5 Things Doctors Want You to Know About Vaccines and Other Medical Developments
Preventive care is more than just a health care catchphrase. Today, people can take an active role in keeping their medical problems at bay. Beyond eating well, exercising and getting enough rest, we asked some of Hawai‘i’s top doctors what you should know about new vaccines, screenings and more.
Little more than 200 years ago, a French physician invented the stethoscope. Thirty-eight years later, Hawai‘i mandated the smallpox vaccine after an epidemic killed thousands. In 1918, doctors—working without antibiotics (discovered 10 years later) or flu vaccines (created 20 years later)—grappled with a flu pandemic that would eventually kill more than 600,000 people in America. In 1967, a surgeon in Ohio performed the first coronary bypass operation on a human.
The world of medicine changes rapidly. Last year, the Food and Drug Administration approved 46 new drugs. Guidelines are regularly re-evaluated to ensure doctors are screening patients regularly enough to catch problems, but not so often that screenings actually impede diagnosis. If you are not an M.D., it’s difficult to keep up. We reviewed the latest medical journals and spoke to local experts about five preventive-care developments you should know about now. (Check your insurance policy to see what is covered.)
One of the medications approved last year, and one of the most publicized, is the new Shingles vaccine. A vaccine for the often painful disease caused by the same virus as chickenpox is not new; Zostavax was approved by the FDA in 2006. However, there are some key differences. First, Shingrix can be given to adults 50 years and older, versus Zostavax, which is suggested for people over the age of 60. But beyond the age difference, according to the Centers for Disease Control and Prevention, two doses of the new vaccine are more than 90 percent effective at preventing shingles and its complication, postherpetic neuralgia. Zostavax is only effective 51 percent of the time.
Patients often ask if they need the vaccine if they’ve already had shingles. You can contract shingles more than once. The disease is not only painful and disabling, it can cause blindness. Another common misconception—people believe that because they didn’t have chickenpox as a child, they won’t get shingles. Doctors say many people had chickenpox as a child and don’t remember.
If you are eligible, ask your doctor soon. Demand for the well-publicized drug has already created a nationwide shortage that the CDC anticipates will last through the end of the year. Locally, people have had to wait a few weeks to as long as a month but the pharmacies will often keep a waitlist and call patients when a shipment comes in.
Abdominal Aortic Aneurysm Screenings
Aneurysms are weakened or bulging walls of a vein. When the compromised area is in your largest artery, the aorta, it can quickly become an emergency if it ruptures. “Although aneurysm disease occurs in only a small percentage of the population, it is a significant cause of death, especially among older men,” says Dr. Peter Schneider, a vascular surgeon at Kaiser Permanente Hawai‘i. Even if a rupture is treated quickly, the survival rate is only 25 percent. That is why men between the ages of 65 and 75 who have smoked should be screened once for abdominal aortic aneurysms.
This holds true even for men who quit decades ago or were so-called “social smokers,” who just lit up occasionally, because it is the total number of cigarettes smoked that makes a difference. “So, let’s say a male smoked half a pack of cigarettes (10 cigarettes) per month for three years in his 20s and then quit,” says Dr. Ryan Hagino, a vascular surgeon at Straub Medical Center. “That would still equal approximately 10 cigarettes, times 12 months, times three years, or 360 cigarettes total. Unfortunately, this would still place the man in the high-risk group.”
A single ultrasound is usually covered by insurance. And if an aneurysm is found, you may be able to keep it from growing. If repairs to the wall of the aorta are necessary, Schneider says new procedures are less invasive. “With smaller caliber delivery tubes and tiny incisions,” he says, the incision would be “on the order of one-eighth to one-quarter of an inch at the top of the leg. The existing blood vessel is relined and reinforced rather than the major operation of taking the aneurysm out.”
The measles, mumps and rubella vaccine is a well-known part of our regular immunization schedule. The two-dose vaccination has been a dreaded part of early doctors’ visits for toddlers since 1971. When Hawai‘i recently experienced the biggest mumps outbreak in the nation—as of July 2018, 1,003 cases have been confirmed in the Islands—the state Department of Health started recommending an additional dose for anyone older than 10, regardless of any previous vaccinations, last October. That’s three months before the CDC recommended the same thing be standard practice during an outbreak.
The recommendation still stands despite the fact that the number of new mumps cases has slowed since the first was reported in March 2017. The DOH says people 10 to 45 years old should consider a third dose if they work or spend a significant amount of time in close contact with others.
Cervical Cancer Screening
When the U.S. Preventive Services Task Force released new recommendations in 2012 for what most women know as the Pap smear, some confusion ensued. The task force said women 21 years and older could receive the cervical cancer screening every three years, instead of annually. After 30, women could go five years between screenings, if they did both the cytology and human papilloma virus (HPV) tests. Some patients assumed that meant an end to annual visits to their OB-GYN. Not true.
“The well-woman exam is critically important for women’s health,” says Dr. Angela Pratt, OB-GYN at Kapi‘olani Medical Center. “It goes beyond cervical cancer. You need a breast exam and a pelvic exam. It might not involve a cervical check with a Pap smear or HPV testing, but it does involve an assessment of your overall health. That’s really vital.”
Also valuable are the discussions that can take place during yearly visits. Pratt says often women are not aware that there are new treatments and technologies for recurrent bladder infections, vaginal dryness and painful intercourse. Having an open dialogue with your doctor can help.
As for cervical cancer, the national task force is considering changing the recommendations again—to say patients only need the HPV test every five years, instead of both the HPV and cytology tests. If this happens, The American College of Obstetrician and Gynecologists will have to decide if its guidelines, which many OB-GYNs follow, will also change. Regardless of the outcome, Pratt says that patients should work with their doctors on an individual risk assessment, to decide how often they should be tested, based on their history and age.
Hawai‘i’s bout with contaminated scallops in 2016 was not the only occurrence of hepatitis A in the U.S. that year. Frozen strawberries from Egypt led to outbreaks in nine other states. And in 2018, we’ve already seen hepatitis A, a highly contagious liver infection, affect thousands in Arkansas, California, Indiana, Kentucky, Michigan, Missouri, Ohio, Tennessee, Utah and West Virginia. In fact, after decades on the decline, the number of hepatitis A cases is on the rise.
Vaccination guidelines have largely stayed the same, but recent news coverage has given local patients more awareness. “It helped highlight some of the complexities around how food is sourced and distributed in modern America,” says Dr. Tarquin Collis, chief of infectious disease at Kaiser Permanente Hawai‘i. “Many adults who would never have considered being vaccinated for hepatitis A chose to get vaccinated during and after the outbreak, which is a great thing.”
Kids are routinely vaccinated for hepatitis A; it is a standard immunization after they turn 1. But, in the case of exposure, it is recommended everyone 18 years and older receive the vaccine. Remember, it takes two doses given six months apart. So, if you only get one, the protection won’t last as long.
The CDC says people at the highest risk of infection are travelers to developing nations and other places where hepatitis A is common, family of kids recently adopted from those countries, men who have sexual contact with men, recreational drug users and people with pre-existing clotting factor disorders such as hemophilia. Even if you are not on this list, it wouldn’t hurt to talk to your doctor about the vaccine, especially in case of another outbreak in the Islands.
“Hepatitis A infection can be incredibly unpleasant and even fatal,” Collis says. “It’s an infection that is absolutely worth avoiding. You can catch hepatitis A through food, even if you’re careful about what you eat and even if you don’t travel abroad.”