>> Here at Johns Hopkins Medicine,
known for groundbreaking research,
teaching, and medical care.
>> Hello and welcome to Johns Hopkins Medicine. Facebook live.
I'm Dr. Lisa Marigakis,
Senior Director of Infection Prevention for
the Johns Hopkins Health System here in Baltimore, Maryland.
Respiratory virus season has arrived
and now we're here today to talk about
influenza and COVID-19 respiratory sensitial virus
and other respiratory illnesses that spread this time of year.
I'm joined by two of my colleagues,
Dr. Aeron Milstone,
Pediatric Infectious Diseases Specialist
with the Johns Hopkins Children's Center,
and Dr. Allison Agwu,
Adult and Pediatric Infectious Disease specialist
with the Johns Hopkins Hospital
and the Johns Hopkins Children's Center.
Thank you both for being here today.
>> Pleasure.
>> I thought we could just start by talking
in general about the respiratory virus season.
If you could tell us the best things
that we can do to protect ourselves,
our patients, and the community every
year against all of these different viruses.
>> Yeah. The first thing I have to
acknowledge our third year doing third or fourth year.
It's really been a pleasure to be
here with you guys talking about this.
I think I'd like to start with just the basics.
The cover your sneeze, wash your hands.
Don't go to work or to school if you really are
sick to spread things and of course, to vaccinate.
I think those are some of the big ones and
I would probably throw another one in.
We've thrown mask out.
But if you are psycho habicl,
it's okay, actually, advisable to
wear masks so you don't spread to others.
I don't know if you had anything to add.
>> Such important things and we learned a lot
about the utility of masks.
>> Absolutely.
>> That makes so, anything you'd like to add to that list?
>> The other thing that people I think
have gotten out of the habit
of doing also is considering testing yourself for COVID.
There still are COVID home tests available there.
Unfortunately, many aren't being covered by insurance anymore.
But especially if you're going to be
traveling over the holidays to see
a vulnerable family member who may be
at increased risk for an infection or complication infection.
I think those home tests, especially if they're done repeatedly,
offer some good reassurance that you're keeping your family safe.
>> Agree.
>> It's such an important point because I don't
think we used testing as much in the past.
We just maybe assumed that it was influenza or
RSV unless you were in the hospital setting.
But now you need to know that more testing is important.
We should talk about these viruses,
especially the big three,
although there's so many that circulate this time of year,
what happens, especially to infants and to those who have weakened
immune systems if they get COVID-19 or RSV or really any of these?
>> We think of these primarily as respiratory viruses.
They affect the respiratory tract.
Our big fear is that children will
develop respiratory complications, have trouble breathing.
Many of us we were talking about before have kids who
we've been up with at night who are either cropping,
or barking, or having
trouble breathing and it can be very scary for parents.
Trying to keep those kids, prevention, again,
the measures that we were mentioning are a great approach,
but we especially worry about pneumonia.
I always say if your child does develop
a fever and is having any trouble breathing,
you should immediately call
and talk to your pediatrician or ask for help,
especially if there's concerns about
breathing problems because those can become
very significant and life-threatening.
We especially worry about kids, adults, elderly,
who may have compromised immune systems
where they're unable to fight off the virus.
Where that illness can get much more significant and
they are more likely to get hospitalized.
Which leads us to our other prevention strategies like
vaccines to protect those populations that are at highest risk.
>> Yeah. I think so.
I think certainly we worry for the little ones,
like Dr. Milson said about the little airways
just easier to get clogged up,
and then getting lower respiratory infections
or pneumonia is super important.
But they also can affect other parts of their bodies as well.
We've certainly seen kids in
the ICU with much more than just pneumonia,
with heart failure, etc.
COVID taught us a lot about high-risk populations.
I think we all were used to thinking about ourselves.
Am I obese, do I have diabetes,
or do I have asthma and underlying lung disease?
I think those certainly in addition to,
cancer, recovering from,
or having an compromised immune system puts you at higher risk for
really all those viruses and then we have to
be careful with more gray hair, with age.
We can't over 60,
definitely over 70, the older we are,
we saw people in nursing homes at the highest risk
for COVID and influenza.
>> Such important points
and very important to remember that these are
serious illnesses that can kill people, really.
Because during the pandemic,
we often have been asked,
well when can we treat this just like the flu,
as if the flu is not serious?
