Letter from Virginia State Health Commissioner Dr. Colin Greene
I am writing to provide you brief updates on COVID-19 and monkeypox.
CDC Updates COVID-19 Recommendations
- On August 11, the Centers for Disease Control and Prevention (CDC) made substantial COVID-19 guidance updates and recommends that in light of high population levels of anti–SARS-CoV-2 seroprevalence, and to limit social and economic impacts, quarantine of exposed persons is no longer recommended, regardless of vaccination status.
- CDC recommends that people who have had recent confirmed or suspected exposure to an infected person should wear a mask for 10 days around others when indoors in public and should receive testing ≥ 5 days after exposure (or sooner, if they are symptomatic), irrespective of their vaccination status.
- CDC recommends case investigation and contact tracing only in health care settings and certain high-risk congregate settings. In all other circumstances, public health efforts can focus on case notification and provision of information and resources to exposed persons about access to testing.
- Everyone is encouraged to stay up-to-date on their COVID-19 vaccinations and use the COVID-19 Community Levels to guide additional prevention efforts for themselves, based on their own personal risk.
- CDC continues to recommend masking at all times in healthcare settings, regardless of the current COVID-19 Community Level.
- The elimination of most quarantine for COVID is in concurrence with VDH policy. VDH policy leaves masking as a personal choice in most circumstances; exceptions are high-risk settings including healthcare delivery, and as part of an isolation protocol, where masking is still recommended.
COVID-19 Vaccine Update: Novavax and Bivalent Boosters
- FDA recently authorized and CDC recommended Novavax’s COVID-19 vaccine as another primary series option for adolescents aged 12 through 17 years. Previously, this vaccine had been recommended for adults aged 18 years and older.
- To reflect the expanded age eligibility, FDA updated their fact sheets for healthcare providers and for patients and caregivers, and CDC updated its Interim Clinical Considerations for the Use of COVID-19 Vaccines in the United States.
- Providers in Virginia may immediately begin using this 2-dose primary series vaccine for these adolescents. As a reminder, Novavax’s COVID-19 vaccine cannot be used for a booster dose or for third doses for immunocompromised persons.
- In the near future, FDA and CDC might provide information about new bivalent COVID-19 vaccine boosters that cover an Omicron BA.4/5 spike protein, and that might be available in the 2022 fall and winter.
COVID-19 Therapeutic Update: Bebtelovimab is Available for Purchase Commercially
- As of August 15, 2022, bebtelovimab has become commercially available for purchase. Orders can be placed directly through AmerisourceBergen.
- The federal government will allocate its remaining supply of bebtelovimab to jurisdictions. Providers should not bill patients or insurance for any product procured from the federal government.
- VDH places a high priority on equitable availability of bebtelovimab. If a facility does not serve the under and/or uninsured, VDH encourages these locations to utilize the redistribution process to reallocate bebtelovimab procured from the federal government for this vulnerable population.
Monkeypox Clinical Evaluation and Management
- CDC recently published a report describing the clinical and epidemiologic features of U.S. monkeypox cases.
- Coinfections with sexually transmitted infections (STIs), like HIV, have been reported. To date, there have been no reported U.S.deaths. Lesions, however, can be painful or pruritic as they progress. Some patients require hospitalization.
- As a reminder, all healthcare staff should implement standard and transmission-based precautions when providing care to a patient with suspected or confirmed monkeypox. VDH has received reports of healthcare staff not using appropriate PPE when performing initial triage or collecting vital information, which puts those individuals at risk.
- For patients with monkeypox, supportive care should be assessed and provided for management of pain, skin and oral lesions, proctitis, and gastrointestinal symptoms. This treatment might include over-the-counter or prescription medication for acute pain management, baths or topical gels for painful or itchy lesions, oral histamines for pruritus, and rehydration for fluid losses. Providers can refer to New York City Department of Health & Mental Hygiene’s guidance on supportive care.
- Antiviral treatment using tecovirimat (TPOXX) is available through an Expanded Access – Investigational New Drug (EA-IND) protocol authorized by the CDC for patients with severe illness or those at high risk of severe illness.
- It is provided by the federal government at no cost; patients should not be billed for the drug, but may be billed for the healthcare encounter.
- It may be prescribed after obtaining informed consent.
- Virtual evaluations (telemedicine) are allowed.
- Additional documentation requirements can be found on the CDC Information for Healthcare Providers on Obtaining and Using TPOXX (Tecovirimat) for Treatment of Monkeypox website.
- To access TPOXX, providers should follow the steps on VDH’s Monkeypox Treatment website for providers.
JYNNEOS Vaccine for People at High Risk of Exposure to the Monkeypox Virus
- On August 9, FDA issued an emergency use authorization (EUA) for the JYNNEOS vaccine, which will allow for an expanded U.S. supply. The standard vaccine dosing regimen is to administer 0.5ml of the vaccine subcutaneously. Under the EUA, an alternative regimen of 0.1ml administered intradermally is available for people aged 18 years or older.
- Adults who received their first dose subcutaneously may receive their second dose intradermally or subcutaneously.
- The EUA also expanded vaccine eligibility to people younger than 18 years of age using the standard vaccine dosing regimen.
- At this time all JYNNEOS vaccines are administered by local health departments and a small number of select community providers.
- If you are a provider caring for a person who is eligible for JYNNEOS, including children, please contact your local health department for information on how to access the vaccine for your patients.
- Effective today (August 25), the following groups of people are now eligible to receive Expanded Postexposure Prophylaxis (PEP) in Virginia:
- All people, of any sexual orientation or gender, who have had anonymous or multiple (more than 1) sexual partners in the last 2 weeks; or
- Sex workers (of any sexual orientation or gender); or
- Staff (of any sexual orientation or gender) at establishments where sexual activity occurs (e.g. bathhouses, saunas, sex clubs).
- Please familiarize yourself with eligibility criteria for JYNNEOS vaccine in Virginia, and visit the VDH website regularly to obtain the most current information.
Colin M. Greene, MD, MPH
State Health Commissioner