Nov. 17, 2020

Meningitis 101

Meningitis 101

Dr. Todd Wolynn, CEO of Kids Plus Pediatrics in Pittsburg, Pennsylvania, works to educate about immunizations, infectious disease and primary care. He stops by to discuss the symptoms of bacterial meningitis, the potential long-term effects, and the vacc...


Dr. Todd Wolynn, CEO of Kids Plus Pediatrics in Pittsburg, Pennsylvania, works to educate about immunizations, infectious disease and primary care. He stops by to discuss the symptoms of bacterial meningitis, the potential long-term effects, and the vaccines available to help prevent it  – as well as the work he is doing to empower vaccine advocates.

 

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Transcript

John:
I'm excited to talk to you about meningitis, which sounds kind of odd, but it's something that is deeply affected my life. And I think it affects a lot of people as well. And I think there's some really good information to get out into the public space about meningitis, but before we get in too deep, tell me what you can about yourself and, and your practice and what you do.


Dr Todd Wolynn:
I am a general pediatrician. I'm a lactation consultant and I'm also the CEO of a, an independent pediatric practice in Pittsburgh, Pennsylvania. The name of that practice is Kids Plus Pediatrics. And we're in Pittsburgh. We have three offices about a hundred employees, so we're kind of a large, I guess, small size practices, is how they categorize us.


John:
Okay. So let's talk about meningitis kind of generally speaking, what is meningitis?


Dr Todd Wolynn:
Meningitis is an inflammation of the meninges. So that's the lining that covers over the brain and the spinal cord. The question gets to what can cause meningitis and there's a few different causes, right? So there's bacterial causes, there are viral causes and rarely there's even fungal causes. But most commonly when people refer to meningitis, they're typically talking about bacteria or viral meningitis. And those two are pretty different.


John:
Different in what way? So I, as I've mentioned before, I'm a survivor of bacterial meningitis, but I know some people that have had viral and it seems to be less severe.


Dr Todd Wolynn:
Correct. Yeah. In general both are pretty uncommon, right? So these are relatively rare compared to other viral bacterial illnesses, but that's correct. I would say viral meningitis, you will have symptoms that represent the inflammation again of the meninges, the lining of the brain and the, and the spinal cord. So you can have symptoms that can be somewhat similar, headache, fever, neck stiffness light sensitivity, visual issues, sometimes cognitive issues, but in viral meningitis, the symptoms typically aren't as severe, are self-limited and typically can go away. They may require some medical support, but oftentimes may not require medical support. Conversely, bacterial meningitis can cause real serious disease. So it, it also is inflaming the lining again, the meninges over the brain, the spinal cord, but these symptoms can become quite severe. And the thing that the that's really the, the scariest piece of bacterial meningitis is that the symptoms can go from mild, almost like cold like or viral, you know, mild viral symptoms like to coma or death with within a day's time. Now it could take longer, but it can go that rapidly. And that's why it's quite terrifying when we hear about outbreaks in our community, because when they hit, you will oftentimes see the picture of a relatively healthy, a child or young adult who gets this disease. And, you know, you hear terrifying stories of these people ending up in ICU, or even, even dead in rapid fashion.


John:
I guess what you're saying is the bacterial would be more aggressive and more fatal. So it sounds like it can happen very quick or maybe not.


Dr Todd Wolynn:
Correct. Yeah. It doesn't always have to have that rapid 24 hour course. And I'll tell you that you hear cases. I'll distinctly remember one of a girl and I think she, I think she did not survive, but she had gone to the emergency room three times, three times within like a day and a half or two. And again, because these symptoms are kind of nondescript at first, maybe some achiness, some fever, some headache that, you know, an onset, it might look like a viral illness and you go to an emergency room and you're not looking at that initially. And while the patient may feel pretty lousy, the, the healthcare providers as they do the workup if they're not suspecting meningitis, they could easily write it off as, Oh, this looks kind of viral. I don't know exactly what it is. Just here have some fluids. They might give them IV fluids or tell them to drink and send them home. And I distinctly remember this girl and I don't remember if she went to the same year, three times. I know she went to at least the same one twice. Second time went back again was told oh it looks viral. I think maybe was for, I don't remember what the particular treatment was, but by the third time she showed up and then went into an ICU. I don't believe she survived. And that just goes to show that this is a really hard disease to, to accurately diagnose early. And even when, even when accurately diagnosed and antibiotics are administered for neisseria meningitidis, the bacteria, even when you do that, you still have kids that die or go on to have significant long-term complications. So it's, it's a, you know, it's pretty terrifying in that respect. Even if you make the right diagnosis, you could have, I think it's about 10 to 15% of people will go on to have death at 10 to 15%, even if accurately diagnosed. And another 20%, like one in five can have long-term complications. And these can include depending on how the bacteria is kind of invading the body. If it's just in the the meninges, you can have damage to nervous tissue, right? So cognitive issues, you can have vision issues. You can go on to have a deafness you can, depending on if it starts to go into the bloodstream, you can have things like amputations, organ loss. So you, you start to look at what's called a meningococcal meningitis, which is inflammation of the lining of the nervous tissue versus meningococcemia where it gets into the blood. And that has a particularly high fatality rate. So when we look at the two different types of ways that it can attack along the lining of the nervous system versus the bloodstream, the death rate goes up to as high as I think, 40%, if it gets into the bloodstream. And if you've ever seen pictures of, of patients who have suffered that type of infection, what you'll see is what are called purpura. Those are ruptured essentially blood vessels with leaking blood and people will have these kind of reddish purplish spots under the skin. And that's a particularly scary sign when we see a purpuric rash that that's a real emergency. And if we ever see kids with that rash, they immediately are into the emergency room in intensive care unit, typically if it's related to neisseria meningitidis.


