M&D Clinical Corner: Respiratory Virus Updates

The Clinical Corner is a monthly feature that highlights a variety of important pharmacist topics that is written by Morris & Dickson’s staff pharmacist, Paula Belle (RPh).

This month’s Clinical Corner will provide an update on current respiratory viral infection in the United States:

• Background
• The Pharmacist’s Role
• Resources for Pharmacists
• Resources for Patients

BACKGROUND

• The Centers for Disease Control and Prevention (CDC) is tracking increased respiratory disease activity in the United States for several respiratory pathogens, including influenza viruses, SARS-CoV-2, (the virus that causes COVID-19) and RSV, across multiple indicators such as laboratory test positivity, emergency department visits, wastewater, and hospitalizations. [1]
• For the 4 weeks leading into December 14, 2023 hospitalizations among all age groups increased by 200% for influenza, 51% for COVID-19, and 60% for RSV. [1]
• As of January 5, 2024, emergency department visits across the U.S. due to influenza and COVID-19 are elevated in all age groups and increasing in all but school-aged children. Recent, holiday-related school closures and associated changes in healthcare seeking behavior may be impacting trends in influenza- and COVID-19-related visits among school-aged children. [2]
• RSV-related emergency department visits decreased slightly nationally per CDC reporting as of January 5, 2024. [2]
• Low vaccination rates, coupled with ongoing increases in national and international respiratory disease activity caused by multiple pathogens, including influenza viruses, SARS-CoV-2, and RSV, could lead to more severe disease and increased healthcare capacity strain in the coming weeks. [1]
• The latest respiratory virus activity levels can be viewed at CDC Respiratory Viruses Dashboard

COVID-19

• As of December 23, 2023, 7.9% of children were reported to be up to date with the 2023-24 COVID-19 vaccine. [3]
• As of December 23, 2023, 18.9% of adults aged 18 years or older were reported to be up to date with the 2023-24 COVID-19 vaccine. [3]
• Everyone aged five years and older should get one dose of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine to be up to date and protect against serious illness from COVID-19. [4]
• Children aged six months to four years need multiple doses of COVID-19 vaccine to be up to date, including at least one dose of the updated vaccine. [4]
• People who are moderately or severely immunocompromised may get additional doses of the updated COVID-19 vaccine. [4]

INFLUENZA

• Influenza vaccination coverage for all children aged 6 months to 17 years is 3.6 percentage points lower this season compared with the same time last season (43.3% compared with 46.9%). [5]
• National influenza vaccination coverage for all adults, including Puerto Rico and U.S. Virgin Islands, is 42.2%, and coverage among states and DC ranges from 32.2% to 54.8%. [5]
• Everyone aged six months and older should get an updated flu vaccine. People aged 65 and older should get a high-dose or adjuvanted flu vaccine if available. [4]

RESPIRATORY SYNCYTIAL VIRUS

• As of December 23, 2023, an estimated 17.4% of adults 60 years and older reported having received an RSV vaccine. [6]
• RSV immunizations are recommended for these groups only [7]:
  • RSV vaccines (Arexvy by GSK and Abrysvo by Pfizer) have been licensed by FDA and recommended by CDC for adults ages 60 and older, using shared clinical decision-making.
  • One RSV vaccine (Abrysvo by Pfizer) has been licensed and recommended during weeks 32 through 36 of pregnancy to protect infants.
• There are two options to protect infants against RSV-associated lower respiratory tract disease [1]:
  • RSV vaccine for pregnant people
  • Nirsevimab for infants.

THE PHARMACIST’S ROLE

IMMUNIZATION

• Healthcare providers should administer influenza, COVID-19, and RSV immunizations now to patients, if recommended. [1]
• Immunizations can prevent hospitalization and death associated with these respiratory diseases. [1]
• Immunizations are especially important for people at increased risk for severe disease, including infants, older adults, pregnant people, and people with certain underlying medical conditions. [1]
• Providers should leverage all available tools to increase immunizations against influenza, COVID-19, and RSV. [1]

ANTIVIRALS

• Antiviral medications are currently underutilized but are important to treat patients, especially persons at high-risk of progression to severe disease with influenza or COVID-19, including older adults and people with certain underlying medical conditions. [1]
• Both influenza antiviral medications and COVID-19 antiviral medications are most effective in reducing the risk of complications when treatment is started as early as possible after symptom onset. [1]

Influenza Antivirals

• Antiviral treatment of influenza is recommended as soon as possible for persons who are at higher risk for influenza complications. Persons with influenza who are not at higher risk and within 2 days of symptom onset can be prescribed antiviral treatment based upon clinical judgement to shorten their illness duration.

