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Vaccinations

Photo from Deposit Photos

By Daniel Dunaief

In a nod to the herd immunity from a combination of illnesses and vaccinations in the population, the Centers for Disease Control and Prevention is widely expected to reduce the recommended number of days of isolation after a positive test to one day from five days.

Even as most of the population has returned to a normal life after the pandemic — toughing through colds with relatively mild symptoms at work and staying home, for the most part, when symptoms become severe — the CDC had urged Americans to remain isolated for five days.

“Covid has diminished as a real threat for the majority of people,” said Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “The responsiveness between vaccinations and multiple events [such as infections] is reasonable to prevent hospitalization and death in most people.”

In addition, Covid treatments, such as Pfizer’s Paxlovid, have become effective in reducing the severity and duration of symptoms.

The CDC likely couldn’t have provided such guidance a year ago, but, for most people, the consequence of contracting the virus that altered the course of life for people for several years, has been less problematic for their health, doctors said.

Despite ongoing illnesses and symptoms, people have become less likely to test for Covid.

“Insurance companies used to pay for eight per month, but now, people just buy one [test box] at a time,” said Michael DeAngelis, the owner of Village Chemist in Setauket.

Dr. Sunil Dhuper, chief medical officer at Port Jefferson’s St. Charles Hospital, understood the CDC’s decision, with an important warning.

“The rationale behind changing the timing of isolation guidelines is based on looking at the evolving severity of cases,” Dhuper said.

“People who are younger get more mild levels of illness and recover,” he added.

Concerns for the elderly

“The disease is beginning to behave more and more like other respiratory viruses, but we are not there yet,” Dr. Dhuper cautioned, particularly for those who are over 65.

Hospitalization for people who contract Covid is 11.2 per 100,000 for people over 65, compared with 6.9 per 100,000 in the week ending Feb. 10, according to data from the Centers for Disease Control and Prevention. 

The mortality for those over 65 from Covid is higher than for the flu, Dr. Dhuper said.

“We have to be a little cautious, sending a message to the community that you can continue to do what you want to do,” Dr. Dhuper said. “When they are around the elderly” people, particularly those who might have symptoms even if they haven’t been tested, should consider wearing masks or keeping their distance.

The incidence of Covid, among other illnesses, climbed after the December holidays and the start of 2024, as people traveled to visit with family or on vacations. Those numbers have come down, although the upcoming spring break from secondary schools and colleges raises the possibility that illnesses could climb again, doctors predicted.

Be careful of grandkids

While the public may not want to hear it, Dr. Dhuper expected that it might take another five years before Covid reaches a comparable level of potential risk to the elderly as the flu, which could also present a risk to people’s health.

Dr. Dhuper urged those who have symptoms to test themselves for Covid. Even if they don’t isolate themselves for more than 24 hours, they should be cautious around vulnerable groups.

Dr. Dhuper’s advice to grandparents is to “be careful when you’re around your grandkids, because they are like petri dishes, harboring tons of infections.”

While for many people in the community, Covid has become like white noise, it’s still causing medical problems and leading to some hospitalizations, the St. Charles doctor added.

Any change in isolation guidance from the CDC should come with an asterisk that “yes, we are changing the guidelines, but people should still exercise precautions,” Dr. Dhuper said.

Vaccination research

Amid discussions related to vaccines, Dr. Nachman added that several compelling papers have demonstrated that people who are up to date on their vaccines, including flu, are at lower risk for dementia.

The link between vaccinations and overall brain health is unclear, and it is possible that people who receive vaccines also have a lifestyle that reduces the risk of developing dementia.

“We have an aging population in New York, particularly on Long Island,” said Dr. Nachmman. “If we want to keep them healthier longer, getting appropriate medical care, including vaccines, is probably helpful.”

Dr. Chrisy Beneri, below, suggests people leave a window cracked while entertaining such as above. Stock photo above; photo of Dr. Christy Beneri from Stony Brook Medicine

The time between Halloween and Thanksgiving often involves lists.

Dr. Chrisy Beneri. Photo from Stony Brook Medicine

Thanksgiving hosts make lists of people to invite, food to purchase, reminders of relatives who need to sit as far from each other as possible, and specialty items, like dairy-free, nut-free, gluten-free and sugar-free desserts.

This year, people should also consider adding healthcare steps to their holiday preparation, particularly as new COVID-19 variants and a host of respiratory viruses like the flu and respiratory syncytial virus, also known as RSV, threaten to put a damper on the holiday festivities or the days immediately after family gatherings.

Even as new COVID variants circulate in the area, cases of the flu have recently been climbing throughout the county, state and country.

