RCP Update: 11/22/23

Tracking Covid

  • CDC tracker (week ending November 11)
    • All indicators trending up
    • +8.6% in hospital admissions
    • +9.1% in percentage of COVID deaths
  • CDC wastewater surveillance tracker measure of prevalence of virus
    • As of November 13, 36% showed modest (10%-99%) or large (>100%) reduction in virus (915 sites reporting)
      • 48% showed modest or large increase
    • Contract dispute leads to indefinites shutdown of ¼ wastewater tracking sites
      • Previous contractor of sites, Biobot, is appealing change to new contractor Verily

Other Threats

  • Study on prevalence of pathogens among patients in Maryland acute and long-term facilities (October 26)
    • 482 patient at 51 facilities
    • 7% tested positive for A baumannii, 6.6% for C auris
    • Significantly more common in Long Term Care Facilities
  • Joint WHO and CDC report shows impact of missed measles vaccinations worldwide during pandemic
    • 18% increase in cases, 43% increase estimated deaths from 2021-2022
    • On track to double from 2022 to 2023
    • 47 countries have reported “disruptive outbreaks” in 2023 (37 in 2022, 22 in 20921)

Guidance

  • New mask mandates in health facilities in some bay area counties (November 1)
    • Health Care workers (Alameda, Contra Costa, San Mateo, Sonoma)
    • Health Care Workers, Patients and visitors (Santa Clara)
  • CDC reports highest exemption rate ever from 4 key childhood vaccines (MMR, DTaP, polio, chickenpox) in 2022 (November 10)
    • 3% rate (2.8% non-medical reasons)
    • Rise in 40 states
    • 10 states had raise of 5%+
    • Idaho had 12%

Vaccines

RSV

  • Monoclonal antibody nirsemivab (Sanofi-AstraZeneca Beyfortus) is in short supply (October 30)
    • CDC Health Alert Network (HAN) Health Advisory to prioritize infants under 6 months and with underlying conditions (high risk population) (October 23)
    • CDC also recommends suspending use in children 8-19 months eligible for older prophylaxis palivizumab

Covid

  • Study shows vaccination of pregnant mothers gives protection to newborns up to 6 months (October 23)
  • Study suggests higher prevalence of stroke risk among older adult who received flu and bivalent covid vaccine within 6 weeks of each other (October 26)m
    • FDA and CMS preprint (not yet reviewed)
    • Fall 2022
    • 20% for Pfizer; 35% for Moderna
    • Compared to those who received Covid only; no risk elevation for covid only

Mitigation

  • Study suggests Paxlovid does not reduce chances of developing long covid symptoms (November 1)
    • Based on analysis of records of 9,593 veterans diagnosed and treated January-July 2022
    • Blood clots less frequent among Paxlovid group
  • Gargling or nasal rinsing with saline associated with lower hospitalization rates for Covid (November 10)
    • 55 individuals with low (27) or high (28) regimens
    • Compared to 9,398 in reference population
    • 2020-2022

Variants

  • 10/29/23-11/11/23 distribution of subvariants (all omicron)
    • 1: 29% (from EG.5)
    • 5: 21.7%
    • 1.5.1: 9.3%
    • 3: 7.8% (also from EG.5)
  • All XBB line; about 60% from EG.5 and direct descendants