Administration Could Start Following the Labor Day Weekend

Today, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) of the Moderna COVID-19 Vaccine and the Pfizer-BioNTech COVID-19 Vaccine to authorize bivalent formulations of the vaccines for use as a single booster dose at least two months following primary or booster vaccination. The bivalent vaccines, which will also be referred to as “updated boosters,” contain two messenger RNA (mRNA) components of SARS-CoV-2 virus, one of the original strain of SARS-CoV-2 and the other one in common between the BA.4 and BA.5 lineages of the omicron variant of SARS-CoV-2. The monovalent COVID-19 vaccines that are authorized or approved by the FDA and have been administered to millions of people in the United States since December 2020 contain a component from the original strain of SARS-CoV-2. As U.S. health officials make preparations to roll out new COVID-19 boosters, the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) will convene this Thursday and Friday to discuss potential recommendations. Should the CDC approve the new shots following the FDA's authorization today, the vaccine could be shipped and administered starting soon after Labor Day. Administration of the vaccine can begin only after the CDC's official recommendations are released.

Vaccine Program Key Considerations:

• The bivalent COVID-19 vaccine will be administered as a single booster dose at least two months following primary or booster vaccination.
• Moderna COVID-19 Vaccine, Bivalent is authorized for use as a single booster dose in individuals 18 years of age and older.
• The Pfizer-BioNTech COVID-19 Vaccine, Bivalent, is authorized for use as a single booster dose in individuals 12 years of age and older.
• Practices are encouraged to promote primary series vaccination and boosters (for ages 5-11) with current vaccine supply.

Recommendations for Identification, Treatment, Prevention

The Centers for Disease Control and Prevention (CDC) issued a Health Advisory to provide updates on recent variant1 influenza virus infections and summarize CDC’s recommendations for identification, treatment, and prevention of variant influenza virus infection for the summer and fall of 2022. Five cases of human infection with influenza viruses that usually spread only in pigs, also known as variant influenza virus infections, were reported to CDC in August 2022. These cases include three infections with influenza A(H3N2) variant (A(H3N2)v) virus and two infections with influenza A(H1N2)v virus. These cases were identified in West Virginia (3), Oregon (1), and Ohio (1). Four of the five cases reported exposure to pigs or attendance at an agricultural fair prior to illness, and one reported no contact with pigs or attendance at an agricultural fair prior to illness. Clinical characteristics of these cases have been similar to those of seasonal influenza infections and have included fever, cough, pharyngitis, myalgia, and headache. No hospitalizations or deaths have occurred among these five cases, and all patients are recovering or have recovered from their illnesses. To date, no person-to-person spread associated with the five recent variant influenza virus infections has been identified. CDC anticipates that state health departments may identify more cases of infection with variant influenza viruses in 2022 as the agricultural fair season continues. Testing for variant influenza viruses should focus primarily on persons with exposures known to be associated with variant influenza virus infection (e.g., agricultural fair attendance or workers in the swine industry). Novel influenza A virus infections, which include those caused by variant influenza viruses, are notifiable conditions in the United States, and all confirmed cases should be reported to CDC within 24 hours. Recommendations for Physicians:

• Outside of the traditional influenza season, ask patients with suspected influenza if they have any recent exposure to swine.
• For suspected influenza in persons with recent exposure to swine:
• Obtain a nasopharyngeal swab or aspirate from the patient,
• Place the swab or aspirate in a viral transport medium, and
• Contact the state health department to arrange transport and request a timely diagnosis at a state public health laboratory.
• Recommend antiviral treatment in patients with suspected or confirmed variant influenza virus infection who are hospitalized, have severe illness, or are in a group considered at increased risk for complications from influenza2. Antiviral treatment can also be considered for those not at increased risk based on clinical judgement and if treatment can be initiated within 48 hours of illness onset.