But of course, all of these are for
some individuals, very serious.
>> Exactly.
>> Maybe we'll take each virus in turn
then and talk about COVID-19,
Sars, COVID two virus.
Some people feel like we've moved beyond the pandemic.
Tell us Dr. Agwu,
maybe we'll start with you.
>> Sure.
>> What is the landscape right now? What are we seeing?
>> Yeah. I think when we talked last year and
the year before we said we thought it was going to be with us.
I think we were trying to predict and it is with us,
we see peaks about a month ago we
saw a peak and then we see an ebbs and flows.
But certainly, as we come indoors
and all the viruses starts co-mingling,
it's possible we may see peaks again,
I think in terms of the severity.
I think certainly we're not seeing
the high hospitalizations and deaths, but certainly,
there are still hospitalizations and still deaths,
particularly for high-risk populations or at-risk populations.
>> That brings us to the vaccine.
Can you tell us more about the new vaccine
and how it's different from previous boosters or vaccines?
>> Many of you are aware that
a new vaccine just came out recently.
A couple of companies have this,
what's now a monovalent vaccine.
It's just targeting one part
of the virus where the prior vaccine targeted
both and the vaccine manufacturers are doing
a great job trying to keep up with
this virus that keeps changing and mutating.
Now we have a vaccine that is more closely
aligned with the current circulating COVID strains,
and that's why it's only one strain.
We think that everyone has really good immunity to
that original strain that came out three
or four years ago in 2020.
>> Now this new vaccine is hoping to help boost the immune system
to what's currently in our community. There's a new.
It's called a monovalent vaccine
and the current recommendations is that people,
especially high risk people, should get boosted with that again.
What I found really helpful,
especially for parents who have young kids who
haven't yet gotten the vaccine because they were too young,
is now the CDC has put out
really good guidance for kids who either
haven't been vaccinated yet or maybe got one vaccine last spring,
or have gotten two vaccines over time.
There's really now nice guidance that the CDC is put out
about how to catch your kids up so
that you can be as protected against COVID as you can.
>> Maybe we'll turn then to respiratory syncytial virus.
You've already said how serious this can be,
particularly in children but also in
those with weakened immune systems.
But thankfully, we have a couple of new tools in our toolbox,
so how about talking first about
the vaccine and any recommendations,
or information about that new vaccine for RSV?
>> First I think it's so exciting.
We've talked about an RSV vaccine for
years and there's been many trials.
It's nice to actually see two vaccines coming,
anybody for prime time.
Briefly, there are vaccines available
for first since we talked about infants, for pregnant women.
In the third trimester when we can get that vaccine,
and that vaccine we know definitely if you get in
pregnancy and time enough before the baby comes out,
those antibodies are passed on through the baby,
so it's a way to protect
those youngest infants from getting RSV huge.
That's available and we really want people to seek out to do that.
Certainly, if the infant does not get,
the mom gets vaccine less than 14 days before the baby is born,
we now have a monocle antibody to
give all infants under the age of eight.
This is game changing stuff with
all the hospitalizations we see for little ones.
Then there's vaccination available for people age
60 and above another high risk group,
which does decrease risk of disease and hospitalization.
It's a really exciting time for RSV.
>> Very exciting. You mentioned the antibody,
and Dr. Milson, maybe you can talk a little more about that.
>> Just to reiterate, Dr. Agwu was saying,
as pediatricians it's a amazing how many kids get admitted to
the hospital in the winter for
complications of RSV and other respiratory illnesses.
To have something and multiple things,
we are very fortunate to be
able to offer that to infants this year.
We're really excited in pediatrics about what
that may do to the number of kids coming into the hospital.
Hopefully, we'll see reductions.
The antibody is a new product.
It's similar to a previous product that we had,
and it's been so successful in reducing.
Again, antibodies, like we learn with
COVID don't prevent infection.
But the antibody protects kids who do get
infected from getting significant enough disease
that they wind up in the hospital.
The idea is that it's been so successful in reducing
hospitalizations that it's actually been
recommended for all infants under eight months of age.
Any infant under eight months of age
is eligible for obtaining this product.
This year, there's going to be a little.
It's going to be a little rocky because
the product just came out over the summer.
The CDC and FDA just finalized
the recommendations in the American Academy of Pediatrics
over the last month or so.
Hopefully, parents are excited but patient
because it's going to take some time for it to get
into the market and get into
pediatrician's offices and hospitals for it to be available.