John:
As far as what meningitis looks like, I think you just kind of walked through most of it there. Purple spottiness I've heard that. Are there any other telltale signs that would, it would indicate meningitis versus...


Dr Todd Wolynn:
Yeah, if we think of like classic meningitis signs, right? So the purpuric lesions are when the blood stream on the bacteria is getting into the bloodstream. When we think straight meningitis, we'll oftentimes hear kind of the classic things you're taught in medical school is, you know, people complaining of a headache sometimes like, you know, just a horrific headache, neck stiffness, light sensitivity. If we see those, you know, are, are kind of the red flags should be going up for, Hey, am I possibly dealing with some form of bacterial meningitis here? And neisseria meningitidis isn't the only bacteria, but it's it's certainly the main one we think of for these symptoms. And again, that requires getting those kids or young adults or infants or older adults. I mean, it can affect any age group, but in this disease, it does affect kids and young adults particularly Meningococcal B. And we can talk about the different stereotypes, which are different kind of types of neisseria meningitidis. But yeah, when you see symptoms of horrible headache, neck stiffness, light, sensitivity fever, boy oh boy, that that is something that should get any healthcare provider pretty nervous, and getting that patient in for immediate care. The bloodstream, again, it could have achiness, fever, but by the time you're seeing the purpuric rash, these patients are gonna look horribly sick. They could already have impact of organs, again, they potentially could also have neurologic issues. But when their organs are getting affected and that purpuric rash is being impacted really you're starting to see systemic or full system effects of that bacterial infection.


John:
Why do you think that it is that it affects adolescents and youth so much more so than other generally the population?


Dr Todd Wolynn:
Some of these diseases have relation to either a condition so like infancy we know kids are more susceptible to certain bacteria. So meningococcal B is known to impact infants and can cause disease. But adolescents and young adults for meningococcal B also are susceptible as are the other types of meningitis, which we'll talk about. And that's more likely related to types of behavior and living quarters. So we know that certain types of meningitis really seem to, for whatever reason cause infection in these populations that live in close quarters. So dormitories at like colleges, barracks and military installations where lots of people living in close contact. And the other thing, when we think of dormitories in college life are certain types of social behaviors, sharing drinks and intimate contact is also felt to spread this disease. So in college, we know those are all pretty high risk types of behaviors. So those are the two things we often think about for a higher risk for kids with meningitis. So in the military you know, the recruits are now, I believe uniformly immunized against both meningitis B as well as types A, C, Y, and W and again maybe following this, we can talk about the different types. And now in, in general population, I would say for high school, at least in our area in Pennsylvania, it's mandated to get what's called the quadrivalent meningitis vaccine. And that protects against types A, C, W, and Y, and then the B, which does not fit in the same vaccine, you have to get a separate meningitis B vaccine. That is given at an older age and required by some colleges, but not all. So if it's okay with you, if you'd like, I can talk a bit about the different types of meningitis.
John:
Yeah, absolutely. Let's do that.


