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Healthcare Professionals Newsletter |
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Emerging Public Health Issues
Invasive Meningococcal Disease Outbreak in Eastern Virginia
VDH continues to monitor an outbreak of invasive meningococcal disease (IMD) serogroup Y in eastern Virginia. The first case was detected in June 2022, and the outbreak was declared in September 2022. In May 2023, VDH updated the vaccination strategy due to the expanded age range of case-patients associated with the outbreak. In addition to post-exposure prophylaxis (PEP) antibiotics, VDH is recommending 1 dose of MenACWY vaccine, which provides protection against serogroup Y, to all outbreak-associated close contacts who are ≥11 years of age or considered high-risk for IMD (e.g., persons living with HIV).
CDC Lab Advisory: Guidance for Marburg Virus Disease Specimen Testing
On May 25, CDC released a laboratory advisory indicating that the risk of travel-associated Marburg virus disease (MVD) is very low in the United States. MVD is like other illnesses associated with viral hemorrhagic fevers (VHFs). Since the likelihood of MVD is very low, patients with symptoms should be tested and treated for other, more likely, conditions.
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COVID-19 General Updates
New VDH Wastewater Dashboard
On May 8, VDH announced a new COVID-19 wastewater surveillance dashboard. The dashboard shows how much SARS-CoV-2 is in wastewater sewage in participating communities across Virginia. The dashboard, which is updated on Tuesdays, provides information about viral trends and compares wastewater surveillance trends with reported patient case counts.
Considerations for Implementing Broader Use of Personal Protective Equipment in Healthcare Settings
The CDC COVID-19 Community Transmission Levels, which informed mitigation strategies for healthcare facilities, were discontinued with the end of the federal COVID-19 Public Health Emergency (PHE). Healthcare facilities should consider performing a risk assessment to determine their infection prevention and control recommendations, including when broader use of source control or universal use of personal protective equipment (e.g., eye protection for all patient care encounters) in the facility might be warranted. Some factors to be considered are available local data metrics, including county-level SARS-CoV-2 hospital admissions data on the CDC COVID-19 Data Tracker and VDH emergency department visits for COVID-like illness, and facility-level information (e.g., recent transmission inside the facility, the population’s risk for severe outcomes from COVID-19, and facility characteristics that could accelerate spread) to determine when to add and remove prevention strategies. Facilities could also follow trends of several respiratory viruses using CDC RESP-NET interactive dashboard or data from the National Emergency Department Visits for COVID-19, Influenza, and RSV to make decisions about broader use of source control based on national respiratory virus incidence. For more information, visit updated CDC COVID-19 Infection Prevention and Control guidance.
COVID-19 Vaccine Updates
Moderna COVID-19 Vaccine Shelf-Life Extensions
Several lots of bivalent Moderna COVID-19 vaccine have received shelf-life extensions. Moderna has verified the new expiry dates below and updated the Moderna Vial Expiration Checker.
COVID-19 Vaccine Resources
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COVID-19 Therapeutics Updates
FDA Approves First Oral Antiviral for Treatment of COVID-19 in Adults
On May 25, the U.S. Food and Drug Administration (FDA) approved the oral antiviral Paxlovid for the treatment of mild-to-moderate COVID-19 in adults who are at high risk for progression to severe COVID-19, including hospitalization or death. ASPR will continue distributing the EUA-labeled Paxlovid product as usual. This approval does not cover the treatment of children—these people will continue to be covered by Paxlovid under an Emergency Use Authorization (EUA). Both the FDA approved label for Paxlovid and the Fact Sheet for FDA authorized Paxlovid come with a black box warning regarding the possibility of severe drug-drug interactions when using Paxlovid with other medications. The U.S. government has sufficient supply of this product remaining and will continue to make it available at no cost to patients. The ordering process and reporting requirements will remain the same. The current provider agreements will remain in place, with no alterations to the expectations outlined in those agreements. For questions, please contact COVID19.Therapeutics@hhs.gov.
Eleventh Amendment to the Declaration under the Public Readiness and Emergency Preparedness (PREP) Act for Medical Countermeasures Against COVID-19
On May 9, the Secretary of the U.S. Department of Health and Human Services (HHS) signed the eleventh amendment to the declaration under the PREP Act for COVID-19 Medical Countermeasures. Effective May 11, this amendment clarifies that COVID-19 continues to pose a credible risk of a future public health emergency, adds two new limitations on distribution, extends the time period of coverage for certain Covered Countermeasures and Covered Persons, clarifies the time period of coverage for Covered Persons authorized under the Declaration, and extends the duration of the Declaration to December 31, 2024. For more information, visit the Federal Register.
Gilead's Advancing Access® Program for patients prescribed VEKLURY
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Assisting patients starting a Gilead Medication, including VEKLURY (Remdesivir)
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Support with insurance verification: prior authorization and appeals process information
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Co-pay coupon program for commercially insured eligible patients
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Patient Assistance Program (PAP)
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Free product support for uninsured/under-insured eligible patients
Updated COVID-19 Therapeutics ASPR Webpages
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Paxlovid, Lagevrio, Veklury
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These updated webpages include additional and updated FAQs and information that that maps latest EUA and current approval for each product
COVID-19 Therapeutic Resources
Mpox Updates
Potential Risk for New Mpox Cases
On May 15, CDC distributed a message through the Health Alert Network (HAN), to highlight the potential risk for new mpox cases. This was in response to the mpox cluster reported in Chicago and that summer events could lead to a resurgence of mpox. CDC anticipates more cases among previously vaccinated people, but those who have completed a two-dose JYNNEOS vaccine series may experience less severe symptoms than those who have not. At the time of the HAN alert, only 23% of the population at risk has been fully vaccinated for mpox.
