#551 - RSV Vaccine Update, Social Media Impact, Speaking Appreciationese

From the Advisory Committee on Immunization Practices

1)  New RSV (RSV) Vaccine Indications for Adults

At it's June meeting, the ACIP reviewed new evidence to tailor respiratory syncytial virus (RSV) vaccine recommendations for adults 60 years and older. The new recommendations are:

• Adults 75 years of age and older should receive a single dose of RSV vaccine

• Adults 60–74 years of age and older who are at increased risk of severe RSV disease receive a single dose of RSV vaccine.
  • The list of risk factors is NOT yet finalized, but the possibilities mentioned include: asthma, chronic kidney disease, chronic obstructive pulmonary disease, coronary artery disease, current smoker, diabetes, stroke, obesity, heart failure, immune compromise, and living in a nursing facility.

• Patients who got an RSV vaccine last year do not need another. It is best given in late summer or early fall.
• The ACIP includes in this recommendation three vaccines: the protein subunit-based Pfizer vaccine (Abrysvo) and GSK vaccine (Arexvy) and Moderna’s new mRNA vaccine (mResvia).

The ACIP based this recommendation on as-yet-unpublished data presented to the CDC that showed that the following factors increased the risk of RSV-associated hospitalization:

• Number of chronic conditions:
  • One condition - relative risk (RR) 2.1 vs. none, and
  • Two conditions - RR 7.3 vs. none
• Age group:
  • 60-74 years – RR 1.9 vs. 50-59 years
  • 75 and older – RR 6.0 vs. 50-59 years

In the older populations, RSV illness is similar to strains of COVID-19 or influenza in terms of severity, is associated with a higher-than-expected rate of acute cardiac events, and usually results in prolonged convalescence needs, including skilled nursing facility.

In the Evidence-to-Recommendations presentation at the ACIP meeting, the evidence supporting these recommendations was reviewed as moderate to high for the protein subunit-based RSV vaccines preventing “medically attended RSV” (outpatient, emergency department or inpatient) and low for preventing hospitalization. For harms, RSV protein subunit vaccines cause no increase in Serious Adverse Events (moderate evidence) but may increase the risk of inflammatory neurological outcomes (e.g., Guillain-Barre syndrome) slightly (low evidence). The Moderna mRNA vaccine, in a single phase 2/3 study, had a vaccine effectiveness of 39% for prevention of medically attended RSV, and 80% for prevention of hospitalization. The evidence was graded low to very low for these outcomes. The harms from the mRNA vaccine were mostly an increased risk of severe reactogenicity (i.e., fever, local reaction; RR 1.54, 95%CI 1.40-1.68)

John’s Comments:

Note the conspicuous absence of any “shared decision making” recommendations in this update. CDC heard loud and clear from clinicians that SDM in this context was infeasible. In addition, it sounds like they realized that pharmacies were actively marketing the vaccine without worrying about the SDM. So, they gave up on it, but tightened the recommendations a bit, which I think is a better idea. In my opinion, the evidence for the mRNA vaccine is notably weaker than that for the protein subunit vaccines (largely because it’s newer), despite the equal recommendations. It may be that the ACIP wanted to provide an option for those concerned about “inflammatory neurological adverse events.” The mRNA vaccine must be stored deep frozen (-40 to -15 degrees Celsius) and can be thawed only for 30 days – all of which will limit its usefulness in practices. However, because this vaccine will be paid for only through Medicare Part D and not part B, it will be given primarily in pharmacies anyway.

References:

• CDC Newsroom. CDC Updates RSV Vaccination Recommendation for Adults. CDC. Published January 1, 2016. Accessed June 27, 2024.Link
• CDC. ACIP Vaccine Recommendations and Schedules | CDC - Recent Meeting Recommendations. Published June 28, 2024. Accessed July 1, 2024. Link
• Britton A, Melgar M, Roper L. Evidence to Recommendations Framework (EtR): RSV Vaccination in Adults Aged 50–59 years, 60–74 years, and 75 years and older. Presented at: Advisory Committee on Immunization Practices; June 26, 2024; Atlanta, GA. Accessed July 1, 2024. Link

From the Literature, the Surgeon General, and the Blogosphere

2)  The Negative Impacts of Social Media on Youth

It is estimated that more than 95% of adolescents utilize social media as an integral aspect of their lives.  With the social medial platform Facebook (now 20 years old) having over 3 billion active users, Instagram having an estimated 2 billion and TikTok 1.5 billion, the constant exposure to these platform algorithms has in many ways become a social experiment on a scale never before experienced in human history.

Yet, the potential negative mental health impacts of these platforms for youth and adults has been raised as a concern for years.  Studies published as early as 2014 began to show the increased risk for anxiety, depression, poor self-image, loneliness, self-harm, and suicidal ideation.  Additional studies showed that the structures and algorithms used on these social media sites strongly impacted the dopamine reward systems of the brain, raising concerns of their potential “addictive” properties.  

Smartphones did not initially raise major developmental concerns for children.  As social psychologist Jonathan Haidt and his colleague Zach Rausch have noted in their research, the problems started around 2010 when the smartphone platform was combined with other factors to form a perfect psychological storm, including social media apps, high-speed internet, extensive wireless networks, a backward-facing camera (encouraging selfies), addictive games, easily accessible pornography, and free apps that maximize profit by cultivating addiction and social contagion.

