Blog

Posted on

Should I Get the RSV Vaccine?

This article is intended to provide information about the RSV vaccine in adults and factors to consider when thinking about getting the vaccine. For your specific situation, I recommend you consult with a trusted clinician to arrive at a decision tailored to your medical needs.

What is RSV?

RSV stand for Respiratory Syncitial Virus. It is an RNA virus belonging to the Pneumoviridiae family of viruses and one of the pathogens that cause the common cold between October and May in the Northern hemisphere. Most people who contract RSV experience mild cold symptoms: sore throat, runny nose, cough, and congestion.  These are signs of infection in the upper respiratory tract (nose, mouth, and throat).  In certain cases, the virus can migrate to the lower respiratory tract (the trachea or windpipe and lungs) and cause a more serious infection up to and including pneumonia.  Some studies show that RSV can cause death in up to 8% of people 50 and older who are hospitalized with RSV infection.  The CDC notes that RSV causes 6,000 to 10,000 deaths per year in people 65 years and older and an order of magnitude more hospitalizations (60,000 to 160,000 per year) in that age group.  People who suffer from medical conditions like lung disease (i.e. asthma and COPD), heart disease (i.e. congestive heart failure, coronary artery disease), neurological disorders, kidney disease, diabetes, chronic liver disease, blood disorder, and a suppressed immune system have a higher risk of complications with RSV infection.

How is RSV Transmitted?

RSV is transmitted from transferring secretions containing the virus to the nose, mouth, or eyes.  The virus can live on surfaces for several hours, which is why it is important to clean shared surfaces and clean your hands before touching your mouth, eyes, and nose.   The incubation period for RSV is generally four to six days.

The Vaccines

There are two new vaccines approved for prevention of RSV in adults 60 and older: Abrysvo made by Pfizer and Arexvy made by GSK.  Both vaccines are administered as a single dose.  Both vaccines are recombinant vaccines.  A recombinant vaccine is made by engineering an organism, usually bacteria, to produce a protein found in the vaccine’s target pathogen (RSV in this case).  This protein is purified and packaged in a vaccine.  When injected, it triggers the immune system to produce antibodies against the target pathogen.  The main difference between the vaccines is that Arexvy (the GSK vaccine) contains a substance called and adjuvant (AS01E in this case) that primes the immune system to generate antibodies.

Efficacy of the Vaccines

Abrysvo (the Pfizer vaccine) was tested in around 37,000 study participants 60 and older in 7 different countries.  A single dose of the vaccine was studied across two RSV seasons.  During the first RSV season, it was found to prevent lower respiratory tract disease in 88.9% of study participants who received the vaccine. During the second season, this protection dropped to 78.6%.  The combined efficacy of the vaccine across the two seasons was 84.4%.  

Arexvy (the GSK vaccine) was tested in around 25,000 study participants in 17 different countries.  A single dose of the vaccine was studied across two RSV seasons.  During the first RSV season, it was found to prevent lower respiratory tract disease in 82.6% of study participants who received the vaccine.  During the second season, this protection dropped to 56.1%.  The combined efficacy of the vaccine across the two seasons was 74.5%

Side Effects of the Vaccines

With Abrysvo (the Pfizer vaccine), the most common side effects among people who received the vaccine were fatigue (16%), headache (13%), and pain at the injection site (11%).  Reactions severe enough to impair normal activities occurred in 1% of people who received the vaccine.  Three people who received the vaccine reported serious inflammatory neurological conditions including Guillain-Barré syndrome.  People who received the vaccine also reported more instances of atrial fibrillation (a form of abnormal heartbeat).

With Arexvy (the GSK vaccine), the most common side effects among people who received the vaccine were pain at injection site (61%), fatigue (34%), muscle pain (29%), and headache (27%).  Reactions severe enough to impair normal activities occurred in 4% of vaccine recipients.  Three people who received the vaccine reported serious inflammatory neurological conditions including Guillain-Barré syndrome and encephalomyelitis (inflammation in brain tissue).  People who received the vaccine also reported more instances of atrial fibrillation (a form of abnormal heartbeat).