As of the week ending Oct. 29, which is the most recent week for which the state and country produced data, Suffolk County reported 255 confirmed cases of the flu, which is up 86% from the previous week, according to the New York State Department of Health. Statewide, the number of cases reached 3,476 for the same week.

Dr. Christy Beneri, program director of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, suggests that the “ideal time is now” to get COVID and flu vaccines. “It generally takes about two weeks for the immune system to show a response to the vaccine to provide protection,” which means that the clock is ticking to prepare immune systems for visits with friends and relatives who might be bringing unwitting viral passengers with them to the dinner table.

The Centers for Disease Control and Prevention recommends that people get a bivalent booster — the version from Pfizer/ BioNTech or Moderna that includes protection against some of the newer omicron variants — if it has been at least two months since their last COVID-19 vaccine or since their original booster.

Beneri urges residents to get both COVID and flu vaccines, which people can receive at the same time.

The effects of these combined shots may have increased side effects of flu-like illnesses, like fever, aches and fatigue, which generally lasts for about a day.

The CDC reported that observational studies show greater disease severity in patients with influenza and COVID than in patients with COVID alone. 

As for ways to protect guests in people’s homes, Beneri explained in an email that no specific house filters are effective at reducing the spread of disease.

“Good air flow is important,” she wrote. “Leaving some windows cracked and telling guests to wear an extra layer” could reduce the risk of spreading viruses.

Beneri added that area medical facilities have seen patients with more than one respiratory virus.

“Having multiple viruses can lead to more severe disease and thus [the] need for hospitalization for supportive care,” Beneri added.

Treatment options currently exist for COVID and influenza, which is not the case for other respiratory illnesses. The NIH COVID-19 Treatment Guidelines suggested that there are no significant drug-drug interactions between the antiviral agents used to treat the flu and antivirals used to prevent or treat COVID.

While vaccinations may not completely prevent disease, they can help reduce severe disease and hospitalization, which is “especially important with the increase in other respiratory infections, such as respiratory syncytial virus,” she explained in an email.

Boosting immunity

In general, people can enhance their health by eating well, exercising and getting a good night’s sleep, Beneri said.

She also generally recommends a multivitamin.

The COVID-19 Treatment Guidelines Panel indicates that there is not enough evidence to support the use of additional supplements, such as Vitamin C, D or zinc in patients with COVID.

Beneri advised residents to review any supplement use with their doctors to avoid drug interactions and possible side effects.

At this point, the bivalent vaccine has improved effectiveness for the omicron strain based on the immune response, Beneri explained.

More data, however, is expected on the vaccine efficacy in the short and longer term with the new bivalent boosters, Beneri said.

Additionally, more data should be forthcoming on treatment options, which will also be important with anticipated new waves over the holidays and new variants emerging, she added.

Combined vaccine

Recently, Pfizer/ BioNTech said it was in phase one trials for a single vaccine that would provide immune protection against COVID and the flu.

Local doctors urged patience as the pharmaceutical company and the Food and Drug Administration review the results from these trials.

“Although there may be benefits with combination vaccines from a compliance perspective, we need to weigh that against the risk of safety and efficacy,” Dr. Sunil Dhuper, chief medical officer at Port Jefferson’s St. Charles Hospital, explained in an email.

The medical community needs to ensure that the combination is neither less immunogenic nor less effective than the singular vaccines on their own, he added.

“Safety and tolerability are other important concerns with combination vaccines,” Dhuper explained. He hopes the clinical trials will answer a host of questions related to immune response, efficacy, and reactogenicity, which refers to injection site pain, redness, swelling, fever headaches and other responses to the vaccination.

Photo from Pixabay

By Daniel Dunaief

Daniel Dunaief

We live such a two-handed life these days. On the one hand, we are emerging from our pandemic shells. On the other, we don’t want to race out too quickly, undermining all the work we did to protect ourselves, our families and our school communities. To that end, I had a few topics on the two-handed nature of our lives:

The weather

On the one hand, it’s a relief that we can enjoy warmer weather. The summer is approaching. The calls from seagulls blend with the steady rhythm of water lapping up on the shores, urging the fortunate residents of Suffolk County to return to the peace and harmony of the water.

On the other hand, the temperature will undoubtedly climb into the hazy, hot and humid zone at some point. While the beaches are wonderful, we won’t all have time to stroll on a sandbar during the week.

Vaccinations

On the one hand, many people are getting vaccinated, increasing the likelihood that we’re taking an immunological stand against a deadly virus. With a greater percentage of the population inoculated, we stand a better chance of coming together, revisiting family and friends we’ve only seen on Zoom for over a year.

On the other hand, a subgroup of people are reluctant to take the vaccines, worried about side effects, the speed at which the vaccine was developed, and a host of other concerns. If enough of them don’t get vaccinated and/or if variants evade the vaccine, we may not be able to beat back this virus as quickly as we’d like.

