In Virginia, low-income patients now have access to community-based doula services thanks to new initiatives by the Virginia Department of Health (VDH) and the Department of Medical Assistance Services (DMAS). 

A community-based doula has shared lived experiences with their clients and is trained to provide continuous, culturally congruent support to families throughout pregnancy, during labor and birth, and up to one year postpartum. 

Community-based doulas can improve maternal and birth outcomes and work to eliminate the racial maternal and infant mortality disparity. In Virginia, the five-year maternal mortality rate (2017-2021) was 28.5 per 100,000 live births. Non-Hispanic Black birthing persons had a rate (43.9 per 100,000 live births) that was nearly 2 times more than non-Hispanic White birthing persons (26.3 per 100,000 live births). In 2021 alone, the Black/White disparity was nearly 2.5. In 2021, 568 infants died before their first birthday (5.9 per 1,000 live births), with non-Hispanic Black infants (10.1 per 1,000 live births) dying at 2.2 times the rate of non-Hispanic White infants (4.6 per 1,000 live births). 

VDH launched a State Doula Certification Program in 2022. To become state-certified, doulas must receive training in certain topics from an approved trainer as outlined in regulations promulgated by the Board of Health. The application and a list of all certified doulas are on the Virginia Certification Board webpage. 

Doulas who become state-certified have the option to enroll as Medicaid Fee-For-Service (FFS) or Managed Care Organization (MCO) providers. Medicaid members can then use their Medicaid coverage to access doula support. Virginia currently has 116 state-certified doulas, 65 of whom accept Medicaid. 

For more information, visit the VDH Doula State Certification webpage or contact Consuelo Staton, State Doula Certification Program Coordinator, at consuelo.staton@vdh.virginia.gov or (804) 864-7673. 

Wildfire Smoke Exposure Poses Threat to At-Risk Populations 

On June 30, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Advisory reminding healthcare providers to be aware of the adverse effects of wildfire smoke exposure, especially among those at higher risk for severe outcomes. Proactive counseling and prompt treatment are essential in reducing adverse events and morbidity from wildfire exposure. For more information, visit the CDC HAN website. 

Summer Influenza A Testing in ICU Patients  

CDC and VDH are encouraging increased consideration for testing for influenza among individuals with severe respiratory illness this summer in response to the continued global outbreak of highly pathogenic avian influenza A(H5N1) in wild birds and poultry. Hospitals and clinical laboratories are additionally asked to ensure influenza A positive samples from ICU patients are subtyped either in the clinical laboratory or sent to the state public health laboratory, DCLS, to identify cases of novel influenza. This is an important step for continued surveillance of A(H5N1) in the U.S. as well as variant influenza cases. This is especially important in the summer when influenza testing is not as routine as it is during the flu season, and exposure to poultry and swine may increase during agricultural fair season. For more information, please visit the CDC website.  

CDC Recommends RSV Vaccine for Older Adults 

On June 29, CDC recommended the use of the new Respiratory Syncytial Virus (RSV) vaccines from GSK and Pfizer for people aged 60 years and older. Individuals may receive one dose of a vaccine in consultation with their healthcare provider using shared clinical decision-making. 

Locally Acquired Malaria Cases Identified in the United States 

On June 26, the Centers for Disease Control and Prevention (CDC) issued a HAN Advisory regarding locally acquired malaria in Florida (4 cases) and Texas (1 case) in the last 2 months with no evidence that the cases are related. There is concern for potential increase in imported cases due to summer international travel. Clinicians are advised to consider malaria diagnosis for any person with fever of unknown origin, regardless of travel history. Patients suspected of having malaria should be immediately evaluated in a facility that can provide rapid diagnosis and treatment, within 24 hours of presentation. For more information, visit the CDC HAN website.  

Guidance on Measles during the Summer Travel Season 

As the summer travel season begins, VDH asks that clinicians be on alert for cases of measles and provide guidance for measles prevention to international travelers. In a June 8, CDC HAN Alert, CDC has been notified of 16 confirmed U.S. cases of measles across 11 jurisdictions, with 14 (88%) linked to international travel. Clinicians should consider measles as a diagnosis in anyone with fever and a generalized maculopapular rash with cough, coryza, or conjunctivitis who has recently been abroad, especially in countries with ongoing outbreaks (e.g., India, Somalia, and Yemen). Additional guidance for healthcare professionals can be found on the CDC HAN website.  

