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Infectious disease consult: Vaccine Q and A

Alwyn Rapose, MD, FACP, FIDSA, Reliant Medical Group

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Founded in 1929 by Dr. Michael Fallon, and having become a part of Optum in April 2018, Reliant Medical Group was the first group medical practice established in Central Massachusetts.

Reliant Medical Group has over 500 providers and care for over 320,000 patients, offering a full range of primary care and over 30 different specialties from podiatry to vascular surgery.

In addition to primary and specialty care for children and adults, we also provide an array of convenient ancillary services including comprehensive radiology services, eye services, same-day care for urgent needs, diabetic and nutritional counseling, and much more.

Reliant Medical Group consistently delivers clinical outcomes that meet or exceed national standards. Our entire healthcare team is committed to ensuring our patients receive the right care, in the right place at the right time.

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As part of the Reliant Medical Group, Alwyn Rapose, MD, FACP, FIDSA, is one of three specialists in infectious diseases.

Consulting on patients both in-hospital and in the out-patient settings, he spent time informing practice with the best available science as it relates to antibiotic resistant infections, HIV/AIDS, pneumonia, meningitis and other common and less commonly seen diseases.

However, the COVID-19 pandemic of 2020 has brought a flood of new queries.

As we move into the fall of 2020, Alwyn Rapose, MD, FACP, FIDSA, offers his advice on some of the most pressing infectious diseases issues facing the health care community.

Question 1: How do you recommend providers encourage patients to get this year’s Influenza vaccine?

Limiting diseases of any kind, particularly respiratory viruses like the Influenza virus for which a vaccine is available, should be an important goal for clinicians and patients this year.

The way we as clinicians speak with patients about their choice to get the vaccine matters: Young, healthy patients may feel the flu vaccine is not necessary for them.

Helping your patients see themselves as members of a community coming in close contact with family and friends who might not be as healthy, recognizing their potential to protect a wide circle, including their loved ones, will encourage these healthy folks the opportunity to contribute to community health by taking the flu vaccine themselves.

Question 2: When should patients be getting their flu vaccine?

According to the US Centers for Disease Control and Prevention (CDC), influenza antibodies to the specific strains included in the vaccine develop over the course of a couple of weeks.

Hence patients should be advised to get their flu shot prior to widespread flu activity in their community. That said, the flu shot when given in September 2020 may not confer immunity through the end of the flu season – say March or April 2021.

The smartest bet is to give patients their flu shot when the local health department reports onset of flu season. A caveat to this rule is if you have a patient who you only see once or twice a year, offer the Flu vaccine while you have the patient in the office.

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Question 3: What quality information can I share with my patients about the COVID-19 vaccine?

There are a lot of unanswered questions with regards COVID-19 disease, its treatment and the vaccines that are in development. This is a completely new virus and scientists all over the world are doing their very best to understand and manage this new disease.

I believe that a doctor-patient relationship based on honesty, openness and trust allows for the reality - that we as doctors and scientists are human - is a necessary foundation for the discussion of any medical condition or intervention.

This is even more important today as we work with patients through this COVID-19 pandemic. Similar to counseling on the Influenza vaccine, where the past few years’ less-than-stellar efficacy left many patients saying “not worth my time,” for this year’s flu shot and as COVID-19 vaccines become available, we will do best for our patients by leveling with them.

We need to explain why efficacy of even 50% is not super on an individual basis but will go a long way to reducing overall spread of the Flu in the community. We are hoping that this season’s Flu vaccine and the anticipated COVID-19 vaccines will be much more efficient than that.

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Living your recommendation also goes a long way. When there is trust in the patient-doctor relationship, me as the physician having taken the vaccine myself, is a powerful motivator to my patient to consider the same.

In my estimation, the trust in the relationship with your patients will ease - to a considerable extent - the reality of the uncertainty regarding the COVID-19 vaccine.

Based on our experience in watching the progress of the pandemic, the understanding and implementation of prevention strategies, the development of COVID-19 therapeutics, it will not be surprising when there are many unanswered questions regarding the COVID-19 vaccines.

For patients and physicians who are curious about how the next chapter in this pandemic will unfold, I would point to the experiences of the past nine months with regards to protective equipment, public health measures and therapeutics.

It has been a challenging virus. Nonetheless, we have seen continuous improvement.

Question 4: How do I know I have the best quality information?

As physicians, we need to be rigorous in reading published literature with critical thinking, understanding their strengths and weaknesses and evaluating the validity of various studies.

When we speak to patients about potential therapeutics or vaccines, it is important to do so with that temperance. Our patients are more capable of understanding nuance that perhaps we give them credit.

Question 5: What about patients who are hesitant to come back to the clinic due to the pandemic?

I can only speak authoritatively for the Reliant Medical Group, but I believe that the doctor’s office is one of the safest places to be.

With our daily health checks, cleaning, masking and the limiting of gathering places like waiting rooms, we’ve followed best evidence to prevent spread of disease and hence have reduced the risk of contracting the disease in the doctor’s office. Reaching out to tell patients about our changes is key to regaining trust.

Question 6: What other communicable diseases are a concern currently?

While amid dealing with the current COVID-19 pandemic, it is important to stay vigilant about routine vaccinations that prevent other infectious diseases with potential for outbreaks in the community.

Children should keep to their pediatric vaccination schedule. Adults require boosters in the form of Tetanus, Diphtheria, Pertussis (TdaP), measles, mumps, rubella (MMR) and others which may be specific to the patient’s condition, age, lifestyle and travel. The CDC vaccination charts provide a helpful guide.

Keeping patients on track with all the protection we can afford them, is time and effort well spent. Outbreaks of preventable disease continue to threaten our communities.

In the case of all these diseases, the old adage is truer and more urgent than ever: An ounce of prevention is worth a pound of cure.

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This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice. 
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