Dr Todd Wolynn:
I think there are 12 different types of neisseria meningitidis. And they're broken down by what are called serogroups. So they're identified by different proteins expressed on the outside of the bacteria. And it's pretty interesting. If you look at the epidemiologic studies, they can tell you what types are more predominant during different times. So different decades you'll see that sometimes type A's more prominent, or type C is or type w and so it's also geographically different. So what might be very common types in the Eastern hemisphere might be very different in the Western hemisphere. Now you heard me reference type B and I kept mentioning it separately from several of the other types. So the most common types we see in the U S and the Western hemisphere are definitely types A, C, W and Y. And that's why they came up with a vaccine to address those four types. So there is, what's called a quadrivalent vaccine, quadrivalent standing for four serogroups, and that's types, A, C, W and Y with a first dose given an age 11 to 12 years of age. And then a second dose of boosting dose given at around age 16 years old. So it's a two dose series again, first dose at 11 to 12 with the second and final dose given at age 16. Now you heard me say the quadrivalent at A, C, W and Y, you didn't hear me say B and while they've tried and tried, and they're continuing to try to get a vaccine that takes care of A, B, C, W and Y so far, they haven't been able to get the B in there without interfering with the other types. So currently the meningitis B vaccine is given at age 16 with a follow-up dose. Usually they recommended about a year. So we give that dose at 16 and 17. And again, that's the one that we see pretty commonly in those groups. Like I said, that college age, or living close-quarter living in barracks or dormitories.


John:
I don't want to get into COVID-19 specifically, but just in general, how does the infectious rate of COVID and how COVID has spread? How does that link or become common with meningitis? Is it through the droplets?


Dr Todd Wolynn:
Yeah, there's still a lot to be found out about COVID right? So it's a virus. So we're comparing that as we compare it to these types of bacterial meningitis, different in that COVID is a virus that neisseria meningitidis as a, as a bacteria, the while they both infect secretions, the droplets that are spread spreading COVID, we believe are small to very small droplets, so it can travel three to six feet, and there's even some modeling that shows it could even travel further and smaller droplets. In bacterial meningitis, we don't think of it really being suspended in air very long. When we think of fatality the COVID depending on the data you're looking at could have a fatality rate of 1, 2, 3%, I think, in the higher range. But we've already talked about the neisseria meningitidis can have pretty significant fatality. If you are looking at the meningitis, we said maybe 10 to 15%, and if it gets into the bloodstream up to 40%. So the thing that's terrifying about the bacterial disease neisseria meningitidis is it's absolute rapid symptoms progressing to severe or death within 24 to 48 hours, whereas COVID, which is scary and certainly has killed lots and lots of people isn't nearly as fatal, but it's pretty darn infectious. And as we see, and I do like to point this out, what we're seeing with COVID right now is a world without any herd immunity. So it's a, it's a new virus. There's no real protection in the, in the population from it. So if you're exposed, we see how rapidly it's tearing through the, the USA and the globe. The interesting thing with neisseria meningitidis that bacteria is that people can carry this in their nasal pharynx in the back of their throat, essentially, without causing any disease. And we don't know why some people, it goes on to progress to disease and another people, it doesn't. They just seem to carry the bacteria. So that's another kind of fascinating quandary that we have with neisseria meningitidis.


John:
Yeah. And that's the same thing for me too, especially with the infectious rate of meningitis, it seems to be pretty infectious. But where I was in a college setting, when I, when I got meningococcal meningitis, I was the lucky one. So nobody else had any symptoms or nobody else was hospitalized or anything with, with any kind of symptoms. So is it normal for that type of scenario as well?


Dr Todd Wolynn:
Correct. Right. So a lot of times you'll see one person get it while maybe living in a dorm or in a fraternity, or even at home, and nobody else getting any symptoms. Now, there have been cases certainly were, if you swab everybody, they come in contact with, you can see people that may be carrying the bacteria, but again, having no symptoms. And so we still don't have a clear understanding as why that may be related to certain types of genetic predisposition or behavior, but we don't have absolute answers on that. If you're in close contact with somebody that has meningitis, meaning sharing a household or an apartment or a dormitory, we will treat those people. Just because we know there's risk. And we can't predict if they might go on to get the disease. So there is treatment that goes to, to close, close contacts of people that go on to get the disease.


John:
In your practice or in your medical experience, have you had any firsthand encounters with meningitis?


Dr Todd Wolynn:
Yeah, I mean, it's the thing is it's rare. So in my twenty-five years of practice, we've had a couple patients that have had it. I saw more when I was a resident, because don't forget when you're a resident and you're working at the hospitals, you are that referral center for a large region, as opposed to a practice where you could potentially go your whole career with maybe only seeing a couple of cases or perhaps a few. When you're working at the hospital in the emergency room or in the intensive care unit, you definitely are going to be seeing those patients referred in from the entire region's worth of practices. So there, sadly, I did see kids with meningitis now, thankfully the majority that I remember over those three years of residency and four years of medical school the majority survived, but some did not. And someone on to have really terrible complications, again, there's amputations there's organ failure. And then having you know, the wonderful opportunity of working with the national meningitis association, I've had the chance to meet other survivors like yourself. So Blake Schuchardt and Francesca Testa both survive, but both had complications whether it was cognitive and muscular kind of need to recuperate or amputations or organ failure. So you know, I've, I've certainly met people as well that have survived. And I actually did 14 years of clinical vaccine research. And I remember when we were involved in the early studies looking for a meningitis vaccine, I met a gentleman who had four limbs amputated because of his experience with neisseria meningitidis. So it's it can be a pretty, pretty devastating disease.


