CDC recommends COVID-19 booster; ACP updates practice points for outpatient treatment

Everyone ages 6 months and older should get an updated COVID-19 vaccine to protect against a potentially serious outbreak this fall and winter, the CDC said last week.

The CDC recommended an updated COVID-19 booster, and ACP updated its rapid, living practice points for outpatient treatment of COVID-19.

The CDC recommended last week that everyone ages 6 months and older get an updated COVID-19 vaccine to protect against a potentially serious outbreak this fall and winter. Updated COVID-19 vaccines from Pfizer-BioNTech and Moderna are expected to be available soon, and the CDC noted that this is the first fall and winter virus season when vaccines are available for the three viruses responsible for most hospitalizations: COVID-19, respiratory syncytial virus (RSV), and flu.

This week, ACP updated its COVID-19 practice points to consider new evidence regarding outpatient treatments. ACP said that molnupiravir and nirmatrelvir-ritonavir should be considered to treat symptomatic patients with confirmed mild to moderate COVID-19 who are within five days of symptom onset and at a high risk for progressing to severe disease. Molnupiravir probably improves recovery and reduces time to recovery compared with usual care (moderate certainty), while nirmatrelvir-ritonavir is probably associated with a reduction in all-cause mortality and hospital admissions due to COVID-19 compared with no treatment (moderate certainty), according to the practice points.

The practice points said the evidence does not support the use of ivermectin or sotrovimab for outpatients with confirmed mild to moderate COVID-19. In addition, there were 18 other treatments for which no eligible studies were identified for the Omicron variant. The practice points and their accompanying evidence review were published Sept. 19 by Annals of Internal Medicine.

The practice points noted that the decision to begin treatment for COVID-19 in the outpatient setting should be personalized and based on clinical judgment. Best practice is to use an informed decision-making approach with patients regarding potential treatment benefits and harms; patient characteristics (such as risk factors, comorbid conditions, and disease severity); patient preferences; and social determinants of health. Clinicians should review all medications and potential drug interactions before beginning outpatient treatment for COVID-19, the practice points said.

In other COVID-19 news, an unrelated prospective cohort study of Israeli health care workers found that reactogenicity and immunogenicity were mostly unchanged when COVID-19 and seasonal influenza vaccines were coadministered versus when COVID-19 vaccine was administered alone. Results were published Sept. 8 by JAMA Network Open. In the reactogenicity cohort, compared with COVID-19 vaccination alone, the risk for systemic symptoms was similar in the coadministration group (odds ratio, 0.82; 95% CI, 0.43 to 1.56). In the immunogenicity cohort, geometric mean titers in the coadministration group were estimated to be 0.84 (95% CI, 0.69 to 1.04) times lower than in the COVID-19 vaccine-alone group. The results support the coadministration of these vaccines, the authors concluded.