San Antonio Express-News (Sunday)
Questions about COVID vaccines answered
Q: Can you tell me why the Johnson & Johnson vaccinations only requires one shot to be considered fully vaccinated as opposed to the others that require two shots? I understand some vaccinations require a booster shot. But usually it’s months or a year or two before the second one is required, if I remember giving my kids their vaccinations and the scheduling requirements. And no, I’m not vaccinated yet. I have trouble with things that are being shoved down my throat, requiring me to sign off on my rights, as this obviously hasn’t been put through normal tests. I didn’t have to sign off on any vaccinations for all three of my children, so I’m not sure why they’re expecting me to sign off on these ones — other than the fact that they’ve been rushed and the manufacturing companies don’t want to be liable for the mistakes that they’ve possibly made.
A: Many vaccines require multiple doses. Maybe you’ve forgotten, but hepatitis B is three shots; DTaP is five shots; polio is four shots for the primary sequence. Our immune system is very good, but repeated exposure to a germ helps our immune system learn how to fight off invaders.
The Johnson & Johnson vaccine uses a viral vector technology, different from the Moderna or Pfizer vaccines, which use mRNA. All three of those vaccines are effective at preventing serious illness and death from COVID-19. Early data from the Johnson & Johnson vaccine showed very high effectiveness after one dose. However, data presented in October showed that giving a booster shot after the Johnson & Johnson vaccine dramatically improved the immune response. Giving a second dose of Johnson & Johnson increased the neutralizing antibody level in the blood more than fourfold. However, giving a booster dose of the Moderna vaccine to people who had a single dose of the Johnson & Johnson vaccine increased the neutralizing antibodies by 75fold.
I do understand that nobody likes to be forced to get a medical procedure done, especially one, like COVID-19 vaccines, that has not been around a long time. There are some important reasons
why you should still get it. The most important is that COVID-19 has killed over 5 million people worldwide as of this writing, including almost 750,000 in the U.S. and almost 30,000 in Canada. You really want protection from this deadly disease.
I’d also say that nobody is forcing you to get the vaccine (since you haven’t had it). However, businesses have the right to refuse you if you aren’t vaccinated, just like schools don’t allow children to enroll who don’t have their vaccines up to date. You certainly had to agree to your children getting vaccinated. You don’t give up your rights when being vaccinated. The National Vaccine Compensation Program and Countermeasures Injury Compensation Program provide benefits in the unlikely event of injuries caused by covered vaccines in the United States.
I’m also going to disagree that the process has been rushed in such a way that mistakes are likely. It is true that the vaccines were approved faster than any other vaccine in history, but that corresponds to the normal testing being done more quickly than in previous vaccines. Truly enormous resources were put into the development and testing of these vaccines. More than 7 billion doses have now been given out, and the safety of the vaccine is very high. Serious side effects include allergic reactions, blood clotting problems and myocarditis (inflammation of heart muscle). The likelihood of a severe reaction is less than 1 in 10,000.
Q: I am an active 76-year-old man. I became aware of an increase in my resting heart rate in April 2021, going from a resting rate of 48 to 74 beats per minute in a six-day period. It is persistent. This led me to a cardiologist who diagnosed me with atrial fibrillation three weeks ago. I bruise and bleed easily, and do not want to take more blood thinners. I had a CHA2DS2-VASc score of 2. Both my cardiologist and electrophysiologist confirmed there is a 2.2 percent to 2.5 percent chance of stroke from nonvalvular-related AFib with a 1 percent chance of stroke even if taking blood thinners. Both immediately recommended Xarelto, Eliquis or at a minimum an aspirin a day. My math tells me that taking blood thinners provides a 1.2 percent to 1.5
percent benefit in preventing a stroke. Do you concur with that assessment? Isn’t that a low-risk number for the negative side effects blood thinners produce in me?
Currently I am taking metoprolol. My resting heart has come from 74 bpm down to 67.
I do not want to take any blood thinners. I am leaning toward having a WATCHMAN device implanted and trying Tikosyn to see if it can return me to sinus rhythm.
A:
Atrial fibrillation is a common problem in which the natural rhythm of the heart is disturbed. The heart rate often increases, and people are at higher risk for a stroke. Treatment is designed to bring the heart rate to near-normal and to reduce stroke risk. The metoprolol has accomplished the first part. Dofetilide (Tikosyn) is an anti-arrhythmic.
The CHA2DS2-VASc score is a way of classifying risk of stroke. The numbers you quote come directly from the study, but it’s important to recognize that these are the risks of a stroke every year. In the next 10 years, that’s something like a 22 percent to 25 percent risk of stroke with no medication versus a 10 percent risk on anticoagulant medication. If you have ever seen a person with a severe stroke, I think you would not be so quick to dismiss the risk. There is a risk of taking the medication: worsening of your easy bleeding and bruising. For people who do not want to take an anticoagulant, the WATCHMAN device is a reasonable alternative.
The WATCHMAN device (or the newer-generation WATCHMAN FLX device) is designed to block the part of the heart where most blood clots come from, called the left atrial appendage. The most recent data suggests that the benefit from the WATCHMAN device in preventing stroke is similar to anticoagulation. However, a study just released in October suggested that lower-dose anticoagulation even after WATCHMAN placement reduced the risk of adverse outcomes, including stroke, bleeding and clotting in the device.
Q: A recent column on urinary tract infections did not mention cranberry juice. I used to have this painful problem, but not anymore. What cured me was replacing my daily orange juice with cranberry juice. I hope this can help others with this problem.
A: Some studies have shown a benefit in reduction of urine infections by drinking cranberry juice or by taking cranberry capsules. Cranberries contain a substance that blocks bacteria from sticking to the wall of the bladder. However, systemic reviews of all the available studies have concluded that there isn’t strong enough evidence to recommend cranberry juice for prevention of urine infections. Even so, I have had patients like you who have had relief. The only downside is that most cranberry juices have a fair amount of sugar; otherwise, cranberry juice is safe.