On May 18, the director of the CDC sent out a letter emphasizing that preventing outbreaks of mpox requires collaboration among healthcare providers, people affected by mpox, and public health officials to ensure people who need care can readily access it.
In Virginia, the mpox outbreak peaked in August 2022. Since January 1, 2023, five new cases have been reported. As a reminder, VDH maintains a dashboard of mpox cases, which is updated weekly.
Additional resources have been created to support mpox prevention efforts:
Mpox Vaccine Effectiveness
If you are a provider prescribing tecovirimat (TPOXX), consider first seeking access through enrollment in the Study of Tecovirimat for Human Mpox Virus (STOMP) trial, which is evaluating the efficacy of TPOXX. In this study, all adults with severe mpox, severe immunodeficiency, or other noted criteria will be enrolled in the open-label arm to receive oral TPOXX. Patients should be informed about the STOMP clinical trial and encouraged to enroll. More information about the trial can be found at www.stomptpoxx.org.
Virginia Commonwealth University (VCU), Division of Infectious Diseases is actively recruiting patients for enrollment. Enrollment must be in-person but follow up visits may be virtual. Compensation for time and travel is provided. To learn more, please call 804-828-9711 or email vcu.stomp.tpoxx@gmail.com.
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 Other Updates and Resources
Updated Case Definition for Childhood Lead Cases
On May 22, Virginia adopted an updated lead case definition. A case definition is a set of uniform criteria to define a disease or condition for the purposes of public health surveillance. The Centers for Disease Control and Prevention (CDC) is no longer using the term “elevated blood lead level.” Now, confirmed blood lead levels 3.5+ μg/dL are referred to as “blood lead levels (BLLs) at or above the CDC blood lead reference value.” This is reflected in the updated case definition below.
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A confirmed BLL ≥ CDC’s blood lead reference value: A child with one venous blood test ≥ 3.5 μg/dL or two capillary blood tests ≥ 3.5 μg/dL drawn within 12 weeks of each other. Note: the previous lead reference value and threshold for follow-up action was 5 μg/dL.
The healthcare provider is primarily responsible for:
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Screening high risk children for lead exposure at ages 1 and 2, or up to age 6 if they have never received a blood lead test.
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Scheduling confirmatory and follow-up blood lead tests (confirmatory and follow-up blood lead testing should now occur for all blood lead levels 3.5 μg/dL and higher).
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Providing lead poisoning education materials to the family, including information on sources of lead, exposure prevention, and nutrition.
If you have questions about these updates or childhood lead poisoning procedures, please contact the Virginia Department of Health (VDH) Childhood Lead Poisoning Prevention Program team at leadsafe_co@vdh.virginia.gov.
National Maternal Health Hotline
Each May, we bring attention to maternal mental health. It’s important for healthcare providers to tell patients about the National Maternal Mental Health Hotline, which had its first anniversary on Mother's Day this year! This hotline, 1-833-TLC-MAMA (1-833-852-6262), is available 24/7 in English and Spanish and offers free, confidential support to pregnant and postpartum individuals via voice and text. Reminding people that they are not alone and that they can access free help and information about resources can be lifesaving, especially during pregnancy and in the postpartum period. For more information and a toolkit, visit the National Maternal Mental Health Hotline webpage.
School Entrance Physical Resources
Many of Virginia’s families will need a school entrance physical for their child to enter kindergarten this summer. The School Entrance Health Form (MCH 213G) and instructions for healthcare providers are available below and on the VDH School Health Website.
Get Signed Up
Do you receive the VDH Infection Prevention and Control Newsletter? The newsletter discusses the impact of the Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Infection Prevention Program within VDH on building infection prevention and control capacity across the Commonwealth. It includes details about on-site infection prevention and control (IPC) assessments, healthcare facility IPC strengths and areas for improvement, as well as how facilities perceive the site visits. To receive this quarterly newsletter, sign up on the VDH HAI/AR website.
Mark Your Calendar
2023 Community Health Forum: Taking Action for Community Health Improvement
VDH is excited to announce the 2023 Community Health Forum: Taking Action for Community Health Improvement (CHF) on June 14 and 15, 2023 in Virginia Beach. The theme for this forum is "Using Virginia's Plan for Well-Being to foster community collaboration, enhance data equity, and develop policies and systems to make Virginia the healthiest state in the nation." The overall mission of the forum is to educate and revitalize our public health workforce by determining best practices for change and innovation.
Team members from the Community Health Epidemiology Program (OFHS Division of Population Health Data), the Center for Community Health Improvement (OEpi), the Office of Health Equity, and other leaders have prepared an exciting and informative agenda for this 2-day conference. The CHF is open to all VDH staff as well as community partners, students, and other public health and healthcare professionals with an interest in improving community health in the Commonwealth. The forum is free with registration (maximum 200 participants).
To register and for more information on CHF, including opportunities for poster presentations and virtual vending, please visit the CHF website. We look forward to collaborations and innovative practices that will arise from this meeting, and we hope to see you there!
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