Graduations

On the one hand, we are so incredibly proud that our children have made it through whatever stage concludes this year. We appreciate all they have done to get here and to become the incredible people they are.

On the other hand, wait, hello? How did the time go by so quickly? Did we prepare them for the real world? What is the real world? What does it mean to graduate into the second year of a pandemic and how can we prepare them for some of the unknowns and unknowables ahead? 

Politics

On the one hand, we can, potentially, talk about politics again without the echoes of personal animus reverberating from an angry White House. In theory, we can even agree to disagree or to consider compromise.

On the other hand, has the left become too powerful even as the right engages in party strife? Are calmer waters really around us, or is it a temporary reprieve until the tempest returns with the elections in 2022 and 2024?

Freedom

On the one hand, we are freer than we’ve been in over a year, to travel and visit family, to take our masks off outside and read people’s lips and study their smiles. We can even consider traveling outside the country.

On the other hand, after living with a fear of human contact, how much can we set aside our concerns about the public health dangers of interacting with other people? 

A return to offices

On the one hand, we have a chance to speak with each other in person, to share stories about our lives and our children and to discuss the surprising run of a Knicks team guaranteed to have a winning record this year.

On the other hand, we have to deal with traffic, parking spots, lines at lunch, and conversations that keep us from returning to the homes we couldn’t wait to leave.

File photo

The Comsewogue School District has added its name to the list of districts that are standing up to New York State on a proposal that would mandate the HPV vaccine in state schools. 

The proposed amendment to Section 2164 of the public health law would require that all students born after 2009 receive the human papillomavirus vaccine as part of the state’s mandated school immunization program.

In a letter sent to Gov. Andrew Cuomo (D), Dec. 6, the district detailed its stance on the matter. 

“While the vaccination may be helpful in preventing certain forms of cancer, the choice as to whether to have children vaccinated should be made by parents in consultation with their physician,” John Swenning, board president, said in the letter. 

The HPV vaccine is designed to prevent cancer-causing infections, but several school districts including Shoreham-Wading River and Three Village have written letters similar to Comsewogue’s saying it is unnecessary.

In a letter signed by the school board and superintendent, SWR said they did not believe it was necessary for a vaccine for something not usually transmitted in schools.

“The HPV vaccination has historically been a parental decision, is not transmitted in schools, lacks the full support of the medical community and would require schools to enforce a widely unpopular mandate by excluding children,” the letter stated. “It should not be adopted.”

The Comsewogue School district went on to say the activities that cause this spread of HPV should not be occurring on school grounds, and HPV is not a public health risk in the school setting. They also said that if this bill passes, it will preclude children from being able to access a public school education.

In addition to the letter, Comsewogue district board held a workshop Dec. 5 to discussed the proposed mandate.

Superintendent Jennifer Quinn said the feeling she got from speaking with local officials is that the proposed mandate will not likely pass, but is still concerned about what it could potentially mean for students and parents in the district. 

“They told me that it is not happening,” she said. “I’m concerned that the other immunization changes happened so fast … that this might pass at the 11th hour, which could happen. It has been a little hard to predict lately.”

Quinn and other board members urged parents to reach out to local lawmakers. 

“It’s our kids, I don’t know if it’s the right thing to do but they’re telling you what they can put in their bodies,” Swenning said. 

Parents in attendance also brought up how the mandate could harm immunocompromised children, who can’t take certain vaccines and how the state may take away exemptions for the HPV vaccine. Current vaccine mandates exempt people who are immunocompromised.

Others were concerned the mandate would take away a parent’s prerogative and choice whether or not their child would get the vaccine. 

School officials also brought up the possibility of setting up a legislative committee session between elected officials and residents.

Stock Photo

With the start of the school year less than a month away, school officials and parents are in the midst of adjusting to stricter state immunization requirements for children that will eliminate exemption from vaccines due to religious beliefs.  

The new measure, which took effect immediately after Gov. Andrew Cuomo (D) signed it into law June 13, comes in the wake of numerous measles cases throughout the country including cases in Brooklyn and Rockland County. This year, over 1,000 new measles cases have been reported — the highest in 27 years, according to the U.S. Centers for Disease Control and Prevention.  

“We are responsible for implementing the new state immunization regulations exactly as they are written.”

— Marianne Cartisano

New York joins four other states — California, Maine, Mississippi and West Virginia — in eliminating the religious exemption.

While school districts have been notifying parents and guardians about the new requirements through posts on their websites and letters sent in the mail, the new law remains to be a divisive topic. 

Advocates of the religious exemption say that eliminating it violates their freedom of religion rights. 

