​There has been a lot in the news about the current outbreak of measles, and many people are asking about it, so we wanted to send out some information to everyone.
 
Measles is one of the most contagious viruses we know. It mostly presents as headache, fever, and rash, but one child out of 1000 with measles develops swelling of the brain which can lead to deafness, seizures, or even death. Adults who get measles oftentimes have complications more frequently than children do. Worldwide, approximately 120,000 people die each year from measles, including the recent first death we had in the US in over 10 years. Measles was thought to have been eradicated in the US because of universal vaccination, but over the last few decades, more and more parents have chosen not to vaccinate their children, so there is now a resurgence of measles in certain parts of the country.
 
The measles vaccine was initially licensed for use in 1963, and later it was combined with vaccines against mumps and rubella in 1971 (MMR). The initial vaccine was a live attenuated (weakened) vaccine which did cause some side effects in people, so a non-live vaccine was developed and given for several years. Unfortunately, this 2nd vaccine was not as effective and did not provide lifelong immunity, so that’s the reason that some adults should now get a booster if they were vaccinated around that time. In 1968, we started using a single shot of the live attenuated vaccine exclusively, and that one shot gives you 93% lifelong protection against measles, which we consider sufficient protection. In 1989, we started giving children a second shot, and the second shot increased the lifelong protection to 97%.
 
A very important thing to know is that the measles vaccine DOES NOT CAUSE AUTISM. This myth first started in 1998 when a group of physicians published a study of only 12 children, insinuating that the MMR vaccine caused autism. The lead author did not disclose that he was funded by lawyers who were suing vaccine-producing companies. Eventually, 10 of the 12 co-authors of that paper retracted the interpretation of the data stating, “no causal link was established between MMR vaccine and autism.” Eventually, the lead author was found guilty of deliberate fraud because he chose data that suited his case and falsified facts. Multiple studies have since shown that there is no link between vaccines and autism.
 
BOTTOM LINE: The measles vaccine is SAFE and EFFECTIVE.
 
WHO DOES NOT NEED A MEASLES BOOSTER?

• If you had measles as a child, as you have lifelong immunity
• If you were born before 1957, you are assumed to have natural immunity to measles because it was so prevalent before the first measles vaccine was developed
• If you have documentation that you received two measles vaccines as a child, as was customary after 1968
• If you have evidence of immunity with positive antibody testing as an adult
• If you are taking strong immunosuppressive medications such as chemotherapy, because the vaccine is a live vaccine and can cause side effects

 
WHO SHOULD DEFINITELY GET A MEASLES BOOSTER?

• If you were born between 1957-1968, you were likely vaccinated with an older measles vaccine that was not as effective, so you should get one additional dose of the MMR vaccine.

 
WHO SHOULD CONSIDER GETTING A MEASLES BOOSTER?

• If you were not born in the US and don’t know what measles vaccines you’ve had
• If you are traveling to an area where there is currently a measles outbreak
• If you are living with or in close contact with severely immunocompromised people

 
WHAT ABOUT TESTING?

• There is an antibody blood test to make sure you are immune to measles
• If you are born before 1957 or have documentation of two measles vaccines, you do not need to be tested
• If you are unsure of your vaccination status and want to be safe, you don’t need an antibody test. You can just get vaccinated at most pharmacies, as the vaccine is safe and effective

 
If you have additional questions, please reach out to the office.
  
Wynnshang Sun, M.D.
Casey Fulinara, PA-C

​Flu season is coming soon, and we will have some COVID and RSV vaccine updates. We still feel the optimal time to get vaccinated for influenza in San Diego is late October or November because flu season here usually peaks around January or February, and by vaccinating around November, you will have the most antibodies to protect you around the peak of flu season. However, if you are traveling out of town before November, you can certainly get your vaccine sooner, and in some years, flu season can come early. The CDC usually recommends getting the flu vaccine right now, as soon as it's available, but that's because they are more concerned about developing "herd immunity" in a community (if more people are vaccinated early on, there is less chance that influenza hits that community hard later on). That’s different than our recommendation, which is based on the best protection for an individual.
We carry TWO different flu vaccines, and we already have them in the office. We have the usual 4-strain (quadrivalent) flu vaccine that everyone is eligible to receive. We also have a HIGH DOSE 4-strain vaccine called Flublok which was not available last year, but we do have it in the office already. This vaccine has three times the amount of antigen for 4 different strains, and studies show that it gives 30% better protection than the usual 4-strain flu vaccine when tested in patients ages 50 and above. We do NOT carry the so-called "senior” flu shot (Fluzone High-Dose) which is usually the one that most pharmacies will try to administer to seniors. Given a choice between Flublok and Fluzone, I would choose Flublok because this vaccine is not grown in eggs (unlike Fluzone), so it avoids the possible mutations that can occur in egg-grown vaccines that can alter the final product. However, the difference is not huge, so if you can’t get Flublok, the Fluzone High-Dose is certainly a good substitute. We are recommending the Flublok vaccine in ALL patients ages 50 and above, although you certain can get if you under 50 if you choose to. If you get your flu shot elsewhere, please let us know so we can document it in our records.
Most insurances, including Medicare, do cover all flu shots, but if it is not covered, Flublok costs around $80. If you happen to be in the Ximed building on a Tuesday (9 am-12pm and 2 pm-4:30 pm), Wednesday (9 am-12pm and 2 pm-4:30 pm) or Friday (8:30 am-2 pm), you can just stop by the office without an appointment to get any vaccines. If you want to come in on a Monday or Thursday, please call us first.
 