John:
Without a question. It can. So I guess it's the combination of the rareness of the disease and kind of the ambiguous nature of the symptoms that makes it really hard to detect in a, in a timely manner.


Dr Todd Wolynn:
That's right. Yeah. You don't seem, you don't see it frequently, so it's not necessarily the top of your mind and the symptoms can start off as pretty run of the mill viral symptoms of achiness, a little fever, just not feeling right. Some headache. I mean, that can be anything right. That could be flu. That could be just a, a non-flu viral illness. And as I said, that one girl that went into the ER, three times, you know, within, I think it was like 24 hours or so two times they sent her back out saying it looks viral. And I think the second time gave her some fluids. But you know, if you're not thinking of it, if you're not doing the testing, which can include blood work to see how the immune system, particularly the white blood cells are reacting to the infection that could give us an idea if it's bacteria or not. And if you're thinking meningitis besides getting blood samples for looking for cultures of blood counts, we usually do, what's called a lumbar puncture. And while this sounds pretty terrible when needles inserted into the cerebral spinal fluid to get a sample of that, and that should lower in the spinal column it is, it is a test that can tell us if there's a bacteria invading into the cerebral spinal fluid. So those, those tests really help guide the decision for types of treatment.


John:
In my experience, when I was taken by ambulance to the hospital, of course I'm unconscious. So I don't have any memory of that, but the doctors that were at the ER, when I arrived, we're trying to identify the, what the issue was. And based on the way I was presenting to them, they originally thought that I had a drug overdose and it wasn't.


Dr Todd Wolynn:
So how long were you sick for before you were unconscious?


John:
Basically, I was feeling bad starting on a Thursday evening and I was in the hospital by noon on Saturday. So I went to bed Thursday evening feeling kind of like I had the flu, which is another thing I want to ask you about too, as a, as it relates to the flu and woke up Friday morning with the worst, you know, looking back at it, the absolute worst flu symptoms anybody could ever have with getting sick. And I had to like vertigo feeling where I was, everything was spinning. I couldn't, I could stand, but I couldn't stand for more than a few seconds because it, I fell like this, the world was spinning to me and I was violently getting ill and after maybe an hour or two that stopped. And I went back to sleep in my bed and by the grace of God and lots of other miracles that happened in between a friend of mine found me unconscious called 911. And they took me to the, to the hospital by ambulance. And it was at that point where the, they thought that I had overdosed on or they had thought that I had overdosed on drugs or something.


Dr Todd Wolynn:
Right, I mean, cause unless you had fever, the very first thing that goes through a lot of people's heads are teenager you know, unconscious, let's start thinking of things. They can cause loss of consciousness. So there's, there's basically algorithms we go through, but they include, you know, overdose, which certainly is not uncommon. And if you look at the reasons for a loss of consciousness in that age group, drug certainly is high. So you have to consider it, but you always have to consider infection. Then it sounds like they must have realized at some point that infection was a possibility. And it sounds like they ended up treating you for that too as well.


John:
I think the way that they finally determined it was through the lumbar puncture or what I would call it, what I call a spinal tap.


Dr Todd Wolynn:
That's right. Yep. And there's, once you get a positive lumbar puncture, you know, you could have a negative one if you perhaps maybe don't get the needle in the right space and get enough fluid. But if it's positive, it's positive. So if you're getting white blood cells that are increased in the spinal fluid, and if you see any bacteria, when you do the analysis, that's pretty definitive. And then again, combined with their symptoms and the history, whatever history they could get, then you got to jump into the action and start supportive measures and get antibiotics on board as quickly as possible.


John:
Yeah. And that's one of the things that I think is so important and critical too, is that I don't, I didn't have any history. Now, I don't know if the ER knew that, you know, initially, but I wasn't on any kind of drug. And I had no medical history as far as, as far as anyone was concerned. I was 19 at the time. And of course I was also 10 feet tall and bulletproof. So I mean, I had no history of any kind of disease or illness or any kind of, I was I was your average 19 year old. And so for my timeline there, the Thursday evening to Saturday, sometime around probably 10:00 AM to noon, you know, we're talking 24 to 48 hours, like you said earlier. And it went from, from zero to, to something pretty quickly.


