Virus World

This report describes the prevention and treatment of monkeypox in people with HIV infection. 

What is already known about this topic?

 A multinational monkeypox outbreak disproportionately affecting men who have sex with men, including persons with HIV infection, is ongoing worldwide.

What is added by this report?

 CDC has developed clinical considerations for prevention and treatment of monkeypox in persons with HIV infection, including pre-exposure and post-exposure prophylaxis with JYNNEOS vaccine, treatment with tecovirimat, and infection control.

What are the implications for public health practice?

 Persons with advanced HIV might be at increased risk for severe monkeypox. Post-exposure prophylaxis and antiviral treatments are available for persons with HIV infection. Prompt diagnosis and treatment and enhanced prevention efforts might reduce the risk for severe outcomes....

The panel says adults aged 75 and older, as well as frontline essential workers, be designated as the second priority group. n expert panel that advises the Centers for Disease Control and Prevention recommended Sunday that adults aged 75 and older, as well as frontline essential workers, be designated as the second priority group to be vaccinated against Covid-19. The Advisory Committee on Immunization Practices also voted to recommend that the third stage of the national vaccination program should focus on adults 65 to 74, people 16 to 64 years old with high-risk medical conditions, and essential workers not included in the second phase of vaccination. The committee defined frontline essential workers as first responders, teachers and other education workers including day care workers, food and agriculture workers, correctional facility staff, postal workers, public transit workers, and people who work in manufacturing and in grocery stores. The vote came after hours of data presentations and debate, and pleas from members of the public to move up individual groups in the priority listing. “I voted for this recommendation because in my opinion, it follows the evidence about the risk from coronavirus and the ethical principles that we have developed on ACIP to maximize the benefits and minimize harms, promote justice, and to minimize health inequities,” said Peter Szilagyi, a pediatrician at UCLA.  “We are trying to thread the needle here.”

Szilagyi and multiple members of the committee said the work to decide who gets priority access to Covid-19 vaccines has been agonizing.   “This is without a doubt the hardest vote that I have taken in my 6 1/2 years on this committee,” said chair Jose Romero, secretary of health for Arkansas.  The committee voted 13 to 1 to approve the groups to be included in Phase 1b and Phase 1c of the vaccination program. Phase 1a, which is currently ongoing, gives top priority to health care workers and residents and staff of nursing homes. The lone dissenter, Henry Bernstein, a pediatrician and professor at the Zucker School of Medicine at Hofstra/Northwell, said he felt that adults aged 65 and older should have been in Phase 1b. The toll the virus takes on people 65 to 74 is not substantially different from its impact on people 75 and older, he argued. The ACIP recommendations now go to CDC Director Robert Redfield, who must sign off on them in order for them to become CDC guidance. However, state and local health authorities make the final decisions on how to roll out vaccination in their locales. At the end of Sunday’s meeting it was announced that more than half a million people in the country have already been vaccinated with the Pfizer Covid-19 vaccine. Moderna’s vaccine, which was given an emergency use authorization Friday evening by the Food and Drug Administration, will begin to be rolled out this week. 

The ACIP’s Covid vaccines work group, which proposed the priority groups, explained it was trying to balance the prevention of illness and death with trying to maintain societal functioning as well as equity. Frontline essential workers are in jobs where they cannot work from home; they may not even be able to practice social distancing because of the demands of their work. Previously the committee had talked about putting all essential workers ahead of seniors — an idea which drew pushback from Health and Human Services Secretary Alex Azar, among others.  But the entire essential workers group, which is based on a list drawn up by a division of the Department of Homeland Security, represents about 87 million people — too big a group at a time when vaccine supplies are scarce. Essential workers who will have to wait for Phase 1c for vaccine include people who maintain water and wastewater systems, people who work in the IT and communications sector, members of the media, and public safety workers.  Operation Warp Speed, the federal government’s program to fast-track vaccine production, estimates there will be enough vaccine to vaccinate 20 million people in December, another 30 million in January, and an additional 50 million by the end of February. Phase 1a of the vaccination effort, which began last week, involves offering vaccine to 24 million people. In Phase 1b, 49 million people will be eligible to receive vaccine. Phase 1c is a much larger group, including roughly 129 million people. In total, the first three priority groups will cover 202 million people — double the number of people the country expects to have vaccine for by the end of February.....

