Department of Health Clinical Update - Monday, December 12
RSV in Alaska: Update and Management Strategies
On Wednesday, December 14 from 6-7pm, the Alaska Department of Health is hosting an online presentation and discussion to learn more about RSV and how to manage it here in Alaska. There will be an opportunity to ask local experts questions to help with the current RSV surge, especially affecting our pediatric population. The talk is geared for medical providers and those on health teams caring for sick children.
Register Here
Health equity continuing education needs assessment
The Alaska Center for Rural Health & Health Workforce is working collaboratively with the State of Alaska to implement a CDC funded grant focused on Health Equity in Continuing Education. Please complete this needs assessment to help us identify continuing education topic areas in the realm of health equity in order to provide meaningful training and education opportunities for Alaska's healthcare workforce.
Bivalent COVID-19 vaccines authorized for children 6 months through 5 years
On December 9, the CDC and FDA expanded the use of updated (bivalent) COVID-19 vaccines for children ages 6 months through 5 years. Children ages 6 months through 5 years who previously completed a Moderna primary series are eligible to receive a Moderna bivalent booster 2 months after their final primary series dose. Children ages 6 months through 4 years who are currently completing a Pfizer primary series will receive a Pfizer bivalent vaccine as their third primary dose. Children who have already completed all three doses of the Pfizer primary series are not currently eligible for a bivalent dose.
Bebtelovimab no longer authorized for use
In late November, the FDA announced that bebtelovimab, the sole remaining COVID-19 monoclonal antibody treatment, is no longer authorized for emergency use because it is not expected to neutralize Omicron subvariants BQ.1 and BQ1.1 according to the most recent data. Bebtelovimab was the last monoclonal antibody available for treatment of COVID-19.
Evusheld Fact Sheet updated
In early October the FDA added important information to the authorized Fact Sheets for Evusheld (tixagevimab co-packaged with cilgavimab) to inform health care providers and individuals receiving Evusheld of the increased risk for developing COVID-19 when exposed to variants of SARS-CoV-2 that are not neutralized by Evusheld. Detailed neutralization data can be found in the revised authorized Fact Sheet for Healthcare Providers. Health care professionals should inform patients of this risk and advise patients who develop signs or symptoms of COVID-19 to test for SARS-CoV-2 infection and promptly seek medical attention, including starting treatment for COVID-19, as appropriate if they test positive.
American Society of Anesthesiologists releases guidance on perioperative testing for the COVID-19 virus
The American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation released updated guidance on perioperative testing for COVID-19. Recommendations include: screening all patients for symptoms and exposures prior to presenting to the healthcare facility; elective surgical procedures should be delayed if a patient tests positive for SARS-CoV-2; in communities with low to moderate disease transmission, facilities “could consider a more permissive approach” to perioperative testing.
Paxlovid likely safe in pregnancy
In a case series of 47 pregnant patients who were treated with Paxlovid (nirmatrelvir and ritonavir), the medication was well tolerated without evidence of an increase in complications affecting birthing parents or their offspring. Medication was initiated at a median (range) of 1 (0-5) day after symptom onset, and only 2 patients [4.3%] did not complete the course of therapy because of adverse effects. Thirty patients (63.8%) treated with nirmatrelvir and ritonavir had a comorbidity in addition to pregnancy that could be a risk factor for developing severe COVID-19. Most patients who received nirmatrelvir and ritonavir were vaccinated, and relatively few Black patients were included in the cohort, suggesting that disparities in vaccine uptake may also be reflected in the use of nirmatrelvir and ritonavir as a therapy in pregnancy.
Mpox vaccine can be administered either intradermal or subcutaneous
On December 6 the CDC updated section 15 of the mpox program provider agreement to highlight concerns about intradermal administration should not be a barrier to vaccination. The change aligns the provider agreement with the interim clinical considerations providing flexibility regarding the route of administration. Public health jurisdictions and healthcare providers have the flexibility to offer the intradermal or subcutaneous regimen based on balancing optimal vaccine use and acceptance, feasibility of administration, and available vaccine supply.