Posted on

The World of Weight Loss Medications

.

The quest for effective weight loss solutions is an ongoing journey for millions of people worldwide. As obesity rates continue to rise, there is a growing demand for safe and effective weight loss medications. While a balanced diet and regular exercise are the cornerstones of any weight loss journey, some people may require additional support to achieve their goals. This article will delve into the world of weight loss medications, providing an overview of their effectiveness, safety, and types available on the market.

Obesity is a complex, multifactorial condition that can significantly impact an individual’s quality of life and increase the risk of various health complications, including type 2 diabetes, cardiovascular diseases, and certain types of cancer, like colon cancer.  For some individuals, lifestyle modifications alone may not be enough to achieve significant weight loss. In such cases, weight loss medications may be needed as a supplementary tool to assist in achieving and maintaining a healthy weight.

Weight loss medications work through various mechanisms, targeting different aspects of the weight regulation process. The most common types of weight loss medications include GLP-1 (glucagon like peptide 1) agonists, appetite suppressants, and fat absorption inhibitors.

We will start with a discussion of GLP-1 inhibitors as these medications have garnered a lot of media attention recently (i.e. Ozempic, Saxenda, Wegovy).  These medications are related to a class of hormones called incretins.  Incretins are released from the gastrointestinal tract after a meal and, among other things, cause a sense of satiety (fullness), making individuals who take them feel less hungry.  A similar medication, Mounjaro, is undergoing FDA approval for use in weight loss.  They are administered as weekly or daily injections.  Generally, people taking these medications can expect a 5-15% weight loss.  They can cause gastrointestinal side effects like nausea, vomiting, and diarrhea.  The medication is started at a low dose and gradually increased while monitoring for side effects.  In rare cases the medications can cause serious side effects like pancreatitis, which is inflammation of the pancreas.  Cancers have developed in some animal studies, though the significance of this for humans is unknown.  Cost can be a factor with these medications.

Appetite suppressants help to reduce hunger and promote satiety by acting on neurotransmitters in the brain.  Some medications in this class are sympathomimetic drugs that activate the “fight or flight” nervous system response and suppress appetite in this manner.  Examples include phentermine (Adipex-P) and diethylpropion (Tenuate).  These are controlled substances, as they can cause dependence in some people.  They are administered as oral pills usually taken once a day.  There is a combination pill (Qysmia) that adds topiramate (an antiseizure medication) to phentermine and can achieve an 8-10% weight loss.  Another medication in this category is Contrave, which is not a controlled substance.  Contrave combines bupropion (a dopamine reuptake inhibitor) and naltrexone (an opioid receptor antagonist).  This medication is thought to control cravings by acting on the dopamine areas in the midbrain.  It has been shown to produce around a 5% weight loss.  Generally, this class of medication can cause high blood pressure, constipation, and nervousness.  They are not ideal for people with cardiovascular disease or anxiety.

Fat absorption inhibitors block the absorption of fat in the digestive tract.  Orlistat (Xenical, Alli) is the most well-known example of this type of medication.  It works by inhibiting the enzymes that breakdown fat in the digestive track.  Fat that is not broken down cannot be digested and is excreted in stool.  This leads to lower amounts of fat and hence calories entering the body.  The medication is an oral pill and people taking it have lost about 8% of baseline weight.  Side effects of the medication include diarrhea, abdominal cramping, gas, and incontinence of stool.  More serious reported side effects including liver injury and kidney stones.

Weight loss medications are not a “magic pill” or a one-size-fits-all solution. They should be used as part of a comprehensive weight management plan that includes a balanced diet, regular physical activity, and behavior modification. These medications can provide additional support for individuals struggling to lose weight through lifestyle changes alone, but they are not a substitute for a healthy lifestyle.  As always, it is important to consult with a trusted clinician before undertaking treatment with any of these medications.