COVID-19 vaccines
New 2024-2025 COVID-19 vaccines have been approved by the CDC and should be in our office in the next couple of weeks:

• Both Pfizer and Moderna are releasing a new booster vaccine based on the recent KP.2 strain of the Omicron variant, very similar to what’s recently circulating.
• We are viewing the COVID vaccines similar to the flu shot in that there will likely be a new vaccine every fall that targets the most current circulating strain.
• We recommend that everyone get annually updated vaccine when it becomes available, especially if you are over 65 of have significant medical conditions. However, if you recently had COVID, it’s best to wait at least 3 months before getting the new booster.
• Please do NOT call to office asking if we have the vaccines yet. We will send out an email and text alert to let you know as soon as we have them available to give.

 
RSV (Respiratory Syncytial Virus) vaccine
RSV is a wintertime respiratory virus similar to influenza, and it can cause hospitalization and death, especially in the elderly or in people with compromised immune systems. We discussed with many of you last year that we recommended waiting until we had more data on the new vaccine. After another year of data, it turns out that the serious neurologic side effect (Guillain-Barre Syndrome) is very rare, occurring less often than cases of GBS that are the result of catching influenza. The CDC also adjusted their recommendations, encouraging everyone ages 75 and above to get the vaccine, as well as certain people ages 50-74, such people with diabetes, asthma, COPD, and other problems that may affect their immune systems. It is a one time shot (for now), and it is not covered by normal Medicare Part B. Many Medicare Part D plans that cover drugs may pay for it, so we will need to check your insurance before we give it to you. Most commercial insurance do cover RSV.
 
Timing of vaccines
If you are planning on getting all 3 vaccines separately, I would recommend getting the COVID vaccine as soon as it’s available (as long as you have not had COVID in the previous 3 months), the influenza vaccine late in October or November (earlier if you have an international trip before then), and the RSV vaccine at any time. You can combine the influenza vaccine with either the COVID vaccine or the RSV vaccine, but I would not do COVID and RSV together, and certainly not all 3 of the vaccines at the same time!
 
One Last Thing - YES ON PROP 35!
In the upcoming election, we are asking every to vote YES on Prop 35.  This proposition extends the existing tax on health insurance companies, without increasing taxes on individuals, and requires the funds to be used to protect and expand healthcare access for all Californians.  It also prevents the State from taking these funds and using them for other non-healthcare related areas.  You can read about it more at https://voteyes35.com.



Please reach out if you have any questions, and we hope everyone has a safe and healthy Fall and Winter!
 
Wynnshang Sun, M.D.

COVID shots for 65+
As many of you have heard, last month the CDC announced that all patients 65 years and over should get another COVID vaccine if it has been over 4 months since their last one. This vaccine is the exact same one that was introduced last September, and this recommendation was made because in patients over 65, antibodies formed to the COVID vaccines are not as robust and do not last as long. At this point, COVID levels in the community are not as high as they were over the winter, and the numbers of people being hospitalized or dying are definitely much lower. However, people are still getting infected, and the vast majority of people who are hospitalized are those over 65. We are also worried about long COVID, with more than 15% of people reporting they have long COVID symptoms. The best way to prevent long COVID of course, is not to get it. One of the concerns I initially had with getting another COVID vaccine was that in the beginning, there were some studies that suggested that too many COVID vaccines may blunt the desired protective effect of subsequent vaccines. However, it seems that it is not the case, as people do still mount a good response. There is even a case of a 62-year-old man in Germany who got over 200 COVID vaccines in a little over two years! He agreed to be studied, and his immune system was still functioning normally. While we would never recommend this, at least it is reassuring that in this particular case, there was no sign of a blunted response to multiple vaccines. We also know that the current vaccine is about 40-50% effective at preventing infection (although much higher at preventing severe infection). This supports the phenomenon that we’ve all seen where people who have been properly vaccinated still end up getting COVID. While we would love this to be higher, a 50% reduced risk with the vaccine is better than a 0% reduced risk for not getting the vaccine.
 