Dr Todd Wolynn:
And were you living in an apartment or a dormitory?


John:
I was in an apartment at the time. I had two roommates. I'd been in a dorm that the pre the previous year, but no, but I was, you know, very social and in lots of things and in intermural sports and I, which is some of the things that are kind of baffling to me is that I, I didn't, you know, I sit in classes with anywhere between 10 and 200 kids throughout the week and doing intermural sports where particularly the basketball was going on when I was, I was playing and coaching a basketball team and coming into contact with, with people physically and all those kinds of things. And again, I was, I was the lucky one. I was the chosen one. So, look at me.


Dr Todd Wolynn:
Well, and again, you, so by medical history standpoint, while nobody might've known exactly what went on for those 24, 12-24, 36 hours proceeding, what ends up being you being sent to the hospital, your age and your setting of 19 year old attending college, right there already puts meningitis much more high on my list, but it also puts up, you know, alcohol and drug overdose, right. And trauma. But if you didn't have a obvious hit to the head where we saw a blood or a wound to the head, you start kind of going through this decision-making process, which says, okay, if it doesn't look like trauma, could this be seizures? Could this be, you know lots of other things, but then you start looking at tests in addition to your history and your physical exam. So you rapidly start trying to acquire all this information. So you get as much history as you can simultaneously you start applying your knowledge base as to what we call index of suspicion. What are the kinds of things that we know that can cause these symptoms? Well, not narrowing it down too quickly because you don't want to miss something. Right? So what if we say, Oh my God, this could be meningitis, but in fact, you overdosed on drugs, right? Particularly in narcotic. Well, if I wait too long to administer the medication that can reverse those symptoms your life could be at risk as well. So we, we obviously look at your vital signs and we look at symptoms that would go along with overdose versus infection versus seizure versus, you know, maybe it could be something bizarre. Maybe you had a rare bleed or a stroke, right? All of those things can cause loss of consciousness. So we very quickly have to, you know, check your neurologic exam, check your vital signs, check your pulses because all of those things can start revealing and taking me down one path versus another, a bleed, a tumor, drugs, infection. And as we start doing the work of, sometimes we're working up a few of them at once by doing some of these initial screens, just with history and vital signs and physical exam. And then slowly you start peeling off, nope, this does not look like a bleed or it doesn't look like a tumor from, you know, what we know, or, or maybe we don't know if we say, well, let's get to the things that could most quickly and most having their most devastating impact. If we don't do something. So drugs then goes higher on the list and infection. And again, a bleed would be pretty rare for that age. So, you know, all this stuff is happening like on the fly in the emergency room. That's what those doctors are trained to do is take all that information, the information they're gathering in rapid fashion as well. As soon as you walk in there and start going down the decision tree and deciding what needs to be done. And as you said, blood count would have added to your vital signs. And then if they did a lumbar puncture, they would've gotten, there we go. And I don't know your specific case, but it sounds like if you think it happened after the lumbar puncture, that's usually pretty definitive. If the positive signs are in the blood, in the cerebral spinal fluid.


John:
And just to make things even more fun, it seems to me like it seems to rear its head during flu season or the winter or early spring months. Is that just me?


Dr Todd Wolynn:
Well, there can be some seasonality to it. That's for sure. And don't forget. Closer quarters often is associated particularly with school years, right in the fall and spring that could happen in the winter too. We won't see as much in the summer, but is typically out in the summer as well. And we're not in as close a quarters all the time cause we're outside. But yeah, there can be some seasonality to it and all the more reason why I tell people it's important to get things like vaccines that you can be protected against. So first and foremost, as we're talking about meningitis, there are the two meningitis vaccine. So there's the quadrivalent meningitis vaccine at 11 to 12. And again with the second dose of 16, and if you get that, you're pretty well protected all the way through your college years or at least late teen and even early twenties. And then the meningitis B vaccine, which will be offered at 16 and again, a second dose, a 17-18. And if you get those two that has pretty amazingly successful protection against the five types then that are in those two vaccines. If you go on to get a flu vaccine, that's additional protection against the disease that we're going to have to figure out is flu causing this. Cause as you just pointed out, if it happens during flu season, now I have to also figure out, well, wait a second. If I'm thinking of infection could flu cause this, that would be really typical to put you into a coma, but sometimes flu can be horrific and it can kill people. So we know that flu can be devastating. And then you know, there are other infections that can be pretty overwhelming. So not all of them have vaccines, but the ones we can be vaccinated against makes a lot of sense.


John:
While we're on the topic of vaccines, if you don't mind clearing up any kind of misconceptions that may be out there about vaccines in general.