Updated 2022 Clinical Practice Guidelines for Prescribing Opioids for Pain – CDC
The CDC recently released updated guidelines for prescribing opioids, the first update since 2016 guidelines. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.
In addition to this national resource, the Alaska Department of Health has produced a patient-focused flier about pain management and non-opioid pain treatment options.
MMWR
Paxlovid associated with decreased hospitalization rate among adults with COVID-19
In this retrospective analysis, records from more than 1.7 million persons aged ≥18 years with a COVID-19 diagnosis from April 1–August 31, 2022 were analyzed. 699,848 (40.9%) met the inclusion criteria, including 198,927 who received Paxlovid within 5 days after diagnosis and 500,921 who did not. Overall, 28.4% of eligible persons received Paxlovid. Paxlovid receipt was associated with protection against hospitalization overall (aHR = 0.49, 95% CI = 0.46–0.53), including among persons who had received ≥3 mRNA vaccine doses (0.50, 95% CI = 0.45–0.55) and 2 previous mRNA vaccine doses (0.50, 95% CI = 0.42–0.58). Paxlovid receipt was associated with lower hospitalization rates among persons aged 18–49 years (aHR = 0.59, 95% CI = 0.48–0.71), 50–64 years (0.40, 95% CI = 0.34–0.48), and ≥65 years (0.53, 95% CI = 0.48–0.58). In this sample of U.S. COVID-19 patients, many of whom had previous SARS-CoV-2 infection or were vaccinated against COVID-19, the overall COVID-19 hospitalization rate was 51% lower among those who had received a prescription for Paxlovid for presumed mild-to-moderate COVID-19, compared with those who did not. Similar benefit was seen among persons who had received ≥2 COVID-19 mRNA vaccine doses.
JYNNEOS monkeypox vaccine safety profile is consistent with prelicensure studies; serious adverse events were rare among adults
JYNNEOS is recommended in the United States for persons exposed to or at high risk for exposure to Monkeypox virus during the 2022 monkeypox outbreak. JYNNEOS is a live, nonreplicating viral vaccine licensed for the prevention of smallpox and monkeypox in adults aged ≥18 years. During May 22–October 21, 2022, a total of 987,294 JYNNEOS vaccine doses were administered in the United States. CDC has monitored JYNNEOS vaccine safety using the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD) for vaccine recipients of all ages. The most common adverse health events reported to VAERS for adults were nonserious and included injection site reactions, which was consistent with the prelicensure studies. Adverse health events were reported at similar rates for doses received by intradermal and subcutaneous administration. Serious adverse events were rare in adults, and no serious adverse events have been identified among persons aged <18 years. Fourteen reports (1%) were classified as serious. Two deaths in males aged 37 and 58 years were reported, both within 2 days of vaccination. In one case, drowning was the cause of death. The death certificate is pending for the other case. Nine reports were classified as serious because of hospitalization for the following events: myocarditis (two), pericarditis (two), appendicitis (one), aseptic meningitis (one), atrial fibrillation (one), idiopathic thrombocytopenic purpura (one), and methemoglobinemia (one). The myocarditis reporting rate was 1.53 cases per million doses within 30 days after receipt of dose 1 and 2.99 after dose 2. Three reports of anaphylaxis within 24 hours of vaccination were received (overall reporting rate = 3.04; 95% CI = 0.63–8.88 cases per million doses administered). Monitoring of JYNNEOS vaccine safety in the United States during the 2022 mpox outbreak has not identified any new or unexpected safety concerns among adults or persons aged <18 years.
Providing COVID-19 vaccinations
All Alaskans and people who work or live in Alaska who are aged 6 months and older are eligible for vaccination against COVID-19.
If you are interested in providing the COVID-19 vaccine in your office or clinic, please visit the COVID-19 Vaccination Program Provider Enrollment page. If you have additional questions, please email the vaccination program at immune@alaska.gov
Long-Acting Monoclonal Antibodies for COVID-19 pre-exposure prophylaxis (PrEP)
Evusheld (tixagevimab/cilgavimab) is a long-acting monoclonal antibody therapy that has been authorized by the FDA under EUA for pre-exposure prophylaxis for COVID-19. This product is given by intramuscular injection every six months and may help prevent COVID-19 infection. Evusheld is authorized for adults and adolescents (aged ≥12 years) who do not have SARS-CoV-2 infection, who have not been recently exposed to an individual with SARS-CoV-2 infection, AND who are moderately to severely immunocompromised or are not able to be fully vaccinated with any available COVID-19 vaccines due to a history of severe adverse reactions to a COVID-19 vaccine.