For people who have
pre-term kids or children ask your pediatrician,
ask at the time your child is born what is available for them.
Hopefully, over the winter that'll become more
available and we're really excited to see the impact it will have.
>> The only thing I'd add to that is
certainly it's going to take us
the whole healthcare system
and all of you getting vaccinated for moms,
knowing when that happened.
Keeping track of these things so we know who's eligible for what
so we can use these modalities to the best of their abilities.
>> Because if we can get the mom vaccine during pregnancy,
we might not have to give this to the baby.
Because again, the antibodies that moms pass along
is effectively what we're giving babies
whose moms couldn't get the vaccine.
There are two great options that hopefully will
protect babies this year and to come.
>> So exciting. See these medical advances and have more options.
Do we know what's happening with RSV?
We had a lot of transmission last year.
Have we seen much yet this year or do we know what to expect?
>> [inaudible]
>> We're always perplexed and RSV used to be very consistent in
its pattern and we'd start to see cases
in our institution or a health system in September.
Then it would start to climb in mid October. Here it is.
It's mid October and we haven't really seen RSV,
so we did as Dr. Agwu mentioned,
saw a little COVID spike last month and
whether that impacted the RSV season, again,
we don't know, but this is about the time when we expect to see
RSV flu usually comes November, December.
Crystal balls are just not as [inaudible]
>> It's been very disruptive.
>> We're hoping to be prepared but I don't think we know yet.
>> I think that's right.
>> Then we haven't talked about influenza yet.
Do we know what the landscape looks like,
or perhaps what the Southern hemisphere
has seen because that traditionally has been predictive.
Any information?
>> Yeah. I think certainly everything is I think there's a bit of
flux happening with climate
and COVID and the way things are intermingled.
But that being said, there was a peak seen in
the Southern hemisphere in April,
May, I think and oftentimes,
what we see there predicts what we're going to see.
I don't know for sure what we're going to see.
Certainly, the vaccine is designed to be able to address
that virus that we saw and
hopefully in many years it predicts it well.
But I don't know that we can say for sure what
our season is going to look like based on that.
But certainly, we're hoping we're prepared with
the different modalities that we have in the pipeline.
>> We do have the influenza of vaccine of course.
>> Absolutely.
>> And use that Southern hemisphere information to predict.
>> Exactly.
>> Maybe we should remind everyone.
Even if you've gotten the flu vaccine before,
why would you need to get it again every year?
>> Yeah, flu vaccine just like
the COVID vaccine and hopefully
that RSV vaccine and eligible people,
it won't always protect you from getting the infection,
but it hopefully will keep you alive.
Vaccines were designed to keep people
alive from infectious diseases.
Although some people will recall getting
influenza despite getting the vaccine,
they're still here to talk about it.
To me, these vaccines
are really a miracle and we should take advantage of them.
>> I can't drive this point home enough.
I think it's so often.
Someone says, I got the vaccine and I got the flu.
I'm like, well, I'm glad
you got the vaccine because imagine if you hadn't,
how bad that flu could have been.
We know even in the years where the vaccine is
a total mismatch to the virus that's there,
we still know we see fewer deaths.
We see fewer hospitalizations and
less severe disease and so we absolutely get it,
particularly if you're one of those high risk populations.
>> I just want to bring us back to where you started,
which was in the basic prevention.
We're sitting here saying, we don't know about RSV,
we don't know about COVID,
we don't know about influenza,
but we know from being in the hospital that there are
a lot of sick kids out there now with something,
whether it's entero virus or rhino virus,
or parrot influenza virus.
There are a lot of viruses out there and that's how you started.
All those things we talked about,
although we don't have vaccines for them,
we know that washing your hands, covering your mouth.
If you have a cold and not a fever,
maybe think about wearing a mask to protect those around you.
All those basic things are still
really important to keep people safe and healthy.
>> That is a wonderful place to end.
I'm so glad you brought it back to
those basic prevention measures.
Thank you so much both of you,
for spending time to cover
these topics today and thank you to everyone who was watching.
We hope you enjoyed this presentation
and we encourage you to follow
Johns Hopkins Medicine right here on
Facebook and our other social media platforms.
You can learn more about these illnesses
on our website www.hopkinsmedicine.org.
Thank you again for attending and stay
safe and healthy this respiratory virus season.