Dr Todd Wolynn:
Sure. Yeah. So here's the deal after clean water. And, and the, the work that went into cleaning public water systems really the next most amazing public health feat was the creation of vaccines to prevent vaccine preventable disease. Prior to vaccines, you know, worldwide, we would have millions of kids, including in the U S dying of infectious disease, whether it was polio or whether it was diptheria or whether it's pertusis or meningitis. I mean, all these diseases. And as vaccines started coming out to protect against all these diseases, we saw a dramatic increase in survival of kids remaining healthy all the way through adulthood. When a lot of these kids, you know, yes, you could survive maybe a disease like measles or mumps or rubella, but some kids, a lot of kids didn't or went on to have permanent disabilities, even chickenpox. You know, almost all kids my age had chickenpox. I actually didn't. I was one of the first recipients of the adult chickenpox vaccine, but the point being that all these diseases that we have vaccines for caused horrific illnesses and deaths in kids, and people think, Oh, it's better to get the natural affection and survive it than to get these vaccines, that's a hundred percent not true. In any of the vaccines that we have out now while nothing is risk-free. And that means Tylenol. That means aspirin. That means bananas. That means water. Everything can have a level of toxicity depending on who's receiving it and what dose and how they get it. So yes, vaccines can have risk just like Tylenol or aspirin, but they're incredibly safe and very effective. Most vaccines are incredibly highly effective. I'd say they're probably the most variably effective vaccine we have out there is the flu vaccine. And even that one, while it's less affective than most of the vaccines we have. And it depends on the year. Some years are better than others. We also know it has amazingly protective effects, even on years where it isn't a great match. And even if you still get flu, having gotten the flu vaccine, we now know that it reduces the chance of that flu infection resulting in a hospitalization in ICU admission or even death. So I do want to point out that there's a lot of misinformation out there. And for anybody listening to this podcast, what I would say is that a lot of people hear misinformation on social media. The sources aren't always clear. They come in oftentimes saying, Oh, we're, we're worried about safety or, or, or the impact of vaccines. But what they don't tell you is a lot of people that are pulling the strings behind these campaigns are funding them, is that when they push this agenda being anti-vaccine, that it's often time's got profit tied to it. So there's money to be made. Sometimes it's political gain, or sometimes it's power and even hostile foreign nations. We have good data on this, which this anti-vaccine narrative to cause distrust in our institutions. But imagine, you know, John, if you had had the meningitis vaccine, and when I talk to Francesca and Blake, the same thing, right? They said, you know, I think Francesca was like a month away from getting her first meningitis vaccine when she got the disease. So who wouldn't do anything to protect their kids with a vaccine rather than get these diseases. So, you know, I understand that because of the disinformation out there, there's a lot of questions and having questions does not make you anti-vaccine, it makes you a good parent. And if you want your questions answered, absolutely you should have a healthcare provider take time and answer those questions. But for the people that are pushing absolute nonsense. And I mean, there is some crazy stuff out there, not just vaccines, but conspiracies that the earth is flat, or we never landed on the moon or you name it. All I can say is what does the science say? And as a physician, I took an oath to do no harm. And I took an oath to, you know, really serve families. And that's why I went into pediatrics. So my kids are all vaccinated against all the diseases, including meningitis and all, all, all three of mine got both meningitis vaccines, they got the HPV vaccine, they got the flu vaccine. I mean, they got all the vaccines that they could get and I'm vaccinated too. Like I said, I even even entered into a vaccine study when I was in medical school. My infectious disease professor said, go down to room six and check that kid out with chickenpox. And I looked at him and I said I haven't had chickenpox. He went what and I said, I haven't had it. He goes, are you sure? And I said, yeah, I have my blood tested. I don't have any antibodies. And he, he took out a piece of paper and a pen. He goes, Hey, they're currently doing a study on the first vaccine against chickenpox. So this was before we had a vaccine for chickenpox. This would have been I think it would have been early, early nineties, I think, early nineties, maybe 91, something like that. And I went down and they they interviewed me at the study. They drew my blood. They said, yep. You don't have any antibodies. And told me about the study and I entered it. So I'm also a vaccine study patient who went through clinical trials, got my blood drawn a bunch, got the vaccine as a, as a patient going through testing and continue to get testing for multiple years after that. So yeah.


John:
When did the meningitis vaccines become widely available?


Dr Todd Wolynn:
Yeah, so the quadrivalent remember the ones that covers type A, C, W and Y the first vaccine in the U S that came out for the quadrivalent meningitis vaccine came out around 2005. And then the meningitis B B as in boy vaccine that came out around 2015. So about 10 years later. And there's different companies that make it. So I don't usually, for these purposes mention one particular vaccine over the other, if they're safe and approved and by the FDA and given in offices, I don't care what company makes it as long as it can be used.