They write this toxic technological mix allowed smartphones to take over children’s lives. Usage rates averaging seven hours a day gradually but profoundly rewired their maturing brains. Haidt postulates this rewiring gave rise to four “foundational concerns”:

1. Social deprivation: a smartphone as an “experience blocker”, taking up hours a day that would otherwise be spent in physical play or in-person conversations with friends and family.
2. Sleep deprivation: too many teenagers stay on their smartphones late at night when they need rest.
3. Attention fragmentation: alerts and messages continually drag teenagers away from the present moment and tasks requiring concentration.
4. Addiction: apps and social media are deliberately designed to hack vulnerabilities in teenagers’ psychologies, leading to a dopaminergic-driven challenge to enjoy anything else.  

They note their research showed that girls proved more vulnerable to the damaging effects of social media, while boys retreated into online gaming and pornography.

All of this culminated in May of 2023, when the US Surgeon General issued an Advisory on Social Media and Youth Mental Health in which he made a call to action for policy makers, social media companies, researchers, parents, and youth and the American Psychological Association (APA) issued a Health Advisory on Social Media Use in Adolescence, making a series of recommendations based on the scientific evidence at to that point.  The Surgeon General followed in June of this year with an op-ed in the New York Times and calling on the US Congress to place a warning label on social media apps.  In July of 2024, the Governor of Virginia issued an executive order banning cell phone use in public schools as of January 1, 2025.

Dr. Haidt summarized his work in the 2024 book The Anxious Generation, where he  indicated that the path forward is one of collective action by implementing “new norms.”  These include; no smartphones before high school; no social media before 16; phone-free schools; and more independence, free play, and responsibility in the real world.

Mark’s Comments:

In their "Free the Anxious Generation" initiative, Haidt and colleagues write, “We state an ambitious goal: to begin the end of the phone-based childhood by the end of 2025.”  With movement toward that goal at the local, state and national level, it may not be long until we finally reach the “tipping point” and begin to turn the tide by becoming more intentional as to how this new technology is used in order to maximize its strengths while neutralizing its limitations, for children AND adults.  And perhaps we will carry some of these lessons into how we choose to utilize AI.  But that’s a big “perhaps.” 

References:

See embedded links in the Pointer

From PeerRxMed ( www.PeerRxMed.org )

3)  Do You Speak Appreciationese?

“Each of us wants to know that what we do matters …. and that we matter.”  Gary Chapman, PhD and Paul White, PhD, co-authors of the book The 5 Languages of Appreciation in the Workplace

Do you like to feel appreciated?  Hopefully your answer to that question is “Duh!”  I sure do, and most others do as well.  Yet, in the midst of our incredibly challenging work, “not feeling appreciated” is cited in surveys as an all-too-common theme among not only physicians but all members of the care team.  If we’re not feeling appreciated, we’re likely not expressing it to others either, and that leaves an incredible vacuum for “negative emotional contagion” to run rampant across our organizations and communities (and families).  So, the real question is not if, but rather how do you (and others) like to be appreciated? 

Perhaps you didn’t realize that not everyone likes to receive appreciation in the same way, and that your attempts to show appreciation to others may be missing the mark.  Psychologists Gary Chapman and Paul White have devoted a significant portion of their careers to sharing the positive impact we can have on each other when we connect in a way that is resonant.  Dr. Chapman originally called this type of connection as speaking our “Love Languages,” and the two together brought a similar understanding to the workplace using the “Languages of Appreciation.”  

They observed that we are most deeply fulfilled when we receive appreciation in our preferred language/s and that unless we express our appreciation in another’s, we “miss the mark” and fail to meet their deepest needs to feel appreciated. This can mean  even our best of intentions can fall far short of their potential positive impact and leave others feeling unsupported and not valued – often described as “not feeling the love.”

Chapman and White have identified 5 primary “languages” of appreciation, including Words of Affirmation, Quality Time, Acts of Service, Tangible Gifts, and Physical Touch, and found that most people have a preferred primary and secondary language.   Incorporating awareness of these different “languages” in relationships can help to create stronger connections among coworkers and a more positive workplace environment.  That has certainly been my experience over many years as preferences for how we feel most appreciated are shared and explored.   

Having a culture of appreciation at work will not only help us get through challenging times but will enable us to feel more connected and deepen our relationships.  This week, perhaps you can learn more about (or be reminded of) the preferred language of yourself and others, and then practice learning some new languages to make sure you are “contagious” with appreciation.  And if you want to be contagious with me, a “You da man” with a smile and fist bump will work just fine. 😎

To learn more about your “language” (or for a “refresher”), see the resources below:

• 5 Love Languages Quiz: https://www.5lovelanguages.com/quizzes/  (Free)
• Motivating by Appreciation (MBA) at Work Inventory:  https://mbainventory.com/take-online-personality-assessment-inventory/  (NOTE there is a cost for this of $15 for the basic inventory, $25 for a “Medical” version)

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Mark and John

Carilion Clinic Department of Family and Community Medicine

Feel free to forward Take 3 to your colleagues. Glad to add them to the distribution list.

Email: mhgreenawald@carilionclinic.org