Covid-19 Antivirals

• COVID-19 antivirals are recommended for treatment of mild to moderate COVID-19 in individuals at increased risk of severe illness and can reduce the risk of hospitalization for a wide range of patients, including those who are 50 years and older and people with various medical conditions. [1]
• COVID-19 antivirals can be taken safely even with many other medications. Clinicians should evaluate drug-drug interactions as some medications may need to be stopped or changed. [1]

EVERYDAY PREVENTION

• Healthcare providers should counsel patients about other everyday preventive actions they can do to protect themselves against respiratory diseases including [1]:
  • Testing
  • Covering coughs and sneezes
  • Washing
  • Wearing a well-fitting mask if a patient chooses to wear a mask
  • Improving ventilation in home and work environments.

RESOURCES FOR PHARMACISTS

• • The latest respiratory virus activity levels can be viewed at CDC Respiratory Viruses Dashboard
  • Pharmacists can access the most recent CDC immunization schedules at this link: 2024 CDC Immunization Schedules
  • At-A-Glance: Vaccination Conversation Guide for Healthcare Providers [1]

RESOURCES FOR PATIENTS

• Advise patients who develop symptoms of a respiratory illness, to speak with a healthcare provider about testing and treatment options.
• Make patients aware of everyday prevention measures including covering coughs and sneezes, washing hands, staying home when sick, wearing a well-fitting mask if the patient chooses to wear a mask, and improving airflow at home or at work.
• Patient may use the Vaccines.gov website to find a location to receive COVID-19 and flu vaccines.
• Uninsured and adults can receive COVID-19 vaccines at no cost to them through CDC’s Bridge Access Program.
• Pregnant people and older adults can use the manufacturer’s website (Pfizervax.com) to find a location offering Pfizer Abrysvo RSV vaccine.

Sources

1. Centers for Disease Control and Prevention. Health Alert Network (HAN) – 00503 | Urgent Need to Increase Immunization Coverage for Influenza, COVID-19, and RSV and Use of Authorized/Approved Therapeutics in the Setting of Increased Respiratory Disease Activity During the 2023 – 2024 Winter Season. 2023 2023-12-14T07:56:04Z [cited 2024 January 4]; Available from: https://emergency.cdc.gov/han/2023/han00503.asp.
2. Centers for Disease Control and Prevention. Respiratory Virus Activity Levels. 2024 2024-01-04T05:30:05Z [cited 2024 January 9]; Available from: https://www.cdc.gov/respiratory-viruses/data-research/dashboard/activity-levels.html.
3. Centers for Disease Control and Prevention. Weekly COVID-19 Vaccination Dashboard | COVIDVaxView | CDC. 2024 2024-01-04T03:04:24Z [cited 2024 January 4]; Available from: https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/interactive/vaccination-dashboard.html.
4. Centers for Disease Control and Prevention. Immunization Overview for Fall and Winter 2023-2024 | CDC. 2023 2023-12-28T03:24:46Z [cited 2024 January 9]; Available from: https://www.cdc.gov/respiratory-viruses/whats-new/immunization-overview-2023-2024.html.
5. Centers for Disease Control and Prevention. Weekly Flu Vaccination Dashboard | FluVaxView | Seasonal Influenza (Flu) | CDC. 2023 2023-12-21T08:00:55Z [cited 2024 January 4]; Available from: https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-dashboard.html.
6. Centers for Disease Control and Prevention. RSVVaxView | CDC. 2024 2024-01-04T03:05:58Z [cited 2024 January 9]; Available from: https://www.cdc.gov/vaccines/imz-managers/coverage/rsvvaxview/index.html.
7. Centers for Disease Control and Prevention. RSV in Older Adults and Adults with Chronic Medical Conditions | CDC. 2024 2024-01-05T07:43:28Z [cited 2024 January 9]; Available from: https://www.cdc.gov/rsv/high-risk/older-adults.html.