HHS Issues Advisory on Mental Health Symptoms and Conditions Related to Long COVID 

The U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), has issued an advisory on the Identification and Management of Mental Health Symptoms and Conditions Associated with Long COVID. The advisory discusses the epidemiology of mental health symptoms and conditions of Long COVID and provides evidence-based resources for their assessment and treatment. 

State Code Requirement on Stocking and Administering Albuterol to Students 

Virginia state law requires public schools to possess albuterol metered dose inhalers (MDI), and valved holding chambers, and to administer undesignated stock albuterol to any student in respiratory distress. The medication may be used if a student has a current Asthma Action Plan but does not have prescribed medication available or if a student does not have an Asthma Action Plan and is having difficulty breathing. To learn more about asthma management in schools, visit VDOE School Health Website.   

The Differences in Meningococcal Vaccines 

A minimum of 2 properly spaced doses of Meningococcal ACWY (MenACWY/MCV4) vaccine is required for school entry. The first dose should be administered prior to entering 7th grade. The final dose should be administered, after age 16, prior to entering 12th grade. The MenACWY vaccine protects against meningococcal disease that is caused by serogroups A, C, W, and Y.   

The Meningococcal B (MenB) vaccine protects against meningococcal disease that is caused by serogroup B. The MenB vaccine is recommended, and not required for school entry. For more information, please visit the VDH School Requirements webpage.  

Vaccine

Fall COVID-19 Vaccine Composition 

On June 15, 2023, the Vaccines and Related Biological Products Advisory Committee (VRBPAC) Meeting discussed the composition of the fall COVID-19 vaccine, recommending that vaccines target currently dominant XBB coronavirus variants with a preference for XBB.1.5. Based on the totality of the evidence, FDA advised manufacturers who will be updating their COVID-19 vaccines to develop vaccines with a monovalent XBB 1.5 composition. 

CDC Data Show Low Vaccination Rates Among Pregnant People 

On June 23, CDC’s Advisory Committee on Immunization Practices (ACIP) presented data showing the majority of pregnant patients hospitalized for SARS-CoV-2 infection, regardless of symptoms or reason for testing, were unvaccinated for COVID-19 or had not received recommended booster doses. Vaccination during pregnancy not only protects the pregnant person but has also been shown to protect infants in the first few months of life. This is important since those younger than 6 months of age currently have COVID-19 associated hospitalization rates that are the same as those aged 65–75. Please see CDC’s Vaccine Recipient Education webpage for resources on how to best communicate about COVID-19 vaccines with your patients. 

 Vaccine Ancillary Supply Kit Expiration Dates 

Therapeutics

Update on Chicago Mpox Cluster 

On June 23, CDC released an MMWR about the recent cluster of mpox cases in Chicago. From March 18–June 12, 40 laboratory-confirmed mpox cases were identified, including 22 patients who were fully vaccinated against mpox. Though the cause of this cluster has not yet been determined, please continue to be on alert for cases of mpox, test when indicated (even in people who have been vaccinated), and encourage vaccination with two doses of JYNNEOS for people at risk. People who are vaccinated tend to have fewer symptoms and are hospitalized less. 

Vaccine Effectiveness of JYNNEOS against Mpox Disease in the United States 

A New England Journal of Medicine study found that mpox patients were less likely to have received one or two doses of JYNNEOS vaccine than control patients. The findings suggest that JYNNEOS vaccine effectively prevented mpox disease, and a two-dose series appeared to provide better protection. 

Mpox Funding Opportunity for Community-Based Organizations 

Preventing Mpox Resurgence by Increasing Vaccine Confidence & Community Immunity Through Community-Based Organization Partnerships - Subrecipients will have access to group learning opportunities, peer sharing sessions, materials, and relationship building to support a wide range of innovative, culturally appropriate, and situationally sensitive mpox vaccination confidence and prevention education strategies to prevent a resurgence. Applications are due Friday, July 14. 

STOMP Trial 

This is a reminder that tecovirimat (TPOXX) prescribers should consider seeking access through enrollment in the Study of Tecovirimat for Human Mpox Virus (STOMP) trial, which is evaluating the efficacy of TPOXX. Virginia Commonwealth University is actively recruiting patients. To learn more, please call 804-828-9711 or email vcu.stomp.tpoxx@gmail.com. Visit the STOMP website for more information.    

Mpox Resources 

VDH Resources