AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, monkeypox, medical education, advocacy issues, burnout, vaccines and more.

AMA Update

Monkeypox, bivalent vaccines & updated CDC guidelines for COVID exposure with Andrea Garcia, JD, MPH

Sep 28, 2022

In today’s AMA Update, AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, discusses bivalent vaccine availability—including Moderna shortages and timing on boosters for kids under 12. Also covering the latest from the CDC, including: findings from a new study on patient recovery from myocarditis after receiving mRNA COVID vaccines, plus a summary of recent changes to CDC guidance on infection prevention and control recommendations for health care personnel, as well as interim guidance for managing health care personnel with SARS-CoV-2 infection or exposure to SARS-CoV-2. AMA Chief Experience Officer Todd Unger hosts.

Visit AMA's monkeypox resource center.

Learn more at the AMA COVID-19 resource center.

Speaker

  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

AMA Recovery Plan for America’s Physicians

After fighting for physicians during the pandemic, the AMA is taking on the next extraordinary challenge: Renewing the nation’s commitment to physicians. 

Unger: Hello and welcome to the AMA Update video and podcast, an ongoing series covering a range of health care topics affecting the lives of physicians and patients. Today we have our weekly look at the headlines with AMA's Vice President of Science, Medicine and Public Health Andrea Garcia in Chicago. I'm Todd Unger, AMA's chief experience officer also in Chicago. Good to see you again, Andrea.

Garcia: It's good to be here. Thank you.

Unger: Well, let's get right into the Omicron situation. We've had boosters available for those 12 years and older for a few weeks now. Now we have word on the availability of boosters for kids under 12. When should parents expect that?

Garcia: Well, it's being reported that the CDC expects the updated bivalent COVID booster doses to be available for children 5 to 11-years-old by mid-October. And this information is based on the CDC small vaccination operation planning guide, which was released last Tuesday. And that document indicates that if the vaccines are authorized by the FDA, then CDC anticipates a recommendation for bivalent vaccines as a booster for that pediatric age group in early to mid-October.

Just as a current reminder, Pfizer's vaccine is currently available for those 12 and older. Moderna's is available for those 18 and older. Under this new authorization, Pfizer's vaccine would become available for those aged 5 to 11 and Moderna's for those aged 6 to 17 years. And, of course, the government has said it's ordered more than 170 million updated vaccine booster doses for the fall and last week it had sent out over 25 million doses.

Unger: Well, it's interesting because there have been reports now of shortages of the Moderna booster vaccine. What's going on there and when will that be resolved?

Garcia: Yes, so most of the 25 million doses that have been sent out have been the Pfizer booster. And according to some reports, some pharmacies like CVS, Walgreens, are reporting that the government supply of the Moderna updated booster remains limited. And that's causing appointments for the product to vary across the country.

So both CVS and Walgreens have said they're working with the government to acquire more Moderna doses. The supply shortage of the Moderna boosters does stem from production issues at one of its plants but in a statement last week, Moderna said it expects to resolve those supply issues for its new booster in the coming days. And the company said it does plan to deliver 70 million doses of its bivalent booster by the end of the year.

The assistant secretary for preparedness and response said last week that pharmacies will be receiving millions more doses of Moderna and that production is ramping up. And we anticipate the supply will continue to increase in the coming weeks. I think it's important to note that pharmacies have not seen any supply issues with the Pfizer vaccine booster. So anyone who wants an updated COVID booster should still be able to get one.

Unger: Thank you for that information. And more vaccine news, the results are out from a follow-up study on adolescents and young adult patients who are diagnosed with myocarditis after receiving a COVID-19 vaccine. Andrea, what do we need to know there?

Garcia: Well, a new CDC study found that approximately 80% of 393 patients diagnosed with myocarditis after receiving an mRNA COVID vaccine, such as Pfizer or Moderna, were considered recovered by health care professionals at least 90 days since the outset of myocarditis. The CDC collected this data through follow-up surveys from people age 12 to 29 for whom a report of myocarditis after the vaccine was reported to VAERS, which is the Vaccine Adverse Event Reporting System. And those reports were between December of 2020 and November of 2021.

The CDC is continuing to follow up on those patients who were not considered recovered since myocarditis-symptom onset. They're hoping to understand some of those longer term outcomes. And just a reminder that this data shows that it's a rare risk for myocarditis and pericarditis after receiving the mRNA vaccines.

