Vaccines

I got word from my transplant team last week that they are approving anyone who is on maintenance doses of immunosuppression (which I am) to get the covid vaccine when their turn in line comes. Because I am a mental health provider at Duke, they consider that front line, and I am in the 1a category. I was able to go onto the portal and schedule my first covid vaccine for tomorrow morning! 

I am so excited that I get to take it this soon, but am also not necessarily expecting that I will get the full 95% efficacy given how my immune system works. I'm going to give a brief, simplified version of an immune response below to explain why. 

It's good to know that there is an innate immune system, which is kind of like the front line of an army and heavily hits pathogens, and then there is an adaptive immune system that recognizes things as self versus non-self, and once it's identified something as non-self, can then later attack it with precision, like a targeted hit. Normally, when you get a vaccine or are infected with something new, a macrophage, one of the types of innate immune cells, 'eats' it, breaks it down, and then displays the new weird proteins to a T-cell. In the covid vaccine I'll get, mRNA for the covid spike protein will be injected, my cell will take it in, and then it will read the mRNA to make the protein (since that is what happens normally when mRNA is in a cell). It doesn't get into the nucleus so can't change your DNA, and the mRNA will only last a few hours. The spike protein is part of the virus, but not the whole thing, so you can't get infected from the vaccine. The tcell the does two things. It activates the B-cells to recognize the proten as non-self. Antibodies are made to find this protein in the rest of your body, which then attach to the protein/infection so that macrophages know to come eat it. These antibodies also go into your memory cells, so that next time you're infected you recognize it right away and can make antibodies more quickly. The other thing that happens is that the Killer T cells inject things into the infected cells that make it burst, killing the cell and stopping the infection/protein. Macrophages then clean it up. When these cells burst, it can cause inflammation, fever, achiness, etc. So when people say they get sick after a vaccine, its actually your immune system doing what it is supposed to, and the stronger your side effects, the more you know it did its job.  

So when I got the transplant, this same process would make my body recognize my new heart as non-self. Because of that, I've been on immunosuppressants, and will be for the rest of my life. The two medications I'm on stop my body from having a robust response to my new heart. 

Unfortunately, it also means that the medications will also have this effect for vaccines. That doesn't mean it won't work, but I probably won't get as strong of a response. So even once I'm vaccinated, I won't know how well it worked and will need to keep being very careful. 

With everything happening in our country last week, I have been really holding onto hope. I hope that we can start hearing more of the truth from our politicians and that they are able to calm the masses. I hope that with the new adminstration, we get covid under control. I hope that the domestic terrorists who broke into the Capitol and caused terror and destruction are held accountable, and that our country really takes a deep look inward to understand how this has built up over the last 4 years, and finally do things to address it. I hope that we get back to a place where we value science and actual experts, and where we are humble enough to know that our opinion after a google search is not as valid as that of someone who has studied a subject for years. 

I'll keep you posted on how I'm doing post vaccine, both 1 and 2. I have a fair number of friends who have already gotten it, since they are in the medical field, and it will be interesting to see how similar or different my reaction is.