Evusheld does not neutralize some of the SARS-CoV-2 variants that are increasing in frequency. While the product remains FDA-authorized, patients who have received Evusheld should be advised that they may have less protection than previously and should get tested right away and consult a health care provider if they develop symptoms of COVID-19.
For more information, read the FDA’s update on the Evusheld Fact Sheets
JAMA Patient Page on Evusheld
Pregnancy and COVID-19
The CDC strongly recommends COVID-19 vaccination either before or during pregnancy. For the latest recommendations, check out the CDC webpage on COVID in Pregnant and Recently Pregnant People and recommendations from the American College of Obstetrics and Gynecology. In addition, JAMA has published a one-page patient information sheet on COVID-19 and pregnancy.
Alaska Epidemiology Bulletins
Early Onset Colorectal Cancer – 1996-2019
This Bulletin describes the colorectal cancer (CRC) and early onset colorectal cancer (EOCRC) trends in Alaska and stratifies by two population demographics to better understand the need for focused health promotion efforts to prevent early onset colorectal cancer. During 1996–2019, CRC rates decreased 1.6% annually, from an estimated 62 to 39 cases per 100,000 people. CRC rates decreased by 2.0% annually among adults aged ≥50 years (from
an estimated 226 to 117 cases per 100,000 people), but EOCRC rates increased by 3.9% annually among adults aged 20–49 years (from an estimated 7 to 18 cases per 100,000 people). During this period, 14% of all Alaska CRC cases were EOCRC.
Syphilis Update
This Bulletin provides an update on the changing epidemiology of syphilis in Alaska. Alaska syphilis cases continued to increase during 2021. Most occurred in people who self-identify as heterosexual and those living in urban environments (29% of whom were experiencing homelessness or unstably housed). Also notable is that roughly half of the 2021 cases were in women, and nearly 90% of them were of reproductive age (5 cases of congenital syphilis were reported in 2021).
Public Events, Education & Training
Alaska Public Health ECHO Series
The Alaska Public Health ECHO is a virtual learning network intended for the general public to interface with Alaskan scientific and medical experts and the State of Alaska Public Health Leadership Team. This series recently restarted and is held monthly on the third Wednesday of each month from 12-1pm AKST as we explore critical public health topics and current best practices.
Register for Alaska Public Health ECHO here
Alaska Concussion Care & CTE Knowledge
The Alaska Mental Health Trust Authority (AMHTA) partnered with the Concussion Legacy Foundation and Boston University School of Medicine to offer free, accredited continuing medical education courses to providers practicing in Alaska.
December 13, 4pm: Concussion and PCS with Dr. Robert Cantu
December 14, 4pm: Chronic Traumatic Encephalopathy with Dr. Robert Cantu
December 15, 4pm: Concussion, PCS, and CTE with Katelynn Cataldo, NP
Project Firstline
If you or your organization are interested in learning more about infection control in health care, the CDC has a robust training collaborative and resource library under Project Firstline. If you are interested in learning more about Project Firstline or potentially arranging a training session, please contact Kelley O’Leary at kelley.oleary@alaska.gov
Public Naloxone Training
DHSS OSMAP Project HOPE are conducting public naloxone trainings as a community outreach and to increase awareness and access. Email projecthope@alaska.gov for additional information.
Harm reduction strategies and resources
The Alaska Native Tribal Health Consortium (ANTHC) HIV/STD Prevention and Substance Misuse Prevention programs host free virtual gatherings to discuss harm reduction strategies and resources in Alaska. Guest speakers are Alaska-based experts in the field of harm reduction. Recordings of harm reduction trainings can be found here.
Several useful materials specific to Alaska opioid safety are at the following webpage. Check it out and print out information to hang up in your community.
