FAYETTEVILLE -- The Northwest Arkansas Democrat-Gazette has an online resource for readers to ask questions about covid-19 and its impact on the region.
Dr. Marti Sharkey, Fayetteville's public health officer, answers the questions.
Sharkey is a pediatrician with a background in infectious disease. She reports to the city Board of Health, which advises city officials on matters related to the health and well-being of residents.
The newspaper will post periodic updates with Sharkey's answers to readers' questions. Today's answers pertain to questions about covid-19 vaccination.
To ask a question, visit nwaonline.com/askcovidquestions. Questions should be limited to topics related to the pandemic.
QUESTION: Will taking Advil or Tylenol soon after getting the covid vaccine reduce the effectiveness of the vaccine?
SHARKEY: You can take over-the-counter pain medicine, such as ibuprofen (like Advil), aspirin, antihistamines or acetaminophen (like Tylenol), if you have side effects after getting vaccinated for covid. Taking OTC pain medications ahead of your shot to try and decrease symptoms is not recommended because it's not clear how that could affect the vaccine's effectiveness. The concern is that pre-treating with pain medications that reduce fevers and inflammation (like acetaminophen and ibuprofen) could dampen your immune system's response to the vaccine. The immune system responds to vaccines through a process called controlled inflammation. Covid messenger RNA vaccines work by giving cells RNA instructions that tell them how to make a non-infectious piece of the virus. The immune system then creates antibodies against it and can remember how to trigger an immune response if exposed to the virus in the future. OTC pain-relieving medications reduce the production of inflammatory mediators. That's why it's important to wait until after you've gotten the vaccine and have started creating an inflammatory response to take pain medication.
Research on children has shown that those who take acetaminophen before getting vaccines have a lower immune response than those who didn't. And a recent study out of Yale found that giving mice nonsteroidal anti-inflammatory drugs (also known as "NSAIDS") before being exposed to SARS-CoV-2 led to fewer protective antibodies from the virus.
The exception is for people who normally take these types of OTC pain medications as part of their routine to manage another medical condition. Those individuals should continue as normal but check with their doctor for additional guidance before getting the vaccine, since there could be ramifications for skipping medication.
QUESTION: Do all covid vaccines currently being distributed have equal components, or is one brand better than another?
SHARKEY: Both the Pfizer-BioNTech and the Moderna vaccines are mRNA vaccines. Unlike vaccines that put a weakened or inactivated disease germ into the body, the Pfizer-BioNTech and Moderna vaccines deliver a tiny piece of messenger RNA from the SARS CoV-2 virus to host cells in the body, essentially giving those cells instructions, or blueprints, for making copies of spike proteins (the spikes you see sticking out of the coronavirus in pictures). These proteins stimulate an immune response, producing antibodies and developing memory cells that will recognize and respond if the body is infected with the actual virus. The Pfizer-BioNTech vaccine has a 95% efficacy in preventing COVID-19 in those without prior infection. Thus far, the Pfizer-BioNTech vaccine has been found to protect against the variant that was first detected in Great Britain (B.1.1.7), and, while still providing some protection, it may be less effective against the variant first detected in South Africa (B.1.351).
The Moderna vaccine is 94.1% effective at preventing symptomatic infection in people with no evidence of previous covid-19 infection. Current research suggests Moderna's vaccine may provide protection against the B.1.1.7 and B.1.351 variants. Researchers are still studying this.
The U.S. Centers for Disease Control and Prevention and Food and Drug Administration recommended that states temporarily pause using the Johnson & Johnson vaccine out of an abundance of caution during an investigation into reports of several rare, but serious, clotting problems among women ages 18 to 48, occurring six to 13 days after vaccination. Unlike the other two vaccines, the Johnson & Johnson vaccine is a vector vaccine. Inactived adenovirus (a common virus that, when not inactivated, can cause colds, bronchitis and other illnesses) is used as a shell to carry instructions on how to build the spike proteins to the cells. The cells then produce a spike protein to train the body's immune system, which creates antibodies and memory cells to protect against an actual SARS-CoV-2 infection. The Johnson & Johnson vaccine has a 72% overall efficacy and 86% efficacy against severe disease in the United States. This vaccine's effectiveness has been shown to offer protection against the B.1.1.7 variant, also known as the U.K. variant. According to the analyses the FDA released in late February, there was 64% overall efficacy and 82% efficacy against severe disease in South Africa, where the B.1.351 variant was first detected.
QUESTION: If you had covid, when can you take the vaccine?
SHARKEY: There is not a set number of days you should wait until getting the vaccine. Rather, you should monitor your symptoms and make sure you are not feeling any severe covid symptoms, including a fever. The current isolation period following a covid diagnosis is 10 days after the beginning of symptoms. If it's been at least 10 days and you have minimal or no symptoms, it would be fine to get the vaccine at that point.
QUESTION: Do the vaccines contain ingredients that change a person's DNA?
SHARKEY: No, the vaccines do not contain ingredients that change a person's DNA. People hear "RNA" and are not clear on what RNA is, what it does, and its relationship to DNA. Messenger RNA is present in all human cells, and it is a critical component used in building proteins as it contains the instructions for building all of our proteins. To make proteins, DNA, which is contained in a cell's nucleus, is first transcribed into RNA particles. RNA in the form of messenger RNA (mRNA) and transfer RNA (tRNA) then leaves the cell's nucleus and enters into the cell's cytoplasm. It is important to note that RNA can only leave the cell's nucleus, it can never enter it. The RNA then attaches to a ribosome, where the RNA is translated into proteins. Once the protein is made, the RNA, ribosome, and protein all detach, and the RNA is subsequently broken down and removed from the cell with other metabolic debris. The mRNA in the vaccines enters the cell's cytoplasm, attaches to a ribosome, and is translated into the spike protein. Once the spike protein has been formed, the mRNA is quickly degraded and expelled from the cell. It does not and cannot interact with DNA.
QUESTION: Does the vaccine prevent infection and transmission of the virus? Can it cause infection and adverse reactions, including death? What are the pros and cons of taking the vaccine?
SHARKEY: The vaccines have been shown to prevent 95% of all covid cases and to prevent 100% of severe covid infections and deaths. Although very rare, it is possible to get covid after being fully vaccinated. The majority of these "breakthrough" cases have been asymptomatic and the remainder were mild. The reason that we are seeing these breakthrough infections is due to the still high viral load present in our country, unfortunately.
No, the vaccines cannot cause covid.
As far as adverse reactions, the reported cases of blood clots in women following a Johnson & Johnson vaccination prompted the CDC to recommend the pause. More than 6.8 million doses of the Johnson & Johnson vaccine have been administered in the United States. In addition, very rare occurrences of anaphylaxis, a potentially life-threatening allergic reaction have been reported following both the Moderna and the Pfizer-BioNTech vaccines. For comparison, each year, up to 100 people per 100,000 in the United States experience an anaphylactic reaction triggered by food allergies, insect stings, pollen, latex and other causes.
In other words, adverse reactions from vaccines are rare, especially when compared with the number of covid-19 hospitalizations and deaths in the United States. At least 550,000 Americans have died of covid-19, a rate of 1,700 deaths per 1 million residents. More than 2 million Americans have been hospitalized with covid-19 since August. That's more than 6,200 patients per million.
So, when considering whether or not to take one of the covid vaccines, the risks of the illness far outweigh the risks of the vaccine. The vaccines prevent serious infections and deaths, decrease transmission of the virus, and limit the ability of the virus to mutate and form variants. By getting vaccinated, you are protecting yourself, your loved ones and your community. You are doing the best thing that you can do to help end the pandemic.
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