Too Old for Pediatrics, Too Young for Primary Care — Enter Adolescent Specialists

Q: What is an Adolescent Specialist and why should teens see a doctor if they aren’t sick anyway? 

A: Wellness Visits are important for adolescents to learn about taking health into their own hands and getting a chance to talk about personal concerns with a doctor.  There are specialty trained physicians who are there to support and accept teens as they are, no matter what.  Today’s adolescents face tremendous social and academic pressures, as well as potentially life-threatening illnesses, habits, and behaviors.  Although a pediatricians and family practice providers can care for most adolescent problems, adolescents can receive greater benefit from seeing someone more focused on their needs and challenges.  Adolescent health specialists are medical doctors who have completed at least 4 years of medical school and 3 years of general pediatric, family practice, or internal medicine residency training who then continue specialized training and/or fellowships in adolescent medicine.  These specialists have the training and expertise to help pre-teens, teens and young adults with their complex physical, behavioral, and emotional health care needs—from physical exams and immunizations to reproductive and mental health care. 

RA and COVID-19

Q:  I am on Renvoq.  Can I receive any of the COVID-19 Vaccines? 

A:  Based on the current information, yes.  People with rheumatic diseases will not be able to get any of the live vaccines under development for the novel coronavirus. However, according to William Chen, MD, Chief of the Adult Clinical Studies, Center for Vaccine Development and Global Health, University of Maryland, “…we don’t expect that there will be any issue with non-live vaccines.”  The currently announced vaccines use a new technology whereby a genetic molecule called messenger RNA (mRNA) teaches cells to create a version of the coronavirus spike protein. This prompts the immune system to make antibodies against this protein so the body can recognize the virus and fend off future infections. Unlike traditional vaccines that use weakened live or dead versions of the entire virus, these new types of vaccines are expected to be as safe for immunocompromised patients and patients on immunosuppressant medications. 

Current, although limited, evidence shows that people taking disease-modifying antirheumatic drugs (DMARDs), including biologics, are not at a higher risk for getting COVID-19 and the death rate is the same as the regular population.  2.8% of those hospitalized for COVID have autoimmune disease which is about equal or even less than the percentage of those in the general public.  European League Against Rheumatism (EULAR) suggests that the majority of people with rheumatic diseases who contract COVID-19 have similar outcomes to the general population, regardless of which disease-modifying medication they take. There is some limited, observational data that there are some medications taken for rheumatic disease that may be slightly protective. 

Do note that certain medications may need to be temporarily stopped if you have a confirmed COVID-19 infection, have been exposed to someone with a COVID-19 infection, or are experiencing common COVID-19 symptoms such as fever, dry cough, or shortness of breath. However, please do not stop or change medication dosage without contacting your rheumatologist or primary care provider. This is especially important with corticosteroids, which should never be stopped suddenly.

COVID-19 Vaccine Pre-Testing for Reactions

Q: Flu shots have been making me progressively sicker. Skin rashes, large irritated area at shot site, etc. Might there be something like an allergy test with micro dosing to test COVID-19 vaccine reaction?

A: No, but as far as allergic reactions to previous influenza vaccines are concerned, none of these newly announced COVID-19 vaccines are grown in eggs, so egg allergies (the most common cause of reaction from influenza vaccine) should not be a problem. Also, make sure your provider knows of your reactions from influenza vaccine as there are egg-free options (for flu shots) that might work better for you.

HPV – Who Should Get Vaccinated

Q: Who should receive the HPV Vaccine and why should they get it?

A: The HPV vaccine (Gardasil) is recommended for boys, girls, men, and women age 9 to 45.  HPV is a sexually transmitted virus that causes cervical & vaginal cancer, penile cancer, anal cancer, and cancers of the mouth and throat.  It also causes genital warts.  Data shows that the immune system has a better response when it is given at a younger age.  Once a person is infected with HPV, they may remain infected with HPV long-term.  While the HPV vaccine can help prevent infection, the vaccine does not cure an infection that is already present, so it is most beneficial to get the vaccine long before becoming sexually active.  It is thus recommended to get the HPV vaccine at age 11-12 to provide maximum benefit.