CDC COCA Calls:
COVID-19 Update: Clinical Guidance and Patient Education for Bivalent COVID-19 Vaccines
Tuesday, December 13 2-3pm ET - Link - Presenters will discuss updates on bivalent vaccines including the most recent vaccine effectiveness data, the Centers for Disease Control and Prevention’s clinical guidance for bivalent vaccines, and strategies for communicating with patients about COVID-19 vaccination
Update on Multisystem Inflammatory Syndrome in Children (MIS-C): Epidemiology, Case Definitions, and COVID-19 Vaccination
Link - Presenters reviewed MIS-C epidemiologic and clinical trends, describe changes in criteria for the new MIS-C surveillance case definition, and discuss information relating to MIS-C and COVID-19 vaccination.
New 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Link – Presentation of the new CDC recommendations, implementation principles, and approaches to maximize benefits and minimize risks when starting, continuing, or discontinuing opioids for pain
2022-2023 Seasonal Influenza Testing and Treatment During the COVID-19 Pandemic
Link - An overview of CDC’s recommendations for healthcare providers about influenza diagnostics and the use of antiviral medications for the 2022-2023 influenza season
2022-2023 Influenza Vaccination Recommendations and Guidance on Coadministration with COVID-19 Vaccines
Link - Presenters provided updates on recommendations for the 2022-2023 influenza vaccination season, including guidance for the coadministration of the influenza and COVID-19 vaccines.
Recommendations for Bivalent COVID-19 Booster Doses in People Ages 12 Years and Older
Link - Presenters discussed the CDC’s new guidance on bivalent COVID-19 booster doses for people ages 12 years and older.
2022–2023 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers
During this COCA Call, presenters provided an overview of influenza prevention and treatment recommendations for the 2022–2023 season.
ANTHC Tribal Health Webinar Series
The ANTHC Tribal Health Webinar series occurs on Friday from 12-1pm on Zoom and is open to the public.
https://anthc.zoom.us/j/98667611681
Meeting ID: 986 6761 1681
December 16th: James Benzschawel. Program Manager, Alaska Tribal Health System Emergency Management. Emergency Management framework within the Alaska Tribal Health System.
December 23rd & 30th: Off for the Holidays
January 6th: Mary Thomson, MD. UM Hepatology. Management of Decompensated Cirrhosis for Primary Care Providers.
January 13th: Shijing Jia, MD. UM Pulmonology. TBD
January 20th: Megan Acho, MD. UM Pulmonology. TBD
January 27th: Annette Marley. ANTHC Epidemiology. Firearm Safety.
February 3rd: Namory Bagayoko, MD. ANMC Orthopedics. TBD
February 10th: Bonnie Wang, MD. UM Pulmonology. Pulmonary approach to upper airway symptoms.
February 17th: Nangghaahlaangstangs. Haida People
March 10th: Stephanie Schofield, MD. Chickasaw Nation Medical Center's Empowered Living Obesity Management Program. Management of Pediatric Obesity.
March 17th: Dru Claar, MD. University of Michigan Pulmonology. TBD.
CDC Clinical Support: There is a Clinician On-Call Center, a 24-hour hotline with trained CDC clinicians standing by to answer COVID-19 questions. Call 1-800-CDC-INFO (800-232-4636) and ask for the Clinician On-Call Center.
The most up-to-date, evidence based COVID-19 treatment guidelines can be found at:
NIH COVID-19 Treatment Guidelines
IDSA Guidelines on the Treatment and Management of Patient with COVID-19
Alaska Responders Relief Line (844) 985-8275
Your well-being matters. Your behavioral health colleagues are standing by to talk 24/7: 844-985-8275
Recognizing the unique stressors that providers face, the Division of Behavioral Health has established a 24/7 support line, (844) 985-8275, for healthcare and behavioral professionals impacted by COVID personally and professionally. Staff supporting the call line recognize callers are often first responders and will allow callers to openly express their experiences and feelings serving Alaskans impacted by COVID.
This service is also available to immediate family members of first responders who may be experiencing stress, anxiety and other hard to label emotions as a result of their loved one engaging on the front lines.
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