And then there were three. That’s right, three vaccines: Pfizer, Moderna and Johnson & Johnson (J&J). All highly efficacious according to Dr. Anthony Fauci. And we have these three vaccines not even a year after the first shelter-in-place orders were issued in the US. Now that they’re all available, let’s review how these three vaccines compare.

Comparison of Effectiveness

A great deal of attention has focused on the differences between Pfizer and Moderna vs the J&J vaccine. While the J&J rate of effectiveness is 66.9% and Pfizer and Moderna are 95% and 94.5%, respectively, these numbers are measuring two different end points.

The J&J figure relates to the effectiveness in preventing moderate to severe COVID-19 illness after a single dose. In fact, it was 85.9% effective against the most severe forms of COVID-19. Pfizer and Moderna were measuring symptomatic infection, not necessarily moderate to severe infection.

Rather than focusing on the numbers above, focus on the numbers below: the three vaccines’ effectiveness in preventing hospitalizations and deaths.

Risk of dying or being hospitalized after vaccination

When measuring effectiveness weeks after vaccination, the risk of hospitalization and death fell to zero when receiving any one of these vaccines. In other words, if you get sick, these vaccines with almost certainly save you from hospitalization and death. This is why consumers should not turn down the J&J vaccine if they have an opportunity to get it. Because if you wait for the Pfizer or Moderna vaccine, erroneously assuming they’re “better” than the J&J vaccine, you could contract COVID-19 and die in the meantime, a fate the J&J vaccine would save you from.

Effectiveness against variant strains

While the British and South African variants were not around during the Pfizer and Moderna trials, there’s evidence these vaccines are still effective against them. The J&J vaccine definitively offers protection against the South African variant. It was 81.7% effective against severe forms of COVID-19 in South Africa. Fortunately, these vaccines can include protection against future variants.

Number of doses required

The Pfizer vaccine requires at least 21 days in between two doses. Whereas the Moderna vaccine requires 28 days between each of the two doses. The J&J vaccine only requires one dose. However, J&J has an ongoing trial to determine if a second booster shot would increase effectiveness.

Vaccine technology

Both Pfizer and Moderna use mRNA technology that has been in development for 20 years but this is the first vaccine widely distributed using the technology. The J&J vaccine uses a viral vector technology that has been previously used in an Ebola vaccine.

They all have one thing in common. They all cause our bodies to produce the coronavirus spike protein on our cells’ surfaces, thus stimulating our immune system to produce antibodies. By being “locked and loaded” with antibodies, our body can quickly fight off a future coronavirus infection.

There is fear surrounding the mRNA technology and the erroneous concern that it can affect our genetic code and possibly fertility. The populace received reassurance that this was not the case because the mRNA particle does not enter the nucleus where our genetic code resides. This is accurate.

Ironically, the J&J vaccine, which contains DNA transported to our cells in a re-engineered, harmless adenovirus (in their natural state, adenovirus can cause the common cold), does enter the nucleus to produce mRNA that then goes on to become the blueprint for the spike proteins. While the initial acceptance of the J&J vaccine is a welcome surprise, it’s interesting that it 1) uses a real virus to transport its genetic material to elicit an immune response and 2) enters the nucleus to do so.

Safety profile

Aside from arm pain, fatigue, body aches and weakness, the FDA believes all three vaccines have favorable safety profiles. There are certainly reports of allergic reactions, but this can occur with the annual flu vaccine.

Additionally, the reactions are often due to the “packaging” of the vaccine rather than the active ingredients of the vaccine itself.

Risk of spreading COVID-19 after vaccination

Studies are ongoing. But there is increasing evidence that those who receive the vaccine do not become effective carriers of the virus with a high viral load. Therefore, they are not shedding the virus in numbers to infect others.

Cold storage requirements

Because the mRNA vaccines are so fragile, they require storage at colder temperatures. The Pfizer vaccine requires ultra-cold storage. The FDA is now allowing storage at “warmer” temperatures, citing evidence from Pfizer that the vaccine is still effective in temperatures comparable to a typical freezer.

The Moderna vaccine continues to require freezer temperature storage. In what may make distribution easier to far flung or isolated communities, the J&J vaccine remains effective with storage in a standard refrigerator.

Safety in pregnancy

Anecdotally, the Pfizer and Moderna vaccines appear to be safe in pregnancy and during lactation. In fact, the main obstetrics and gynecological trade organization, ACOG, is actively encouraging pregnant and lactating women to get vaccinated.

There is clear evidence that coronavirus infection in pregnant women is significantly more severe when compared to non-pregnant women. Additionally, there are no known instances of risk to the fetus when the mother receives the vaccine. This makes the choice of vaccination clearer from a risk-benefit perspective.

At this time, both Pfizer and J&J plan to move forward with clinical trials involving pregnant women.

Conclusion

The vaccine is not the only protection against COVID-19. Social distancing, mask wearing and hand washing are still basic CDC recommendations. When combined with these precautions, any of the three vaccines will statistically keep people safe, possibly infection free. But most importantly, they help avoid hospitalization and death. If anyone have the opportunity to receive a vaccination, don’t turn it down because of a perceived ineffectiveness of one vaccine over another. Stay healthy. Get the vaccine.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Three vaccines: Pros and cons first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

In the run up to the current vaccine approvals and post approval process, I’m blown away by what is making people worried about this vaccine. I’m not surprised they’re worried. Totally get that. But surprised by what they’re worried about!

