Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: Even as we wait for a Covid-19 vaccine, the process of vaccine development has been vastly improved, Elizabeth Tracey reports

A given year’s flu vaccine has often not quite matched the strains of the virus circulating, due to the time needed to make the vaccine and other constraints. Now Andrew Pekosz, a vaccine expert at Johns Hopkins, says those days may be behind us with lessons learned from the development of Sars-CoV2 vaccines.

Pekosz: The time line for moving a vaccine through testing into real world vaccination campaigns can be shortened without a compromise in terms of safety. If that’s one lasting legacy of this pandemic it would really be tremendous because there’s so many vaccines that are mired in the moving through the phase one, two three process. So many companies just don’t want to move forward with new vaccine formulations because they’re essentially being told they have to work through this 15 year process.  :30

Pekosz says a more nimble vaccine development and manufacturing process will also allow the system to respond rapidly as new viruses and different strains of old ones emerge. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Different age groups will need different Covid-19 vaccines, Elizabeth Tracey reports

Did you know that children, adults, and elderly people all receive flu vaccines based on their age and immune response? The same is very likely to be needed when it comes to a Sars-CoV2 vaccine, says Andrew Pekosz, a vaccine expert at Johns Hopkins. And that may stymy current vaccine front runners.

Pekosz: Just because you’re first to cross the line doesn’t always mean that you’re the best. Because it’s quite possible that some of the ones that are still just entering phase three trials, may actually have better efficacy. The other thing that’s important for us to understand is oftentimes we think of a vaccine as one size fits all. We have to understand that immunizing  children is different from immunizing adults is different from immunizing the elderly. Each of those age groups has a very different response to infection and a very different disease progression.   :33

Pekosz says even the need for more than one shot for sufficient immunity may vary according to age. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can a mixture of antibodies help our bodies respond to Sars-CoV2? Elizabeth Tracey reports

Engineered viruses form the backbone of a few of the Covid-19 vaccines being used and tested around the world, and these vaccines stimulate our bodies to make a range of antibodies against the virus, while some other vaccines rely solely on a single antibody. Andrew Pekosz, a vaccine expert at Johns Hopkins, says this may turn out to be the more antibodies, the better.

Pekosz: Everybody is focused now on these neutralizing antibodies because that’s the best correlate of protection we have with other coronaviruses as well as with other viruses in general. Those neutralizing antibodies bind to one very specific part of the spike protein, and they primarily work by preventing the spike protein from attaching to infect cells. Are some of those other antibodies, that bind to other areas of the spike protein, do they do something in terms of helping the immune response, in the body?  :30

Pekosz notes that only when these vaccines are widely administered will we know if one strategy is best. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Could some vaccines prompt a broader immune response? Elizabeth Tracey reports

Sars-CoV2 vaccines all attempt to stimulate the body to produce antibodies against the virus’s spike protein, used to infect our cells. Yet Andrew Pekosz, a vaccine expert at Johns Hopkins, says some of the vaccines being tested also elicit other responses.

Pekosz: We always focus on antibodies. What we don’t think a lot about is the role of T cells in protection. T cells do lots of different things but in the simplest way when it comes to a Sars-CoV2 vaccine, there are these T helper cells  which help your B cells make antibodies. There’s a lot of data out there right now suggesting that people who are exposed to common cold coronaviruses may have some T cells that actually cross react with Sars coronavirus 2. We may be able to tap into some level of pre-existing immunity and enhance that a bit to get up broader protection against Sars-CoV2.   :33

Pekosz notes that while antibodies may wane over time, the T cells remain capable of responding to the virus. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: There are still many steps to getting a Covid-19 vaccine to market, Elizabeth Tracey reports

At least three vaccines against Sars-CoV2 are in later stage clinical trials domestically, with another just entering this phase. Andrew Pekosz, a vaccine expert at Johns Hopkins, says there’s no way to speed up the process.

Pekosz: These phase three trials just take time. Because you’re double-checking safety, you’re double-checking, in the case of a vaccine, what’s called immunogenicity, which is does the vaccine induce some sort of an immune response, and that immune response differs based upon the kind of vaccine you’re using, but the thing about phase three trials is it measures efficacy, so it actually goes out there and says, I’ve got a group here that’s been vaccinated, I’ve got a group here that’s been sham vaccinated, and we have less disease in our vaccinated group than in our sham group.  :30

Pekosz says exposure and potential infection with Sars-CoV2 is taking place naturally after a volunteer has been vaccinated, although in the UK there is consideration of exposing vaccinated volunteers to the virus to see if they are immune. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Treatment with radiation for many cancers is easier than ever, Elizabeth Tracey reports

When some women with breast cancer had surgery, a single dose of radiation in the OR proved as effective as a more lengthy course after the procedure, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says improvements to radiation therapy are key.

