As US COVID-19 Vaccine Policy Pivots, CDC Publishes Prevention Measures for Immunocompromised

In light of the emergent Omicron variants circulating across the United States as well as the FDA’s decision on Thursday to withdraw the Emergency Use Authorization for the neutralizing antibody Evusheld for preexposure prophylaxis, the federal government is working to update its COVID-19 public health policies. First, CDC wanted to provide updated measures for preventing COVID-19 in the immunocompromised population.

Specifically, the measures were published in the latest edition of the Morbidity and Mortality Weekly Report.

Although, nothing truly new emerged for the measures, the prevention measures served as reminders and included the following:

-Get an updated COVID-19 vaccine

-Improve ventilation and spend time outdoors

-Learn about testing locations and treatment options before getting exposed or sick

-Get tested if you been exposed to the virus or have symptoms

-Wash your hands often

-Wear a well-fitted mask and maintain a distance in crowded spaces.

It has been well-documented in the past that the efficacy of the COVID-19 vaccines for the immunocompromised has been limited compared to the greater population. However, the authors noted in a previous published MMWR the newer booster demonstrated protection in the former population. “Bivalent mRNA booster doses provide additional protection against symptomatic SARS-CoV-2 in immunocompetent persons who previously received monovalent vaccine only, with relative benefits increasing with time since receipt of the most recent monovalent vaccine dose.”

CDC provided some information as to who are considered the immunocompromised. “This includes people who have cancer and are on chemotherapy, or who have had a solid organ transplant, like a kidney transplant or heart transplant, and are taking medication to keep their transplant. Other people have to use certain types of medicines for a long time, like corticosteroids, that weaken their immune system,” the CDC stated on its website.

And for those who are immunocompromised and believe they might have developed COVID-19, preplanning ahead of time on how to address it is significant according to the authors of this most recent MMWR. “Persons should have a care plan that includes prompt testing at the onset of COVID-19 symptoms and rapid access to antivirals if SARS-CoV-2 infection is detected,” the authors wrote.

A New COVID-19 Vaccine Strategy Emerges
Last Thursday, the FDA VRBPAC met to discuss simplifying the COVID-19 schedule for everyone and emulating the annual influenza vaccine schedule, which is delivered every fall.

Near the end of that meeting, the committee was asked to vote upon this question: “Does the committee recommend harmonizing the vaccine strain composition of primary series and booster doses in the US to a single composition, e.g., the composition for all vaccines administered currently would be a bivalent vaccine (Original plus Omicron BA.4/BA.5)?”

The committee voted 21-0 to recommend harmonizing the vaccine composition.

As the latest bivalent data was reported at the VRBPAC, one of the vaccine manufacturers, Novavax, said it planned to deliver an updated vaccine that will fulfill VRBPAC’s goal of harmonizing the viral strains in primary series and booster shots. “Novavax is prepared to deliver an updated vaccine following FDA guidance on strain change,” Silvia Taylor, executive vice president and chief communications officer of Novavax, said in a statement.

Going forward, the strategy is clear. The US federal government plans to emulate its influenza vaccine strategy and offer annual vaccination, depending on the current strains circulating. The manufacturers will update their vaccines as needed to offer protection against those strains.

This marks a departure of the current strategy of periodic vaccination, and unceremoniously demonstrates one more example that the pandemic has truly moved into the endemic phase.