Anxiety and fear are completely understandable for a vaccine that was developed in record time and with “newer” technology (mRNA (m = messenger)(RNA = ribonucleic acid). I say “newer” because while it’s the first vaccine coming to market using mRNA technology, the technology was actually developed decades ago. Yes, it was approved under an emergency use authorization so we don’t have years of follow up studies confirming its safety. However, with the millions of people who’ve received the vaccine either during trials or since release, severe reactions are very rare. Most side effects include short-term fatigue or headache. But with a greater than 94% effectiveness, these side effects are a reasonable tradeoff.

Of course we shouldn’t go into anything blindly. Of course we should have an idea of what we’re putting into our body. But the concerns people are bringing up suggest misinformation and rumors without a clear basis. My post below, along with this article and this article seek to allay some of those concerns.

Fertility

When someone expresses a concern, I don’t believe we should dismiss those concerns. I think we should be curious as to what is the underlying reasoning for their concern. Once we know, we can more accurately address that concern.

But in the case of fertility, it’s not clear where this fear is coming from. Do they think the vaccine causes a person to become sterile? Impotent? This article suggests the concern is a debunked cross reaction with placental proteins! I want to ask the people that cite this as the reason for not getting the vaccine, “what do you know about placental proteins?!”

An alternative reason for concerns about fertility may lie with the vaccine’s mechanism of action. The Pfizer and Moderna vaccines are messenger RNA-based vaccines. mRNA is genetic code that the cell uses as a blueprint for manufacturing proteins. In the case of the Pfizer and Moderna vaccine, the mRNA goes into the cell and stimulates the cell to create the coronavirus’ spike protein.

The spike protein then goes to the cell surface and stimulates the body’s immune system to create antibodies to that protein. Keep in mind the presence of these manufactured spike proteins on your cell surface don’t last forever. They degrade over time like any protein. They’re there just long enough for your body to stimulate antibodies to them. And if the real coronavirus with its spike proteins enters the body, your immune system is primed and ready to produce antibodies to neutralize the virus.

But at no time does the mRNA ever enter the “inner sanctum” of the cell, the nucleus. This is where our genetic code is kept. Our genome, our DNA. By remaining outside of the nucleus when creating the spike protein, the mRNA never incorporates into our DNA. Therefore it is not passed on to your kids and does not affect fertility.

If additional reassurance is necessary in regards to fertility, keep in mind that The American College of Obstetrics and Gynecology are very clear about vaccination during pregnancy and lactation. They’re for it!

Ultimately, the attempt to dispel a myth regarding fertility is the difficulty in addressing the underlying source of the concern (since it’s not always clear).

So imagine yourself listening to the news during this pandemic and the news anchor says, “Breaking News! Two companies have developed new vaccines for the coronavirus. They work by injecting the actual coronavirus into your bloodstream.”

Concerns over the vaccine technology

Back to the technology used in these first two vaccines. They use mRNA as a way to stimulate the body’s immune response as explained previously. Whether people are concerned that it’s the first vaccine using this technique or because of fear that it interacts with our own DNA (again, it doesn’t), I think it’s important for concerned citizens to consider the alternative types of vaccines.

Keep in mind that all of the vaccines you’ve ever received, stimulated your immune response by using 1) a live, weakened (attenuated) virus (eg MMR or measles vaccine), or 2) a dead virus (eg polio, hepatitis A, most flu vaccines). So imagine yourself listening to the news during this pandemic and the news anchor says, “Breaking News! Two companies have developed new vaccines for the coronavirus. They work by injecting the actual coronavirus into your bloodstream.” It wouldn’t matter that the vaccine contained weakened or dead viral particles. You’d run for the hills!

Therefore, a vaccine that produces a protein that allows your body to produce antibodies to the virus, without ever interacting with the virus itself, is progress. Consider yourself lucky to be living in a time where this technology is available. Now go out and get vaccinated!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post You’re worried about this vaccine?! And other myths! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Facial fillers and the COVID vaccine

First off, it’s not usual to have a reaction to a vaccine. Any vaccine. There’s nothing special about the COVID vaccine in that respect. The preservatives used in vaccines, such as polyethylene glycol (PGE)(used in skin creams and other self care products) can cause a reaction in some people. Typically recipients that are already susceptible to allergic reactions for one reason or another.

In fact, many documented cases of allergic reactions to the vaccine, facial filler patients or otherwise, were consumers that carry an EpiPen because of their risk of having an allergic reaction. That should tell you something about their innate susceptibility to allergens in general. This is different than the vast majority of the population.

Currently, the theory is that people who have had facial fillers, that can contain PGE, develop antibodies to PGE and once they receive the vaccine, which also contains PGE, their immune response “attacks” the fillers, causing facial swelling. For the record, this attack by the immune system is actually a good sign you have a strong, appropriately reacting immune response.

What happens to facial filler patients that have a reaction to the vaccine?

So for those people that have a reaction to the PGE in a vaccine, they have have facial or lip swelling in the area of the facial fillers. But that’s it. The reaction is easily treated with antihistamines like Benadryl, Claritin or Allegra. Oral or an injectable steroid will help tamp down the reaction as well.

The important thing to remember is that no one has had a serious reaction in the case of facial fillers. So if you’ve had facial fillers and are considering not getting the vaccine, please reconsider. This is a risk – benefit decision. And the benefit of getting the vaccine and avoiding an active COVID infection far outweighs the risk of have some facial swelling after facial fillers.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Facial fillers and the COVID vaccine first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.