Nelson: The ability to very selectively target where the radiation goes is beginning to impact on how the dose is given. Now that the aiming can be much more precise that safety margin is substantial now, and it’s enabled the radiation oncologist to begin thinking about can you deliver radiation at a fraction that’s more effective in treating the cancer perhaps, and actually may be even more convenient, and I think that’s what you see here for breast cancer.  :27

Nelson says use of radiation therapy for many cancers is transitioning to much shorter courses of treatment, and these are not only more convenient for patients but also result in outcomes that are at least as good, and sometimes better than more lengthy treatment. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can a mailed in screening test for colon cancer work? Elizabeth Tracey reports

Sending people colon cancer screening kits where they can simply send in a fecal sample they collect themselves at home is cost effective and acceptable, a new study finds. The test relies on the presence of either blood in the stool or cancer DNA, and may also increase the number of people who are willing to be screened. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, comments.

Nelson: I think what we’ve learned is if you have this kind of a test in a serial manner you get it year after year after year, if you have three or more consecutive tests for blood or for cancer DNA, you’re probably in pretty good shape. I think there’s going to be more work on exactly which test to use when and the most cost effective and effective way, but the bottom line at this point is we’re talking about two approaches that have a great deal of effectiveness.   :27

Nelson says if the screening test identifies a problem, colonoscopy to further evaluate and possibly treat is indicated. He notes that colon cancer rates among those younger than 50 have been increasing, and urges people to ask their primary care physician about screening. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Among those with cancer, Covid infection affects those with leukemia most, Elizabeth Tracey reports

If you have leukemia, you may be at high risk for severe Covid-19 disease, a recent study found. Yet William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says delaying your treatment is really not an option.

Nelson: The problem with leukemias is that they are very often highly aggressive diseases that have to be met with significant treatment quickly. There’s very little in the way to get around that. As agents that can treat the viral infection improve and the outcomes with leukemia and in the setting of this infection will likely improve as well. But this business of delaying some of these approaches, there is a significant worry that this will have longer term consequences.  :26

Nelson says that with regard to Covid-19 transmission, no studies have shown that people in hospitals and many other healthcare facilities are at greater risk of contracting the infection, and in point of fact, may be at reduced risk because of intensive infection control practices, so he urges people not to put off cancer treatment for this reason. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A new targeted agent in certain cancers proves very beneficial, Elizabeth Tracey reports

People with a mutation in their cancers abbreviated RET may benefit from an agent called selpercatinib, two studies in the New England Journal of Medicine report. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: They reported on two different studies. One of them for a rare-ish kind of cancer, it’s called a medullary thyroid cancer it very often arises as part of an inherited syndrome, where people get more than one cancer of the endocrine kind of organs, in that one the responses were stunning. The other trial that was reported there are defects in these RET genes, acquired defects, in many different cancers although its not a very common one, one group of them were so-called non-small cell lung cancers, and in that case the drug was also incredibly effective for those people.   :32

Nelson says the number of drugs that target specific mutations is increasing, and that’s good news for people with cancers of all types and argues for genetic analysis of tumors.  At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: The Academy of Medicine updates its view of the nursing profession, Elizabeth Tracey reports

The National Academy of Medicine has updated its report on the state of nursing as a profession. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says the original report is the most downloaded report ever by the academy, and notes that this version once again advocates for a more educated nursing workforce.

Davidson: Because we know that nurses with baccalaureate education in working in institutions there is less mortality and better patient outcomes. In essence we’ve seen the other side of the equation in the Covid-19 pandemic. Where in residential age care facilities where there’s only one registered nurse on duty for eight hours a day that we have had the ravages of Covid-19. And that has been a phenomenon across the world.   :28

Davidson says more education enables nurses to implement things like infectious disease transmission prevention strategies in their workplace, and that helps patients as well as clinicians stay safe. At Johns Hopkins, I’m Elizabeth Tracey.