John:
So those are relatively new. And for me, what it wouldn't have helped me in 1998,


Dr Todd Wolynn:
Correct. Yeah. Right. Because this is before. And like I said, I remember, I think it was Francesca who think hers was like, just like a month or two later is when she, she recalled them. She would have been able to get her dose. She and Blake both have pretty compelling stories. And I was honored to be able to do work with them on behalf of the National Meningitis Association.


John:
And regarding the National Meningitis Association, how do you think education has changed with meningitis over the past 5, 10, 15, 20 years?


Dr Todd Wolynn:
Yeah. I'll tell you what I think is going on. And there's a couple of things. One it used to be, I think that when your healthcare provider there, weren't like all that many vaccines when I started and before I started the reviewer. But if your healthcare provided it, I think most people just went ahead and accepted them. As newer vaccines are coming out and with the advent of social media, particularly its huge popularity over the last 10 to 15 years, there's so much different amounts of information out there and really hard to sort through what is what. And so the really factual sites like the CDC and the NIH and even medical professional organizations, sometimes it's hard to, it's hard to even sort through that. I think in the last five, six, seven years, they've improved the information they provide. So they're not talking to scientifically and making sense of information, but what's happened with social media is you get both good information, but oftentimes a ton of bad information. And it's hard for somebody to sort through that and where the trouble begins is when misinformation comes out, we, as humans are hardwired for detecting threats and risks. And if you think about it clickbait, right, the stuff you tend to click on is really sensational and oftentimes scary whether it's about, you know, shark attacks or Loch ness monster or alien abductions, right. They could be really fantastic, almost believable right after the titles read, but you still have a tendency to want to click on it because we're hardwired to do that. And so when you see information like, Oh, these vaccines sterilize people or government and doctor or pharma, or they're all in bed with each other and making money off of harming people, right. It sounds crazy, but you, you, a lot of people will click on those stories. And again, as I said, the real ulterior motives for people that push this, this information out there, but how do you combat that? Well, you combat that with people who have real stories of what the diseases can do and that's because these diseases harm and kill people. And before we had vaccines, they devastated multiple families each year, which doesn't happen now because the vaccines are there. So the National Meningitis Association just like groups like families fighting flu, go out there and help real people tell real stories of survival from these diseases are sadly people, they lost to these diseases. And that becomes a real awakening. When you see a real person with a story that's their own, or their family's telling you just how bad these diseases can be. And that is a pretty potent anecdote to false and, and, and, you know disinformation. And so that's why I think groups like national meningitis association and other groups that are out there trying to tell people what can really happen really as a potent affect. It doesn't take away from the fact that healthcare providers and doctors need to be better communicators. A lot of times we interrupt our families and our patients. We oftentimes are rushed to get in and out of the room. And so don't give adequate time. I think the families that have questions, and honestly, I believe that visits and the constraints put on healthcare providers are so significant that we can't spend the time we want to, which is why I'm a huge proponent of healthcare providers getting out on social media platforms to be able to engage their families in other ways, which is why our practice has a Facebook page and a Instagram page and Tik Tok. And we have a YouTube and a Vimeo channel and we podcast because then we can reach families 365 days, even seven days a week in 24 hours a day, depending on when they're up and looking for information.


John:
And in general, if somebody feels like they trust their healthcare provider, speaking to you as a, as the provider should I feel like I can't ask these questions or like you are in a rush to do whatever you need to be doing. I mean, these are discussions that we should be having. And as, as the patient and as the parent, we need to have these discussions with the providers, is that right?


