When should I get vaccinated?

CDC recommends that people get vaccinated against flu soon after vaccine becomes available, if possible by October.

It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.

Doctors and nurses are encouraged to begin vaccinating their patients soon after vaccine becomes available, preferably by October so as not to miss opportunities to vaccinate. Those children aged 6 months through 8 years who need two doses of vaccine should receive the first dose as soon as possible to allow time to get the second dose before the start of flu season. The two doses should be given at least four weeks apart.

What flu viruses does this season’s vaccine protect against?

Flu vaccines are designed to protect against the main flu viruses that research suggests will be the most common during the upcoming season. Three kinds of flu viruses commonly circulate among people today: influenza A (H1N1) viruses, influenza A (H3N2) viruses, and influenza B viruses.

All of the 2015-2016 influenza vaccine is made to protect against the following three viruses:

an A/California/7/2009 (H1N1)pdm09-like virus
an A/Switzerland/9715293/2013 (H3N2)-like virus
a B/Phuket/3073/2013-like virus. (This is a B/Yamagata lineage virus)

Some of the 2015-2016 flu vaccine is quadrivalent vaccine and also protects against an additional B virus (B/Brisbane/60/2008-like virus). This is a B/Victoria lineage virus.

Vaccines that give protection against three viruses are called trivalent vaccines. Vaccines that give protection against four viruses are called quadrivalent vaccines.

I have purchased Fluzone quadrivalent for the adult Sandwich flu clinics.

Adult Flu Clinics

Flu shots will be offered to the residents of Sandwich 19 years and older on the following dates:

Wednesday September 16, 2015    9AM-12Noon   1PM-4PM

Thursday     October 8, 2015    9AM-12Noon   1PM-4PM

Where:        The Human Services Building

270 Quaker Meetinghouse Road

East Sandwich, Ma.

Cost:           Most insurances will pay for the shot. (exceptions are United and Aetna). Please bring ALL insurance cards including  Medicare and Mass Health.  The cost for self pay is $15.00.

Appointments are necessary.  Please call (508) 833-8020 to schedule an appointment.

Those residents who will be having surgery, chemotherapy, or radiation prior to the clinics should call this office to discuss an earlier appointment.








Tick Season is Here Again-With More Diseases Than Ever!

Most people on the Cape are familiar with Lyme Disease, Anaplasmosis/Erlichiosis, and Babesiosis, but have you heard of Borrelia miyamotoi or Powassan virus?  The now well known black legged deer ticks can also carry these diseases.

Scapularis, Ixodes, Insect, Tick, Deer

In general, adult ticks are approximately the size of a sesame seed and nymphal ticks are approximately the size of a poppy seed.
Borrelia miyamotoi is a spiral shaped bacterium carried by deer ticks (which are active any time temperatures are above freezing).  Nymphs are most active from May to July and adults are more active in the fall and spring. Ticks carrying miyamotoi have been found in Sandwich.  Symptoms of a miyamotoi infection are fever, headache, and muscle aches.  Treatment is 2 weeks on the antibiotic doxycycline, which is also used to treat Lyme disease.http://www.nejm.org/doi/full/10.1056/NEJMc1215469

Powassan virus has been identified in patients in Massachusetts.  While it is generally accepted that a tick must be attached to a person for at least 24 hours to spread  infection, this virus seems to infect people in a shorter period of time.  Symptoms can occur from 1 week to 1 month after a tick bite.  As with other tick borne diseases, some people never become ill while others can have illness such as inflammation of the brain and spinal cord, fever, headache, vomiting, weakness, confusion, difficulty speaking and seizures.  Treatment is supportive.  http://www.cdc.gov/powassan/

How can you protect yourself?  Ticks live in wooded, brush filled, and grassy areas, so if you are in these areas here are some things you can do:

1.  Put deet on skin exposed areas (not on face or palms of hands).  The University of Rhode Island’s Tick Encounter website warns:

Repellents play an integral part in your personal protection strategy. Repellents containing DEET are not sufficient to protect against tick bites. DEET only repels ticks to areas where they could bite and even that little protection does not last long. PERMETHRIN kills ticks on contact. Clothing only repellents that contain Permethrin are very effective and provide long-lasting protection. The best protection you can achieve is by using a repellent that contains Permethrin on your clothes and one that contains DEET for your skin.

2.  Spray permethrin on clothes and boots/shoes

Watch videos about applying clothing-only repellent and how well Permethrin treated clothing repels and kills ticks.

