OCTOBER 2023

by Editorial Board last updated Jan 26, 2024 08:47 AM

CDC Health Alert Network

  • October 23: Health Advisory issued to provide options for clinicians to protect infants from RSV in the context of a limited supply of nirsevimab-alip. Click here for complete advisory, here for Sanofi press release.

SARS-CoV-2 / COVID-19

COVID-19 Vaccination Summary

  • US guidelines have shifted to annual universal vaccination as of September 2023 because:
    1. Persons of any age and health status have at least some measurable risk of severe illness.
    2. Co-morbid conditions that increase the risk of severe illness are widespread.
  • CDC guidelines refer to "2023-24 COVID vaccine" with no preferred product (Modern, Pfizer, Novavax) regardless of past vaccine history. One dose of 2023-4 vaccine is indicated for all persons ≥6 months of age as soon as vaccine is available.
  • A full primary series is no longer indicated for healthy persons >5 years of age as almost the entire US population has antibody against SARS-CoV-2 from previous infection or vaccination.
  • All US persons age >6 months should be up-to-date on vaccination regardless of:
    • A history of symptomatic or asymptomatic SARS-CoV-2 infection;
    • Presence of long COVID;
    • History of SARS-CoV-2 breakthrough infection.
  • In short, a normal host age ≥5 years is up-to-date after receipt of one updated COVID-19 vaccine, regardless of the number of previous doses of mRNA or Janssen/J&J vaccine. Healthy children age 6 months to 4 years are up-to-date after receipt of all recommended primary mRNA doses (two Moderna or three Pfizer) including at least one dose of updated COVID-19 vaccine.
  • Defer vaccination until recovery from an acute episode and discontinuation of isolation. After SARS-CoV-2 infection, consider delaying next dose by three months from symptom onset or positive test.
  • There are no human efficacy data for the 2023-4 vaccine, but there is a documented boost in neutralizing antibody titers (only against current strains).
  • Observational data from recent bivalent vaccine indicates approximate effectiveness against hospitalization of about 50% in close proximity to the date of vaccine receipt.
  • WHO COVID-19 vaccination recommendations:
    • WHO recommends a simplified single-dose regimen for primary immunization, with eligibility determined by national priorities for most COVID-19 vaccines.
    • When monovalent XBB vaccines are not available, any available WHO- approved vaccine, bivalent variant-containing or monovalent index virus vaccines, may be used since they continue to provide benefits against severe disease in high-risk groups.

    ACIP Maternal RSV Recommendations

    • Of the two available RSV vaccines, only Abrysvo (Pfizer) is FDA approved for maternal prenatal vaccination at 32-36 weeks gestation to protect infants with passive antibody.
      • ACIP recommends seasonal administration of a single dose of Abrysvo for pregnant persons who are between 32-36 weeks gestation during the period of September to January to passively protect babies born between October and March as an equal option to nirsevimab-alip (Beyfortus) given to infants for their first RSV season.
        • In Alaska, parts of Florida, Hawaii, Puerto Rico, the U.S. Virgin Islands, and Guam, RSV can circulate year round. The seasonal rule for use of the vaccine would not apply in these areas.
    • When applicable, ACIP recommends seasonal administration of Abrysvo as an equal option to postnatal nirsevimab-alip. At other times of year, outside the maternal indications for Abyrsvo, nirsevimab-alip given to infants would be the only option.
    • Administration of both nirsevimab-alip to an infant and Abrysvo to the mother provides no benefit over administration of one or the other, but may be considered if the mother is immunocompromised or the infant has especially high RSV risk.  
    • Infants born <34 weeks gestation, or if the mother was vaccinated but the infant was born <14 days after vaccination, are recommended to receive nirsevimab-alip.
    • Abrysvo is about half the cost of nirsevimab-alip, but the effect does not appear to last as long (three months for Abrsyvo).
    • The complexities in choice of approach are likely to cause confusion among both patients and providers.

    Other Vaccine Recommendations from CDC

    Approved: Metronidazole Oral Suspension

    • The US FDA has approved metronidazole oral suspension (Likmez) for the treatment of trichomoniasis in adults, amebiasis in adult and pediatric patients, and anaerobic bacterial infections in adults. Product availability: 200 mL bottle, 500 mg/5 mL, strawberry-peppermint flavor. Refrigeration is not required.