South Setauket and Setauket parents Dayna Whaley and Trisha Vasquez, respectively, both ardent anti-vaccine advocates, both said they had a religious exemption for their children but they and others are now considering home-schooling or even moving out of the state. 

“God made us in his image and didn’t make us with an incomplete immune system that needed to be injected with toxic chemicals in order to keep us healthy,” said Vasquez, 50. She added she does not subscribe to any one religion but still believes in God. She has a 9-year-old child in the Three Village Central School District. 

Whaley, 41, of the Jewish faith, said the options are very limited for her daughter, Grayson, who will be entering kindergarten. 

“With religious exemption eliminated, what other things can I look at that maybe could get my child [back] into school,” she said. 

In mid-June, the Three Village school district sent out a letter to parents/guardians alerting them of the new legislation signed by the governor. It advised them that every student entering or attending public school must be immunized against poliomyelitis, mumps, measles, Haemophilus influenzae type b, pneumococcal disease and meningococcal disease. 

Other school districts have also had to quickly deal with the law over the summer. Marianne Cartisano, superintendent of the Miller Place School District, said the number of exemptions in the district was estimated at 60 students, but the number has been reduced over the past several weeks. 

“Miller Place School District remains committed to ensuring a safe school environment for all of our students, while understanding parents have the right to choose if and when they immunize their children,” the superintendent said in an email. “We are responsible for implementing the new state immunization regulations exactly as they are written.”

“You look at the plastic bag ban — you have until 2020 to adjust to that, but our children are thrown out of school immediately and we are scrambling to figure out what to do here.”

— Dayna Whaley

The Miller Place super added the district has no option but to comply.

“We have no authority to deviate from these regulations and must adhere to the guidance provided to our district from the Department of Health and or Office of Children and Family Services,” she said. “During this time of potential transition, we look forward to supporting students and families throughout the vaccination and enrollment processes.”

The New York law requires that parents and guardians provide proof of their child’s immunization within 14 days after the first day of school. Also, within 30 days of the first day of school, parents or guardians must show that they scheduled appointments for follow-up doses for their children. 

Some required immunizations include those against diphtheria, tetanus, pertussis (whooping cough), measles, mumps, rubella and varicella (chicken pox).

Until June 30, 2020, a child can attend school if they receive the first age-appropriate dose in each immunization series within 14 days from the first day of school attendance and can show within 30 days that they have scheduled age-appropriate appointments for required follow-up doses, according to NYS Department of Health officials. By June 30, 2020, all students attending school should be fully up-to-date with their required immunizations. 

One option Whaley and others have looked at is seeking a medical exemption from state, but she said it is extremely difficult to obtain one as an individual has to fit a certain medical profile. 

“Even if we wanted a medical exemption, try finding a doctor that will write one for you or even allow you in their practice,” the South Setauket resident said.

Anti-vaccine proponents are a small but growing group of advocates who argue against vaccination. The group often relies on scientifically disputed pieces of information. The vast majority of the scientific and medical communities have rejected their arguments. 

Beyond the scientific arguments, the Setauket parents took issue with the law going into effect immediately. 

“You look at the plastic bag ban — you have until 2020 to adjust to that, but our children are thrown out of school immediately and we are scrambling to figure out what to do here,” Whaley said. 

Both parents say they are weighing potential co-op and home-schooling options for their children. They said moving would introduce its own host of difficulties.

Dr. Sharon Nachman, division chief of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, said she is glad to have this level of protection for all children in Suffolk County. 

“Just as seat belts protect all kids, even those that don’t like them or feel they are too confining, vaccines will now protect all of our children,” the division chief said. “There is abundant data that shows that when we vaccinate all kids, we not only protect them, but also their parents and grandparents. The vaccine law is not specific to measles and includes all vaccines appropriate for school-aged children.”

“Just as seat belts protect all kids, even those that don’t like them or feel they are too confining, vaccines will now protect all of our children.”

— Sharon Nachman

According to a report by the New York Health Foundation, 26,217 students statewide, had religious exemptions from vaccinations during the 2017-18 school year. 

Nachman said with the implementation of the new requirements, she and her colleagues have seen an increase in both questions about vaccinations, about the numbers of children who are getting their initial vaccines as well as those who are getting up to date with their vaccines. 

“Community protection is a real event,” Nachman said. “As we have seen with the recent measles outbreaks, the only way to combat these outbreaks is by protecting all the children in our community.”

Nachman said the Pediatric Infectious Diseases division at Stony Brook often discusses the scientific data with families who have questions, but those who come in with their minds made up about the risks and benefits of vaccines, especially those who are against them, will rarely agree with the need to vaccinate.