COVID Vaccine 101

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COVID-19 Vaccine Blog

As many of you know, I worked in public health for over 20 years. It probably goes without saying that I’m pro-vaccine. While being pro-vaccine I recognize that many people are vaccine hesitant, vaccine deniers, or just plain leery of vaccines.

Information is power as they say, so I’d like to share some background on vaccines and then look more particularly at the COVID-19 vaccines and finally I’ll discuss COVID-19 vaccine in aesthetics.

A Brief History of Vaccination There was variolation…

It’s interesting to note that vaccination as a practice was first done in China over a thousand years ago. In the western world, vaccination was initially practiced in the 16th century and seems to have come via the Ottoman empire. The earliest version was called ‘variolation’ and it involved exposing an individual via a cut or scrape to infectious lesions on an infected person. It was a kind of controlled exposed to the actual disease and was first used to prevent smallpox.

…and then vaccination

Vaccination is a different process. With variolation there is controlled exposure to the actual disease-causing virus or bacteria. But with vaccination we are looking to protect someone without exposing them to the actual disease. Vaccination was first done in the late 18th century. It was observed that individuals who were exposed to cowpox, a pox virus that infects cattle, were immune to smallpox which is frequently deadly in humans. Cowpox doesn’t cause disease in humans but exposure to cowpox will stimulate the human immune system to produce antibodies against it nonetheless. As it turns out, cowpox antibodies are similar enough to smallpox antibodies that vaccination with cowpox (again it does not makes humans sick) prevents smallpox.

So vaccination is a process by why something similar to an infectious agent is presented to our immune system. Our immune system reacts to it because it is foreign. When it reacts it produces antibodies. Antibodies then provide future protection against that infectious agent. Vaccination is not about infecting an individual, it’s about training the immune to protect you without having to get sick in the first place.

Human Immune System 101 – Antibodies

But let’s take it back a step. What exactly is an antibody? Where does an antibody fit into the roles played by our immune system?

If you like, antibodies are like first responders. When there is a crisis they are the component of our immune system to react first. They are a type of protein that specifically recognizes an invader and they attach themselves to the invader. They are like a flare that alerts the other elements of the immune system that an invader is present. After the rest of the immune system is aware, we have many different ways we kill invaders – killer T cells, poisonous cytokines etc. But antibodies are the advanced warning system – like radar.

If we don’t have antibodies, it can take the body quite awhile to realize an invader is present. Without radar, we’ll only know we’re being bombed once the bombs are upon us. Without early warning the delay is enough to give the invader a big advantage – it has time to multiply and grow its army of invaders before our immune system gets after it.

If we’re lucky our immune system is fast and effective and kills off the infectious pathogen before it overwhelms our body. If we are unlucky or have a weak immune system the invader wins the day and we have long term illness or we die. If we don’t have antibodies against a specific infectious illness we eventually make them during that battle, some early antibodies (IgM for example) to get the process going, some later antibodies to protect us in the future should we face that invader again (IgG for example).

Antibodies will stick around a long time, but not necessarily forever. If have antibodies to an illness but we are not exposed to that infectious agent for a very long time our body will eventually stop making those specific antibodies and we’ll be vulnerable to that illness again. This is why, for example, common vaccines like diphtheria and tetanus must be provided every 10 years in adulthood. In infants and young children, their immune systems are immature so they may need multiple doses of vaccine in short order to keep reminding the immune system to make antibodies against common childhood diseases like polio or rubella (german measles).

And then there was COVID-19

COVID-19 has an advantage because it’s a brand new (novel) virus to humans. Because it’s a novel virus, we do not have antibodies against it or even something close enough to recognize it. Our body hasn’t seen it before and we have no first responders or a flare to alert the immune system. By the time our immune system is aware of the infection, COVID-19 has already invaded and co-opted millions of cells in our body to make copies of itself. This means we end up with such a high viral load by the time the immune system is aware, our immune system goes into full battle stations and throws everything at it. We go from all’s well to immune system RED ALERT.

The consequences of RED ALERT

An immune system in overdrive has consequences of its own. Your immune is powerful and the cytokines it produces for example, are poisonous not just to infectious invaders, but also to your own body. Your own immune system can kill you before it’s able to wipe out an invading virus. This was a common event in the 1918 pandemic. The immune system reacted dramatically to the Spanish flu particularly if it was a young and healthy immune system which why so many healthy young people died in the 1918 pandemic. Immune system reaction is one of the reasons dexamethasone (a powerful immune suppressing steroid) is used to treat COVID-19. This drug is used to suppress your immune system to stop it from killing you.

Why do teens and kids suffer less with COVID-19?

