as soon as possible. But I also had a steroid dose yesterday afternoon, and you can guess how I slept last night...

[LGW59]

1 minute ago, markeb said:

He’s recommended getting the vaccine and driving on with the treatment. And absolutely consult your own physician is the best advice. 
 

Actually meant it to be an example, but somehow left out the fact they recommended I get vaccinated as soon as possible. But I also had a steroid dose yesterday afternoon, and you can guess how I slept last night...

and perhaps it was that good glass(es) of scotch you enjoyed as well 🙂

[LGW59]

Just now, LGW59 said:

and perhaps it was that good glass(es) of scotch you enjoyed as well 🙂

Going to enjoy a good night cap(s) of Angels Envy now myself

[cangelmd]

10 minutes ago, markeb said:

He’s recommended getting the vaccine and driving on with the treatment. And absolutely consult your own physician is the best advice. 
 

Actually meant it to be an example, but somehow left out the fact they recommended I get vaccinated as soon as possible. But I also had a steroid dose yesterday afternoon, and you can guess how I slept last night...

I’ve had burst steroids a couple of times over the years, once a shoulder injection

Orthopedist: this won’t get absorbed outside the joint capsule, you won’t even know it”

Me - I feel like Mrs Hyde on a bender, haven’t slept for a week and my shoulder still hurts!

The other memorable time was a shot of Decadron after a ver nasty case of hives caused by contrast. That didn’t particularly keep me awake because I hadn’t slept in 2days from the itching!

[nocl]

Here is a paper that looked at several studies that some of you might find interesting

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027726/

[TeeRick]

9 hours ago, nocl said:

Here is a paper that looked at several studies that some of you might find interesting

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027726/

Thank you.  A very good review on the topic.

[TeeRick]

Here is a nicely written general article from The Atlantic on COVID vaccines and the important topic of herd immunity and it also covers variant strains.  A nice general read.

https://www.theatlantic.com/health/archive/2021/02/herd-immunity-might-be-impossible-even-vaccines/617973/

[TeeRick]

17 hours ago, larry_s_taco said:

Tee Rick, what do you think about anti-inflammatory effect of daily 81mg ASA? I can't  imagine that it would have any effect on traditional vaccines, but the mRNA is so new I'm just throwing it out there. 

I will defer this discussion to you and your doctor as everybody has recommended.  But I will say that the COVID mRNA vaccines, although new, are not really the primary issue.  Rather it is related to the general question of taking any antipyretic or analgesic medications like ibuprofen, aspirin, acetaminophen, etc.  prior to a vaccination.

[Ken the cruiser]

Just curious, but could the applicable Lilly antibody treatment(s) mentioned in this below article be used by shipboard doctors if someone tests positive for COVID while on the cruise? IAW if (1) you are required to have a vaccine before boarding and then (2) subsequently test positive while on the cruise, would this be an acceptable form of treatment? If so, wouldn't these two factors go a long way to making it safe to start cruising again?

 

Lilly Covid Antibody Combo Gets U.S. Emergency Authorization (msn.com)