        Drug Shortages (US)

        • Bicillin-LA and Bicillin-CR availability: See Dear Healthcare Professional letter here.
        • Antimicrobial drugs or vaccines in reduced supply or unavailable (as of October 8, 2023) due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons: 
          • New shortages since September 14, 2023:
            • Levofloxacin oral solution, 25 mg/mL (9/15/23)
            • Sulfacetamide 10%/Prednisolone sodium phos 0.23% oph soln (9/21/23)
          • Shortage recently resolved:
            • Isoniazid injection, 100 mg/mL (9/23/2023)
            • Neomycin 500 mg tablets (9/7/2023)
            • Tedizolid injection (10/2/2023)
            • Tedizolid phosphate 200 mg tablets (10/2/2023)
          • Antibacterial drugs:
            • Aminoglycosides:
              • Amikacin injection
              • Gentamicin injection
              • Tobramycin injection
            • Bacitracin ophthalmic ointment (unavailable)
            • Carbapenems:
              • Meropenem injection
            • Cephalosporins:
              • Cefazolin injection
              • Cefdinir (all oral formulations)
              • Cefixime 400 mg capsules
              • Cefotaxime injection (FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Provepharm Life Solutions and its distributor Direct Success. Click here for details),
            • Clindamycin injection
            • Doxycycline oral suspension
            • Fluoroquinolones:
              • Ciprofloxacin injection
              • Ciprofloxacin 0.3% ophthalmic solution
              • Ofloxacin 0.3% ophthalmic solution
            • Glycopeptides, glycolipopeptides, lipopeptides:
              • Vancomycin injection
            • Macrolides/azalides:
              • Azithromycin ophthalmic solution 1% (unavailable)
              • Erythromycin 0.5% ophthalmic ointment
            • Metronidazole injection
            • Neomycin and Polymyxin B Sulfates GU Irrigant
            • Nitrofurantoin oral suspension
            • Penicillins:
              • Amoxicillin (all oral formulations)
              • Amoxicillin-clavulanate (all oral formulations)
              • Dicloxacillin capsules (250 mg, 500 mg)
              • Penicillin G benzathine injection (Bicillin-LA)
              • Penicillin G benzathine/Penicillin G procaine (Bicillin-CR)
              • Penicillin VK tablets (250 mg, 500 mg), oral solution (250 mg/5 mL)
              • Piperacillin-tazobactam injection
            • Polymyxin B sulfate/Trimethoprim sulfate ophthalmic solution
            • Sulfanilamide 15% vaginal cream (unavailable)
          • Antifungal drugs: 
            • Amphotericin B injection
            • Amphotericin B Lipid Complex (ABLC)
            • Nystatin topical powder
          • Antimycobacterial drugs: 
            • Isoniazid 100 mg, 300 mg tablets
            • Rifampin capsules
          • Antiparasitic drugs:
            • Primaquine
          • Antiviral drugs: 
            • Oseltamivir capsules, powder for oral suspension
            • Podofilox 0.5% topical gel
            • Ribavirin for inhalation solution
            • Valganciclovir tablets, powder for oral solution
          • Vaccines:
            • None
        • Antimicrobial drugs recently discontinued: 
          • Sulfacetamide 10%/Prednisolone acetate 0.2% oph ointment (Aug 2023 by Allergan, sole supplier)
          • Penicillin G procaine 600,000 units/mL IM injection (June 2023)
          • Ritonavir oral solution 80 mg/mL (January 2023)
          • Lindane 1% shampoo (discontinued by Wockhardt USA in June 2022, no other supplier)
          • Quinupristin-Dalfopristin (discontinued by Pfizer in early 2022, no other supplier)
          • Gemifloxacin 320 mg tablet (August 2022, no further US distribution)
          • Gentamicin sulfate 0.3% ophthalmic ointment (July 2022)
          • Mupirocin calcium 2% cream (Bactroban [GSK], June 2020)
          • Bacitracin injection (February 2020)
          • Interferon alfa-2b (Intron A, October 2019)
          • Mupirocin calcium 2% nasal ointment (Bactroban Nasal [GSK], August 2019)