What about younger people – teens and kids? Why is it less severe in them? This is because they have less of the cells in their body that the spike protein on COVID-19 attaches itself to. The particular cells in the nasal passages, eyes, throat and lungs that COVID targets are much, much fewer in number in children and teens. So if they are exposed to COVID-19 their viral load is much smaller and their immune system has an easier time going after the virus since it has only the occasional enemy soldier to target rather than a whole army to face.

Finally COVID-19 Vaccine

Getting back to vaccination, it’s all about the antibodies. Vaccination involves presenting a protein to your immune system that looks like the spike protein on the COVID-19 virus. When you body sees this protein it chops it up into little pieces and makes various antibodies which will recognize those individual pieces of protein should your body ever see them again. That protein presented to your immune system has no capacity to infect you. It is not the virus itself, just a piece of protein similar to the spike protein on COVID-19’s coating. This is why you can never catch the infection itself from the vaccine. Remember, vaccination is not about infecting the individual, it’s about training the immune system by showing it something similar but not infectious.

What about this mRNA?

All living things require RNA (ribonucleic acid) or DNA (deoxyribonucleic acid). mRNA is just one type of RNA found in viruses (messenger RNA). RNA and DNA are the instructions that tell living cells and other agents like viruses how to operate and reproduce. In the case of COVID-19 the virus has RNA. We’ve all seen pictures of the coronavirus with its spiked exterior coating. Basically COVID-19 is a strand of RNA surround by a fat coating with spiked proteins attached to it (because it is fatty coated it is fortunately very easy to wash away with soap and water). The spike protein allows the virus to attach to certain cells in the nose, throat, eyes and lungs and allow entry of the viral RNA into that cell. The RNA instructs the cell to use its own apparatus make more COVID-19 virus. And so on. Our own cells become virus factories.

So how does this vaccine actually work?

In the case of mRNA vaccines, vaccinologists have created a section of mRNA that carries instructions on how to produce a part of COVID-19’s spike protein. If you inject that bit of vaccine mRNA into an individual it is taken up by immune cells in the body. The immune cell machinery reads the mRNA instructions and produces the protein. The protein produced is only a small bit of the spike protein and has no capacity to cause illness. However, the immune system sees it as foreign and launches an immune response which includes creating multiple types of antibodies against various sections of that spike protein. If that individual then contacts genuine COVID-19 the antibodies alert the immune system (send up a flare!) and the the COVID-19 is immediately destroyed.

Contrary to popular belief, RNA vaccines are not new; they have been studied and trialed since the 1990’s and found to be safe. What’s new is how rapidly the COVID-19 vaccine was developed after the genetic code of the virus was sequenced. The speed at which trials got underway and the number of different trials was also unprecedented. The fact is that the COVID-19 vaccine has had much more testing prior to approval than other vaccines in the past.

If there is a downside to this elegant new type of vaccination, it is the fact that RNA is very unstable and breaks down very easily. This is why the currently approved vaccines must be kept in such a deep freeze and why they must be administered quickly after they are thawed. Once injected into an individual the mRNA also breaks down quickly in the body, typically within a couple of days. But even a day or two of exposure is enough time for the immune system to react and produce antibodies.

Anything special aesthetic patients should know?

We have fielded questions about whether it is safe for individuals with dermal fillers to have COVID-19 vaccination.

The answer is YES. But as we’ve always said, avoid vaccination of any kind 2 weeks before or and 2 weeks after receiving dermal fillers. Dermal fillers are comprised of hyaluronic acid (HA), a natural sugar found in our bodies. In its natural state HA is a liquid. Companies that make dermal fillers have proprietary methods by which they turn that liquid into gels of various densities. When HA becomes a gel it starts to look a tiny bit more foreign to the body. For the vast majority of people HA gels do not cause any reaction. Your body sees them as inert.

However, sometimes people with autoimmune diseases (eg. Crohn’s disease, celiac, lupus, rheumatoid arthritis) have to be careful because their immune systems are on high alert all the time. For these individuals dermal fillers may cause a hypersensitivity reaction. It’s worth noting that dental work (fillings, cleanings) can result in bacteremia (bacteria entering the bloodstream). This will immediately trigger the immune system. If you were to inject dermal fillers around the same time you may react to your filler because your immune system is on high alert.

At ArtMed, we recommend patients avoid dental work for 2 weeks before and 2 weeks after dermal filler injections. Similarly, patients should avoid having vaccines with 2 weeks before or after dermal fillers because vaccines also stimulate the immune system.

In summary, it’s absolutely fine to have the COVID-19 vaccine if you have had dermal fillers injected in the past. But do not have fillers injected 2 weeks before or 2 weeks after receiving your COVID-19 vaccine.

The human immune system is a wonder. It is complicated and awe-inspiring. It has the power to heal and to kill. Learning to harness that raw power and direct it is one of the greatest health care achievements of mankind.

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