A JOLT OF HEALTH

Pandemic, Tripledemic, Epidemic Oh My! Part 1

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This week we begin with a most fascinating and complex topic intricately related to infectious diseases àImmunity or our immune system. This is our defense system against invaders which you can think about like our military; complicated, having many moving parts in different locations with different roles but are connected in key and sometimes elusive ways. The enemies our bodies confront are infectious organisms AND foreign cells that cause danger to our lives, including cancer cells. Yes! Cancer cells are also recognized and wiped out by our healthy immune systems.

There are two main parts to our elegant defense system against foreign invaders:

The innate immune system we inherit at birth and begins functioning immediately. It is made up of at least seven types of cells, many of which recognize invaders and when they do, surround it, take it inside, then eat and kill it.  Really! Kind of like a spider that catches its prey in the web and then eats it; only our immune cells are the spider and the web. This is called phagocytosis.

The adaptive immune system is an even more complicated system that we are born with, but it must have exposure to learn how to behave.  It learns what to hate (i.e. kill and attack to save our life) and then manufactures special soldier cells that live with us forever on alert for that said invader to dare again to attempt an invasion. Those are the B lymphocytes that, after primed, make antibodies. Antibodies are very special molecules built to fit and recognize the specific invader. It takes some time for this to happen after exposure (days to weeks) but once primed and ready, the recognition response is nearly immediate and lifelong.

The immune system and its integration of many parts (this summary is a massive simplification) is nothing less than miraculous!

Here we are, humanity, December 2022 facing two simultaneous epidemics and an ongoing pandemic.  

Because of these unique times, scientists have coined a new word to throw around the media:

Tripledemic = refers to three separate infectious diseases occurring simultaneously as epidemics, specifically RSV (respiratory syncytial virus), influenza and COVID19.

The RSV situation in children is thought to be bigger and more impactful this year because so many children were not exposed when they would normally be (i.e. less than a year old). Because children 1 to 5 years old were kept isolated during the pandemic they did not get exposed to RSV when they were younger and so are getting infected now, training their adaptive immune systems late and simultaneous with the younger ones getting RSV at a ‘normal’ age. If all those extra RSV infections occurring early this year in children isn’t enough, add this year’s early influenza season as well as Covid19 and a couple handfuls of other ‘minor’ cold viruses circulating at the same time. All these infections are expected to happen in the fall and winter (for many reasons some known and others not), just not all at once and with so many children with untrained adaptive immunity like in these times.

Adults are also affected as we were tucked away inside our little cocoons for the last three years.  Those over 65 are more susceptible to becoming severely ill from influenza as well as the other two culprits in this tripledemic. This is because one of the normal consequences of aging is that the power of the immune system declines. This explains why older people get more infections, more severely and have more trouble recovering. It is also why cancer is predominantly a disease of later life.

What do vaccines have to do this?  

Vaccines are immune system trainers, the Army Sergeants. Vaccines inject something like the virus (for instance, the spike protein in Covid vaccines) or the virus itself live -attenuated meaning weakened (MMR and chicken pox vaccines) or inactivated (influenza and hepatitis A vaccines) so that our adaptive immune system can prepare its defense. Most vaccines do not 100% prevent the infection from taking hold, but all (if specific enough to the invader’s form) help us fight off the invader and become less sick. Specifically, this means we recover faster or do not find ourselves fighting for our lives on a ventilator with Covid, suffering pneumonia from influenza if we are over 65 or having a three-day instead of a two-week illness from influenza if young.  This is why our county, state and national health departments are encouraging us to be up to date on our immunizations against Covid (including the latest bivalent booster which is the only one booster active against the currently circulating variant, Omicron) and influenza.

Also, note that infections themselves are immune system trainers. In the case of Covid, a combination of a vaccine and having been infected in the past are additive to our adaptive immune response. Research is active and ongoing in this area.

Tomorrow we'll continue to part 2.

Debra Glasser, M.D., is a retired internal medicine physician who lives in Olympia. Her laughter is infectious. Got a question for her? Write to her at drdebra@theJOLTnews.com

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