CDC ACIP Meetings Recommendations (Nov. 23, 2020):

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-11/COVID-04-Dooling.pdf 

CDC Data on Vaccine Administration and Distribution (updated daily):

https://covid.cdc.gov/covid-data-tracker/#vaccinations

The Centers for Disease Control and Prevention on Monday issued long-awaited guidance to Americans fully vaccinated against Covid-19, freeing them to take some liberties that the unvaccinated should not.  The Centers for Disease Control and Prevention on Monday issued long-awaited guidance to Americans fully vaccinated against Covid-19, freeing them to take some liberties that the unvaccinated should not, including gathering indoors with others who are fully vaccinated without precautions while still adhering to masking and distancing in public spaces. The agency offered good news to grandparents who have refrained from seeing children and grandchildren for the past year, saying that fully vaccinated people may visit indoors with unvaccinated people from a single household so long as no one among the unvaccinated is at risk for severe disease if infected with the coronavirus. That means fully vaccinated grandparents may visit unvaccinated healthy adult children and healthy grandchildren without masks or physical distancing. But the visit should be limited to one household: If the adult children’s unvaccinated neighbors drop by, the visit should move outdoors and everyone should wear masks and distance. The recommendations arrived as state officials move to reopen businesses and schools amid a drop in virus cases and deaths. Federal health officials repeatedly have warned against loosening restrictions too quickly, including lifting mask mandates, fearing that the moves may set the stage for a fourth surge of infections and deaths.

The new advice is couched in caveats and leaves room for amendments as new data become available. The agency did not rule out the possibility that fully vaccinated individuals might develop asymptomatic infections and spread the virus inadvertently to others, and urged those who are vaccinated to continue practicing certain precautions.  Agency officials encouraged people to get vaccinated with the first vaccine available to them, to help bring the pandemic to a close and resume normal life. The agency emphasized that vaccines are highly effective at preventing “serious Covid-19 illness, hospitalization and death,” and said its guidance “represents a first step toward returning to everyday activities in or communities.” “We know that people want to get vaccinated so they can get back to doing the things they enjoy with the people they love,” said Dr. Rochelle P. Walensky, director of the C.D.C. “There are some activities that fully vaccinated people can begin to resume now in the privacy of their own homes.”  Still, she added, “Everyone, including those who are vaccinated, should continue with all mitigation strategies when in public settings.” Many more Americans will need to be fully vaccinated before mitigation measures can be suspended, she and other officials said, as the majority of Americans have yet to get the vaccine.  As of Sunday, about 58.9 million people have received at least one dose of a Covid-19 vaccine, including about 30.7 million people who have been fully vaccinated, according to the C.D.C. Providers are administering about 2.16 million doses per day on average. The C.D.C.’s advice is aimed at Americans who are fully vaccinated, meaning those for whom at least two weeks have passed since they received the second dose of a two-dose vaccine series of Pfizer-BioNTech or Moderna vaccine, and those for whom at least two weeks have passed since receiving a single dose of the Johnson and Johnson single-dose vaccine. What is safe for newly vaccinated Americans and their unvaccinated neighbors and family members has been uncertain in large part because scientists do not yet understand whether and how often immunized people may still transmit the virus. If so, then masking and other precautions are still be needed in certain settings to contain the virus, researchers have said. There is also uncertainty about how well vaccines protect against emerging variants of the virus, and how long the vaccine protection lasts.

The U.S. Centers for Disease Control and Prevention (CDC) on Saturday said it was monitoring reports of allergic reactions to the COVID-19 vaccination and made recommendations on how people with histories of allergies should proceed. Anyone who had a severe reaction to a COVID-19 vaccine should not get the second dose, the agency said, defining severe as needing the medication epinephrine or treatment in a hospital. People who have had a severe allergic reaction to any ingredient in a COVID-19 vaccine should avoid the vaccine formulation containing the ingredient, CDC said. Two vaccines have been approved in the United States under emergency use authorizations. Individuals with histories of severe allergic reaction to vaccines should consult their doctors about the COVID-19 shot. The CDC said people with severe allergies to food, pets, latex or environmental conditions as well as people with allergies to oral medication or a family history of severe allergic reactions could still get vaccinated.

The U.S. Food and Drug Administration is investigating around five allergic reactions that happened after people were administered Pfizer Inc and BioNTech SE’s COVID-19 vaccine in the United States this week. On Friday, the FDA said that the Moderna Inc vaccine, which received emergency use authorization, should not be given to individuals with a known history of a severe allergic reaction to any components of the shot. Britain’s medical regulator has said that anyone with a history of anaphylaxis, or severe allergic reactions to a medicine or food, should not be given the Pfizer-BioNTech COVID-19 vaccine.

New CDC Guidelines (dec. 19, 2020) available:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html