Dr Todd Wolynn:
A hundred percent yes. And if your healthcare provider, isn't taking time to talk to you, I think you give them one more chance by saying, Hey, I have some questions. Can we talk about these? And they have a chance to either take some extra time and discuss it then or say, no, I really have to get out to the next patient, but let's email or find another way, or let's talk via phone and set up a call, which I think is totally fine. Right? Some days may be really crazy or somebody might be really sick in the next room and they may really have strong time constraints. There's nothing wrong with that. If they're willing to say let's talk tonight or talk tomorrow or at the end of this week, but if they don't give you an option to talk to them, I think it's completely reasonable to go and look for another healthcare provider who will answer your questions. I mean, that's, I want a healthcare provider that's going to answer my questions, but again, what we do and I mean, we do Facebook live every every Friday I do Tik Tok live every Monday night. We try and make a bunch of venues and through our Facebook page, we've had thousands and thousands. I think we're closing in on 10,000 questions over the last several years where we take time to answer them there. So we try and meet people where they're at because we recognize the 15 minutes in the exam room or 20 minutes, or sometimes even longer might not be convenient for the patient. Maybe they have to go pick up another kid from childcare, or maybe they have something they have to run do and just want to get the visit done and get immunizations or whatever the issue is they need to have address that day. So it's not just the healthcare provider that may be in a hurry that they could be the family members. So I think in 2020, we have lots of different ways to take time to talk to one another, but we do have to take time to talk to one another. And by the way, for families that have a lot of questions or even fear of particular treatments, including vaccines, I don't view that as, as wrong. I view that as somebody that wants what's best for their kid and needs to have time to answer those questions. Now the, how you meet the, those questions and how you spend that time can vary as I just described, but there's nothing wrong with having questions. The real issue I have and I, you and I talked a bit before we started, this was, you know, in 2017 in the fall, we posted a video about the HPV vaccine and that vaccines an amazingly effective and safe vaccine. But it, for whatever reason, through an HPV seemed to really trigger people that have strong anti-vaccine beliefs. And rather than when we, so we posted a video saying, Hey, did you know the HPV is truly cancer prevention? And it, it was a really popular video. It had 15,000 views. People were calling and making their appointments. And then three weeks after we posted it, the anti-vaccine community, these are not people with questions. These are people that were hell bent on attacking us, found the video and launched a global coordinated anti-vaccine social media attack on us over 800 accounts on Facebook posting over 10,000 times simultaneously attacking our ratings and reviews on Facebook, Yelp, and Google from all over the world. So it was Australia, New Zealand. It was California. It was Czechoslovakia. It was Ireland. It was Italy. It was all over the world. And it wasn't, hey, we have questions about this vaccine. It was you're baby killers. You're killing people. Didn't know us. Weren't even from our community, but they now use the tactics of swerving and attacking. And by the way they, they again oftentimes have very nefarious, ulterior motives. So those are the people that I would say really cause real destructive discord, but people with general questions, absolutely not. And their questions should be answered.


John:
Speaking of social media, Dr. Wolynn, where's the best place to find you on the web?


Dr Todd Wolynn:
Sure. Visiting our practice website, at www.kidspluspgh.com.


John:
Well, thanks. A bunch of Dr. Wolynn. Appreciate everything you're doing, especially as it pertains to the meningitis community. And thanks for joining me.


Dr Todd Wolynn:
I really appreciate the opportunity. And I think what you're doing is great to educate your listeners. So thanks for the opportunity to speak.

Dr. Todd Wolynn

CEO at Kids Plus Pediatrics

Dr. Todd Wolynn always loved to build things. When he was a kid, his favorite toys were his building blocks; he’d create cities and castles for all sorts of battles with his army toys and action figures. A proud product of the Pittsburgh Public Schools — Colfax, Reizenstein, Allderdice — Dr. Wolynn has grown up, but he’s still that same kid at heart; he’s still living in the East End, and he’s still building. These days, his goal is to build the model pediatric practice for the 21st Century.

Dr. Wolynn graduated from Washington and Jefferson University and the University of Pittsburgh Medical School, then earned a Masters in Medical Management from Carnegie Mellon University. He’s been a board-certified pediatrician and an International Board-Certified lactation consultant for more than 15 years, and he currently serves as both the President of Kids Plus Pediatrics and the Executive Director of the Breastfeeding Center of Pittsburgh.

When he’s not seeing patients at Kids Plus, Dr. Wolynn continues to build his reputation as a national expert in immunizations, breastfeeding medicine, pediatric sleep issues, and practice management. He speaks across the country on those and other topics, and is a proud member of seven national medical organizations, including the American Academy of Pediatrics, the Academy of Breastfeeding Medicine, and the US Lactation Consultation Association.

BlocksFor 6 years in a row, Pittsburgh Magazine named Dr. Wolynn one of the region’s “Top Doctors” in general pediatrics. For 9 years in a row (and counting!), he’s been named one of America’s Top Doctors by US News & World Report.

Dr. Wolynn and Dr. Wolf were named EY Entrepreneur Of The Year® 2016 Health Care Award winners in Western Pennsylvania and West Virginia for the innovative care and service work they do at Kids Plus.

A self-proclaimed “Squirrel Hill Boy,” Dr. Wolynn loves both Aiello’s and Mineo’s Pizza (though he thinks Aiello’s might be “a smidge better”), NFL football (he calls it “a bit of an addiction”), all sorts of fantasy and science fiction (he’s gotten his boys hooked on Star Wars), swimming, and frisbee golf (he’ll challenge anyone to 9 or 18 baskets at Schenley Park).