3. Wear light colored long pants and long sleeves, tuck pants into socks or boots.

4.  Do a body check when you go indoors

5.  Treat pets with tick repellants

6.  Have a 3 foot tick free perimeter around your yard   http://www.mass.gov/eohhs/gov/departments/dph/programs/id/epidemiology/ticks/, http://www.tickencounter.org/prevention/protect_your_yard

If you do find a tick on yourself, use tweezers to grasp it as close to the skin as possible and pull straight up.  After removal clean the skin with alcohol and put an antibiotic cream on the area.

clipart style image showing the proper removal of a tick using a pair of tweezers

Helpful Hint

icon of a tickAvoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–do not wait for it to detach.

Go on tickreport.com if you want to send your tick to U. Mass. for testing


Shingles Shot

Zostavax, the “Shingles Shot”, is a vaccine produced by Merck Pharmaceutical Company and has been available since 2006.  The FDA has approved it for use in adults 50 years and older and the CDC recommends it for adults 60 years and older.  Many insurance companies will pay for their clients to receive the vaccine when they turn 60, but Medicare and Medex  plans will not pay for it.  In many cases, it is therefore best to receive the vaccine when you (or the subscriber) are still working, (optimally between the ages of 60-65).  Recent research has shown that immunity to the virus wanes 5-7 years after receiving the immunization.  The Centers for Disease Control and Prevention has not yet recommended a booster shot.

Glaxo Smith Kline pharmaceutical company is working on a vaccine which it believes will reduce the risk of shingles 97.2% in people age 50 and older.  More test results on this vaccine should be out this year.

Please call (508) 833-8020 if you would like more information on the Shingles vaccine.

Nuts Are A Healthy Snack

As little as 1 oz of salt free nuts a day can reduce your risk of heart disease.  Multiple large studies have consistently shown a 30% to 50% reduction in heart attacks or sudden death when  a handful of nuts was eaten several times a week.  Walnuts have omega 3 fatty acids which seem to prevent arrythmias from developing.  Almonds increase Vitamin E levels and lower cholesterol.  Vitamin E is an antioxidant which protects cells against damage.  There is some research out of U.C. Davis that almonds may reduce colon cancer as well as heart disease.  Cashews are also high in omega 3 fatty acids.

Instead of a sweet treat, grab a handful of nuts for a nutritious snack!

EBOLA Update

The Ebola Virus continues to ravage the 3 Western African countries of Liberia, Guinea, and Sierra Leone even as Americans seem to be losing interest.  The World Health Organization has published the following statistics:

Guinea            2793 cases                        1797 deaths

Liberia             8263 cases                         3515 deaths

Sierra Leone   10030 cases                        2977 deaths


21,086  cases                       8,289 deaths



CBS News

There are several vaccines being developed.  Three pharmaceutical companies with vaccines in the pipeline are:

Johnson and Johnson

This vaccine is in Phase I trials where it is being given to a few volunteers to check for safety and side effects.  Two shots must be given 1-2 months apart.

Glaxo Smith Kline

This vaccine is ready for Phase II clinical trials in February.  It will be given to a larger group of people, probably in Africa. It is made from a harmless cold virus and coated with proteins from 2 strains of the Ebola virus-Zaire and Sudan.  It seems to be well tolerated and induces antibodies against Ebola.


Mercks Phase I trial was stopped for a short period when volunteers experienced joint pain.  It has now resumed using a lower dose and seems to be well tolerated.


Tdap Vaccine for Pregnant Women

The Tdap shot (tetanus, diptheria, pertussis) is now recommended for pregnant women during the third trimester of every pregnancy (27th-36th week). The mother will produce antibodies within 2 weeks of receiving the vaccine which will offer her baby short term protection after birth. The infant can then be immunized starting at 2 months of age. An infant without protection can develop whooping cough and suffer severe complications such as respiratory distress, brain damage, and death.http://www.cdc.gov/pertussis/about/signs-symptoms.html

In 80% of cases, infants catch whooping cough from someone in the home (30%-40% of the time from their mothers), so it’s a good idea to have all family members and caretakers vaccinated before the birth.

We offer the Tdap vaccine. Please call (508) 833-8020 for information or to schedule an appointment. Most insurances, including Mass.Health will pay.

Flu Shots

Yes, I am continuing to give flu shots. The normal flu season on the Cape does not usually get into full swing until Jan./Feb. so it is not too late to come in for your shot. Although it has been widely publicized that one of the A strains (H3N2) is only 50% protective the other 3 strains in the shot are still effective.

Prevnar 13

Update!  The first Prevnar 13 clinic was a success and I now have a new supply of vaccine available.  If you would like more information or would like to make an appointment for the newly recommended “pneumonia  shot” for folks 65 years and older, please call (508) 833-8020.