Doc: HIV-positive transplant: Who should get Shingrix?
Dear Dr. Roach: My son is a kidney transplant recipient. Is it safe for transplant recipients to get the new Shingrix vaccine?
Dear J.O.: Because the Shingrix vaccine is not a live vaccine, it is thought to be safe. It is licensed for immunocompromised people, like your son, but transplant recipients were not included in the published trials. As such, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention has not made an official endorsement as of this writing.
However, many experts do recommend the vaccine for people on the kind of immune-suppression drugs used for solid-organ transplant recipients. People with profound immune system disease, such as those receiving chemotherapy or people with very advanced HIV disease, may not respond to the vaccine. People taking lower-dose immune system modifying drugs (such as a dose of prednisone that’s 20 mg or less a day, low-dose methotrexate or azathioprine) generally should receive the vaccine, but the jury is still out for people with diseases like rheumatoid arthritis, who are taking biologic therapies such as rituximab (Rituxan) or adalimumab (Humira).
Studies are ongoing, and the ACIP and other advisory groups will make new recommendations as data become available. Until then, your son should talk with his transplant doctors about the vaccine.
Dear Dr. Roach: I have been unable to complete a yawn for a couple of years. You know, that final “aaah” feeling. My doctor just smiled and offered no explanation; I’m sure she had never heard of this before. I am a 70-year-old woman who is retired.
Any ideas, suggestions or recommendations to end this unsatisfied feeling?
Dear M.G.: Nobody knows for sure why we yawn. It can be related to low oxygen, fatigue or boredom, but there is a “yawn center” of the brain (in the hypothalamus) and even fetuses have been shown to yawn.
I have read two possible explanations why some people have incomplete or unsatisfying yawns: The first is that in some people, anxiety is the impetus to yawn, and that type of yawn just isn’t satisfying.
The second is that stretching of the muscles of the face and jaw are necessary for the yawn to be complete. For some people, repeated stretching (from a “forced” yawn) and breathing in very deeply can lead to a satisfying yawn. I’d be happy to hear advice from readers.
Email questions to ToYourGoodHealth@med.cornell.edu.