So who should get this vaccine now? We do anticipate a new COVID vaccine this fall, which will be newly formulated to best match what the current circulating strains are at that time. As long as you have not had a COVID vaccine or actually had COVID in the last four months and you are 65 years or older, you are eligible. These are the people I feel should get another vaccine now:

• If you have lung disease such as asthma or COPD, diabetes, chronic kidney disease (stage 3 or higher), active cancer, or other diseases that decrease your immune system
• If you are taking medicines that suppress your immune system such as biologics, chemotherapy, or steroid medicine
• If you plan on upcoming travel where you are going to be exposed to a lot of people (such as a large conference or vacation on a cruise ship)
• Or simply if you want another COVID vaccine at this time

 
We currently only have the Pfizer vaccine, so if you specifically want the Moderna vaccine you can get it at a local pharmacy. However, there were some studies earlier on that showed that people that got the vaccines actually had a little better immune response.
 
Finally, a reminder that if you have cold or allergy symptoms, be sure to test for COVID. Even though we don’t have to isolate as long as we did in the past, it is important to know if you have COVID, and some people should still be treated with Paxlovid.
 
Measles
Measles had previously been thought to be eliminated in the US, but there has been a resurgence recently. The number of cases since the beginning of 2024 are now as high as the entire number of cases in all of 2023. The vast majority of these cases are from people who come back to the US after traveling internationally, although there is also risk in children because a higher percentage of children are not getting their measles vaccines. There has been a lot of confusion over the years about measles because there have been both inactivated vaccines, at least two different live attenuated vaccines, and also different dosing regimens. Therefore, depending on when you were born, you may not have been fully vaccinated and therefore may be at risk for getting measles. This is my recommendation:

• If you were born before 1957, you are assumed to be immune because the disease was so common and so contagious before vaccines were available. You do not need to check a blood test for antibodies.
• If you were born in or after 1957, and you have a record that you had two doses of the live measles vaccine (such as MMR), you are assumed to be immune. You do not need to check a blood test for antibodies.
• If you were born after 1957, you do NOT have a record of two doses of live measles vaccine, AND you plan on traveling internationally, you can get a booster shot of MMR without checking any blood tests. It will not hurt you to get another shot if in fact did have two doses of live measles vaccine in the past.  It is also possible to check for measles antibodies by a blood test to check for immunity. We do not carry the MMR vaccine, but you can get it at most local pharmacies. 

 
One last thing – you may have hear there was a cyberattack at Change Healthcare last month. It has not directly affected Scripps, but it did interfere with our ability to get results from Scripps Labs sent directly to our electronic medical record. If it makes no difference to you, having labs drawn at LabCorp or Quest will make it easier for the results to be sent directly to our EMR.  Hopefully this will be fixed soon.

​Thanks for reading!

We now have all the 2023 vaccines in the office — both Pfizer and Moderna 2023 updated COVID vaccines, the high dose influenza vaccine, as well as the new RSV vaccine.  Because we have so many vaccines to give, PLEASE do not call the office for appointments.  Instead, please adhere to the following:
 

• If you already have an appointment in the office, we can just give you the vaccines then, no need to let us know beforehand.
• If you want to get any of the vaccines on a Tuesday (9 am - 12:00 pm and 1:30 pm - 4:45 pm) or on a Friday (8 am - 2:30 pm), just come in to the office, no need to schedule an appointment.
• If you need to come on a different day, please send us a message through the portal, as the office is busier on the other days.

 
Here is a reminder about these vaccines:
 
COVID vaccines

• The Pfizer and Moderna vaccines are interchangeable, so you can get either one
• You should wait at least 3 months after your last COVID vaccine or after you’ve had COVID before getting the new shot
• The vaccines were previously all paid for by the government, but now insurance companies are supposed to cover them
• We have a limited supply, so we cannot give the vaccines to people who are not patients at our office

 
Influenza vaccines

• Best time to get them is still around middle of October through November
• We have the usual 4-strain flu vaccine that anyone can receive.  The Flublok that we previously gave to patients ages 50 and above will probably not be available this year, so if you are 50-64, you should get the regular 4-strain flu vaccine
• This year, for patients 65 and over, we are recommending the high-dose flu vaccine

 
RSV vaccine

• We recommend this vaccine to patients ages 60 and over who have lung disease, coronary artery disease, significant kidney disease, diabetes, or are taking any medicines that suppress their immune system
• For patients ages 60 and over who do not have these conditions, we’re currently recommending holding off for a year or two
• For patients under age 60 who want the vaccine, please note that it may not be covered by insurance and costs around $320

A new vaccine for a virus called RSV (Respiratory Syncytial Virus) is currently available, and we will be offering vaccinations for it by the beginning of next month. Here is some information about this virus and the vaccine.
 
