COVID-19 Vaccination Update

The CDC has issued a COVID vaccination guide at a glance.  It includes bivalent boosters except in children under 5. 

Preliminary findings of the bivalent COVID vaccine compared to the original vaccine showed higher binding antibody responses against multiple other variants (alpha, beta, gamma, and delta) than the mRNA-1273 (original) booster at 136 and 134 days after last booster, respectively. Safety and reactogenicity were similar with the two booster vaccines, and vaccine effectiveness was not assessed in this study.

Mucosal Vaccine Study

A recent article on the mucosal vaccine explains the mouse study, in which a nasal vaccination induced antibody responses that were similarly effective in neutralizing the binding of the parental strain of S-RBD to its ACE2 receptor, but showed greater cross-neutralizing capacity against multiple variants. It also showed greater T-cell response in the spleen than injected vaccine.  This is a start to possibly get to mucosal protection and ultimately reduced transmission among people.

This study compared long COVID symptoms in 951 infected, 637(67%) were vaccinated to 2447 who reported never having been infected. The most prevalent symptoms were: fatigue (22%), headache (20%), weakness of limbs (13%), and persistent muscle pain (10%). Those who received two vaccine doses were less likely to report these symptoms (risk ratios 0.38, 0.50, 0.38, 0.34, p < 0.04 in the listed sequence). Double-vaccinated participants were no more likely to report these symptoms than never infected.

Paxlovid

With Paxlovid, viral load rebound occurred within 14 days, in 23 of 990 patients (2.3%) and in 17 of 980 (1.7%) in the placebo group, not statistically different. 

A case series of 13 Paxlovid treated patients, 29 to 71 years (mean 63), showed rebound results on rapid antigen testing on days 9 through 15, remained positive for 2 to 7 days, and turned negative as late as day 22.

Of 29,947 individuals registered in the National Marrow Donor Program with HLA genotyping data researchers tracked COVID-19 symptoms and outcomes in 640 who tested positive for COVID and replicated their findings in another 788. HLA-B*15:01 was strongly associated with asymptomatic infection with SARS-CoV-2 (OR= 2.32 for heterozygosity and OR 8.58 for homozygosity, and is likely to be involved in the mechanism underlying early viral clearance. This is further enhanced by the presence of HLA-DRB1*04:01.

Blood vessel wall inflammation was found on MRI in 6 of 15 patients with Long COVID compared to MRI on 1 of 12 non-infected.  It may well be that those with prior atherosclerosis have more risk for long COVID and neurologic symptoms.  A larger study controlling for risk factors is needed. 

COVID and Diabetes

Previously stated, SARS-CoV-2 can destroy beta cells and cause diabetes.  This article reviewed multiple studies, finding that “COVID-induced diabetes is associated with remarkably higher mortality rates and worse outcomes compared to COVID-19 patients with pre-existing diabetes. … could be due to beta cell damage and insulin resistance caused by SARS-CoV-2.” Some of the studies reviewed are:

New-onset diabetes in comparison to patients with pre-existing diabetes increased risk of ICU admission or death (RR 3.06 vs 1.55, p = 0.004). Severe disease, with organ damage was suspected. 

A meta-analysis examining the outcomes of 1,943 patients with COVID-induced diabetes had a mortality rate of 25 %, as compared to 9 % in patients without diabetes.

In a mouse model, the antibody SP1-77 bound the receptor binding domain away from the ACE2-mediated viral attachment or endocytosis, and blocked viral-host membrane fusion. If this bears out, it would allow vaccine and antibody development that is independent of variants.

In Geriatric News

For people 65 years and older during the 2022-2023 flu season, the CDC preferentially recommends these vaccines because of enhanced immunogenicity: Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant  flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. 

Legislation creating a 3 year pilot program allowing veterans access to assisted living (AL) care has been introduced in the House of Representatives. Only Medicaid certified facilities are eligible to participate.  Estimated cost savings are $69,000 per resident per year over NH placement.  Since AL facilities are not regulated compared to NHs, which are highly regulated, the quality of care is a concern.

The CMS has posted a new version of the MDS 3.0 version 1.18.11 is 13 pages longer and has been posted with plans to take effect Oct 1, 2023. Major changes include:

1. Section G, functional status (ADLs) has been eliminated

2. Transfer of Health Information has been added

3. Many data elements were added throughout

4. PHQ-2 was added as an initial screening option to PHQ-9

5. Hypoglycemics and antiplatelets were added under high-risk drug classes.

In other news

Hard cognitive work leads to glutamate accumulation in the lateral prefrontal cortex. Glutamate reduces the control exerted over decision-making, reduced control, and favors the choice of low-effort actions with short-term rewards. Another argument for mindfulness, paying attention when our body says “I need a break,” in this case to allow clearing of glutamate.  

The CDC has issued an alert for Rhinoviruses and/or Enteroviruses Including EV-D68 that can lead to acute flaccid myelitis (AFM), a rare but serious neurologic complication involving limb weakness. If a child is identified with AFM, swabs from several sites should be sent to the CDC for identification of polio, rhinoviruses and/or enteroviruses.