These cases occurred most frequently in adolescent and young males within seven days of receiving an mRNA COVID vaccine. And they were more common following the second dose. CDC, of course, continues to recommend vaccination for everyone six months and older, determining that the benefits outweigh the risks. And it's also important to remember that myocarditis and pericarditis have been associated with recent COVID infections as well.

Unger: That's right. Well, let's take a look at the numbers. Speaking of COVID, how are we looking this week?

Garcia: Well, according to the New York Times, cases, and hospitalizations, and test positivity have all fallen noticeably in recent weeks and it's a promising sign. Conditions are improving nationally.

The daily average of reported cases is just over 52,000. That's the lowest level since April. It's a decrease of 23% in the last two weeks. We have a few states that are seeing slight increases in cases in recent days but they are really the exception. Reported cases are declining in most states and territories.

Unger: Well, a little perplexing numbers on the hospitalization and death side, if I understand correctly, still a persistently high number there for deaths. Let's talk about what's going on in that realm.

Garcia: Yeah, so hospitalizations are falling nearly everywhere throughout the nation. The daily average number of those hospitalized with COVID is about 30,000, which is a decrease of about 14% over the past two weeks. But as you alluded to, deaths remain stubbornly high. That daily average is currently around 417 deaths.

It's a 9% increase from two weeks ago. And this is more than twice the number of daily deaths that are typically seen in a bad flu season according to the New York Times. And I think it's all the more reason to get your COVID booster and your flu vaccine as soon as you can. And as a reminder, you can get both of those vaccines at the same time.

Unger: That is an incredibly good advice. And we're going to hear more from AMA's liaison to the ACIP and board chair Dr. Sandra Fryhofer encouraging folks to get that flu vaccine as well. Moving into monkeypox, what is our situation there in regard to numbers?

Garcia: The CDC is reporting just over 25,000 total confirmed cases since the U.S. outbreak began in May. As we talked about last week, there has been one death from monkeypox confirmed in California. That's the first death in the U.S. due to monkeypox. New monkeypox cases in the U.S. have been steadily dropping in recent weeks. And that daily average of cases reported is under 200.

I think with that being said, there was a briefing last week. And David Harvey, who's the director of the National Coalition of STD Directors, said that, while there is some hope with these cases leveling off, that should not be anyone's solace that this outbreak is done. Health leaders added at that briefing that for this hopeful trend to continue, we need continued work and continued investment, especially in reaching those underrepresented groups.

Unger: Absolutely. Well, challenges abound, and as we try to keep this outbreak and our COVID numbers under control, the CDC recently updated its guidance on COVID-19 infection prevention and control in health care settings, what do we need to know there?

Garcia: The CDC published updates to their COVID IPC guidance for health care settings. And that came late last week. The new guidance indicates that these updates reflect the level of vaccine and infection, induced immunity, the availability of effective treatments and prevention tools for COVID. And they really streamlined and consolidated the existing health care IPC guidance.

Some of the things included in these updates are that vaccination status is no longer used to inform source control, screening testing or post-exposure recommendations. And the circumstances for use of source control, which is also known as universal masking, were updated. The source control is now recommended for everyone in a health care setting when that SARS-CoV-2 community transmission level is high, which just note that that community transmission metric is different from the COVID-19 community level metric that we use in non-health care settings.

So 70% of communities across the U.S. are still at a high community transmission level. The guidance provided updates on circumstances when universal use of PPE should be considered. And, in general, indicated that performance of pre-procedure or pre-admission testing for patients and screening testing for asymptomatic health care personnel without a known exposure is now at the discretion of the facility.

Unger: Well, there've been some updates to on managing health care personnel with infection and exposure. What do we need to know about those changes?

Garcia: There's some of the updates to the interim guidance for managing health care personnel with a SARS-CoV-2 infection or exposure include that in most circumstances asymptomatic health care personnel with higher risk exposures do not require work restrictions if they don't develop symptoms or test positive for the virus. There's also updated recommendations for test frequency to detect potential variants with shorter incubation periods and to address the risk for false negative antigen tests in people without symptoms physicians can read these updated guidance documents on the CDC website.

I would just note that we've certainly heard some concerns from physicians about the timing of this guidance coming around a time when respiratory virus season is beginning and noting that the impact this could have on patients most at risk in health care settings, including those in nursing homes and, of course, thinking about the implications for health care staffing shortages. The guidance does note that individuals might choose to continue using source control based on their own personal preference.

Unger: And we'll stay updated on that as things developed. That's it for today's episode. Thank you, Andrea, for being with us today. And we'll be back soon with another AMA Update. You can find all our videos and podcasts at ama-asn.org/podcasts. Thanks for joining us today and please take care.


Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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