Medical Director Report December 2023

If you are testing for COVID-19, also test for Influenza. If both are negative, test for RSV.

• 467 flu hospitalizations
• 2,685 Covid-19 hospitalizations
• 471 RSV hospitalizations (mostly children < 4 y/o)

COVID-19 Vaccinations

COVID-19 vaccine clinic toolkit for long-term care facilities | Department of Public Health & Environment (colorado.gov)

• The previous bivalent vaccines are no longer available in the U.S.
• Currently, the updated 2023-2024 Pfizer-BioNTech, Moderna, and Novavax Covid-19 vaccines are recommended by the CDC.
• If a person/patient has not previously received any Covid-19 vaccination, one of the aforementioned three updated 2023-2024 Covid-19 vaccines is recomended.

Use of Updated COVID-19 Vaccines 2023–2024 Formula for Persons Aged ≥6 Months: Recommendations of the Advisory Committee on Immunization Practices — United States, September 2023 | MMWR (cdc.gov)

COVID-19 Treatment Update

• Consider treatment for anyone over 50 y/o9 with high risk health condition (basically, anyong in long term care.
• Start treatment ASAP, even for mild symptoms. Must be started with 5 days of symptom onset.
• The oral antiviral pill Paxlovid (nirmatrelvir co-packaged with ritonavir) and the IV administered drug Veklury (remdesivir) are the preferred treatments for eligible patients.
  • I’m not sure if we can get Veklury (remdesir) in LTC.
• Checklist for Paxlovid prescribing from the FDA

Paxlovid (Ritonavir/Nirmatrelvir) Drug Interactions

Paxlovid Drug-Drug Interactions | COVID-19 Treatment Guidelines (nih.gov)

Checklist for Paxlovid prescribing from the FDA

• There are so many potential drug interactions that I think it is easier to provide a list of medications that are safe to co-administer with Paxlovid.
• Use the University of Liverpool COVID drug interaction checker (or your favorite drug interaction checker) prior to giving anyone Paxlovid
• Check Renal Function to assess if Paxlovid can safely be given and at what dose.
  • GFR > 60: no dosage adjustment needed. Nirmatrelvir 300/ ritonavir 100mg PO BID x 5 days.
  • GFR 30-60: Nirmatrelvir 150/ ritonavir 100mg PO BID x 5 days.

Influenza Vaccine Information

• Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season | MMWR (cdc.gov)
• Influenza Antiviral Medications: Summary for Clinicians | CDC
• If you are testing for COVID-19, also test for influenza.

RSV Vaccine Information

• Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023 | MMWR (cdc.gov)
  • A single dose RSV vaccine showed moderate-high efficacy in preventing symptomatic RSV related disease.
  • ACIP recommends persons >60 years may receive a dose of RSV vaccine.
  • Shared decision making emphasized.

Viral Respiratory Dz Report

• High influenza transmission in Colorado
• 6.8% increase in lab positive influenza
• Influenza A (H1N1) predominant strain
• Influenza positive tests on the rise
• 11.5% positive COVID-19 test rate nationwide

References:

• COVID-19 Therapeutics Decision Aid (hhs.gov)
• COVID-19 Treatments: Key Messages for Long-Term Care Facilities (hhs.gov)
• COVID-19 Treatments: Information for Long‑Term Care Facilities | HHS/ASPR
• Use of Updated COVID-19 Vaccines 2023–2024 Formula for Persons Aged ≥6 Months: Recommendations of the Advisory Committee on Immunization Practices — United States, September 2023 | MMWR (cdc.gov)
• COVID-19 resources for long-term and residential care facilities | Department of Public Health & Environment (colorado.gov)
• Public Health Data and Analytics | El Paso County Public Health (elpasocountyhealth.org)