What is RSV?
RSV is a respiratory virus that usually causes mild cold-like symptoms, but in older individuals with certain medical problems, it can cause severe symptoms that require hospitalization and can even lead to death. We normally think about RSV affecting young children, but we have found more recently that adults can be affected as well. In the US, more than 177,000 patients over age 65 are hospitalized every year with RSV, and about 14,000 patients over age 65 die each year from RSV.
 
If it’s so common, why are we only hearing about it now?
We have not been testing adults for RSV in previous years, as there is no specific treatment for the infection, but last year, we had a significant increase in the number of adults hospitalized with RSV. Vaccines for RSV have been in development for decades, but now are finally available, both for adults as well as children. Currently there are two vaccines, both manufactured in a method similar to older hepatitis vaccines, and not the method of the recent COVID vaccines. These new RSV vaccines are over 80% effective in preventing severe symptoms and hospitalizations associated with the virus.
 
Which adults should be getting this vaccine?
Right now, the CDC has recommended that adults age 60 years and over talk to their healthcare providers about whether or not they should receive the vaccine. This is different than some other vaccines, where the CDC recommend that everybody over a certain age should get a particular vaccine. You can certainly schedule an appointment to discuss whether you should get the vaccine, but here are our basic recommendations:
 
Who do you recommend should definitely get this vaccine? 
We definitely recommend that you get this vaccine if you are age 60 or over and have any of the following:

• lung disease (such as asthma or COPD)
• a condition that causes a weakened immune system (such as leukemia or diabetes)
• take medications that decrease your immune system (such as steroids or other immune suppressants)
• significant chronic kidney disease
• live in a nursing home

 
What if I don’t meet any of those criteria?
If you are age 60 or over and don’t meet the above criteria, you’re certainly eligible to receive the vaccine. However, for most people that are otherwise fairly healthy, we are generally recommending holding off on the vaccine for right now. These are our reasons:

• These vaccines are fairly new, and we don’t know how long their beneficial effects will last. One study did show that after getting the vaccine, there was still an over 50% effectiveness in preventing RSV infection the second season, but we don’t know how long this protection will last. However, we do know that kids that get RSV can still get it again the following year, so having the infection itself does not give you long term protection, similar to influenza.
• Because most people who are over 60 but are otherwise healthy usually have a mild case of RSV, they may not get a significant benefit from the vaccine. This is very different from the recommendation of the COVID vaccines when they first came out. COVID vaccines were new as well, but because COVID was much more prevalent and could cause more severe disease in healthy people, we did recommend that everyone get vaccinated against COVID.
• There is a report of a rare neurologic condition calls Guillain-Barré syndrome that occurred in very low numbers in the RSV vaccine studies. Guillain-Barré syndrome usually occurs after a respiratory or gastrointestinal infection, and we see about one or two cases in every 100,000 people in the US each year. We have seen this condition with flu vaccines in the past as weel, but it occurs very rarely, with only about one or two cases out of 1 million people who receive the flu vaccine. At this point in time, we don’t know if the cases of Guillain-Barré syndrome in these RSV studies occurred by chance, or if they truly represent an increased risk. After the vaccines have been out for a couple of years, we should have much more data to determine this. Because of this, at our office, we feel that most healthy 60-year-olds can hold off on the vaccine for now.

 
Certainly, if you still have questions about the RSV vaccines, feel free to call the office for an appointment to discuss. For those of you at a higher risk that do want to get the vaccine, we will be getting them in by the beginning of this month. We would not recommend getting the vaccine together with the COVID vaccine, but you can get it with the flu vaccine. There is a mild adjuvant in the RSV vaccine to boost your immune response, but the reaction to it (achiness, low grade fever) is usually less than the other adjuvant vaccines such as Shingles.
 
Update on influenza vaccines
We have been informed by the manufacturers of the Flublok vaccine that there is some issue the CDC has with their reporting this year, so the vaccine release will be delayed, and it may actually not be released this year. Therefore, we will be ordering the Fluzone quadrivalent vaccine, which will be for patients ages 65 and above, and they should be coming in by the end of the month. For patients under age 65, we do have the quadrivalent Flucelvax which we have carried in the past. The timing for these vaccines have not changed – we recommend waiting until the end of October or November, unless you will be traveling overseas in which case you should get the flu vaccine earlier. 
 
Update on the new COVID vaccines
The release of the new 2023 COVID vaccines has been slow, but it may be currently available at some pharmacies if you need to get it right away. We have been told to expect the vaccine at our office by the beginning of October. We will send out an announcement when the vaccine does become available.