Sussex County Man Identified

The Division of Public Health (DPH) is announcing this year’s first human case of West Nile Virus (WNV), in a 78-year-old Sussex County man. West Nile Virus is a mosquito-borne illness that can cause serious health problems. In addition to the first human WNV case, there also have been confirmed cases in a horse in New Castle County, and in 19 sentinel chickens in outdoor-caged and humanely tended stations maintained throughout the state by the Department of Natural Resources and Environmental Control (DNREC). Delawareans should be aware that mosquitoes that cause WNV bite primarily during the evening and morning hours; or dusk and dawn. However, mosquitoes that cause other diseases such as chikungunya, dengue fever, and Zika can bite during the day. WNV is transmitted by mosquitoes, generally in summer and fall, with a peak period for disease transmission from mid-August to mid-October. Nearly 80 percent of people infected with WNV will not become ill. Less than 20 percent of those infected with the virus will develop mild symptoms such as fever, headache, body aches, a skin rash on the chest or back, and swollen lymph glands. Approximately one in 150 people infected will develop severe infection which may include headache, high fever, stiff neck, tremors or convulsions, muscle weakness, encephalitis or meningitis, all possibly leading to hospitalization and very rarely death. The elderly and those with weakened immune systems are most at risk to contract WNV from mosquitoes. Anyone who experiences any of these severe symptoms should immediately seek medical assistance. To report suspected cases of human WNV, call the DPH Office of Infectious Disease Epidemiology at 1-888-295-5156. 

Used to Target Young Americans

The Drug Enforcement Administration (DEA) is advising of an alarming trend of colorful fentanyl available across the U.S. In August 2022, DEA and law enforcement seized brightly-colored fentanyl and fentanyl pills in 18 states. Dubbed "rainbox fentanyl" in the media, this trend appears to be a new method used by drug cartels to sell highly addictive and potentially deadly fentanyl made to look like candy to children and young people. Brightly-colored fentanyl is being seized in multiple forms, including pills, powder, and blocks that resemble sidewalk chalk.

To Be Included in Narcan Kits Dispensed to the Public

The Delaware Division of Public Health’s (DPH) Office of Health Crisis Response (OHCR) is announcing it will begin including fentanyl test strips in Narcan kits it distributes to the public. The effort is part of a harm-reduction strategy aimed at preventing accidental overdoses due to fentanyl consumption. Fentanyl is now the leading cause of drug overdose deaths in Delaware, found in more than 80% of fatal overdoses. Most overdoses are unintentional and individuals using may not realize the strength of the drug they are using or that it contains fentanyl. Fentanyl is unable to be detected by sight, taste, smell, or touch. Individuals will be able to test marijuana, cocaine, meth, ecstasy, and other substances for the presence of fentanyl. The test strips are highly sensitive and will detect fentanyl down to 0.1 mcg/ml.  

In Delaware, testing strips were considered paraphernalia unless used for clinical purposes until June 3, 2021, when Senate Bill 76 was signed by Governor John Carney, which allows for distribution of fentanyl test strips to be used by lay individuals and organizations. Just prior to that, the Centers for Disease Control and Prevention announced in April 2021, that they would permit state purchases of fentanyl test strips with Overdose Data to Action (OD2A) funding for the purpose of distributing to the public. DPH is one of sixty-six jurisdictions that joined the OD2A cooperative agreement that focuses on surveillance and prevention strategies.

Fentanyl test strips are legal in Delaware, though laws may vary in other states. DPH also distributes 10-pack fentanyl test strip kits through a free mail-order program; details can be found at helpisherede.com/understanding-addiction/what-is-fentanyl.

Fatality Data Abstracted From Overdose Data to Action Collaborative

The Division of Public Health (DPH) announced it is releasing a 2020 State Unintentional Drug Overdose Reporting System (SUDORS) fact sheet on all drug overdose deaths that occurred in Delaware. This snapshot contains fatality data abstracted from the state’s Overdose Data to Action (OD2A) collaborative. DPH collects and analyzes unintentional drug overdose death data from death certificate information, medical examiner reports, forensic toxicology results, and law enforcement reports. The fact sheet provides information on the drugs listed as the cause of death on the death certificate and drugs identified as present by toxicology or medical examiner reporting. Almost all heroin overdose deaths had fentanyl present (99%). Furthermore, fentanyl was the drug most frequently listed as the cause of death (84%). Most overdose deaths had more than one drug present (78%) and (84%) of all cocaine overdose deaths had fentanyl. Similarly, fentanyl presence is high among methamphetamine (79%) and benzodiazepine (79%) overdose deaths.

Aims to Prevent Drug Overdoses and Reduce Death

On Tuesday, the U.S. Food and Drug Administration (FDA) FDA published the FDA Voices: “FDA’s Overdose Prevention Framework Aims to Prevent Drug Overdoses and Reduce Death,” by Robert M. Califf, M.D., Commissioner of Food and Drugs. The priorities within the framework are: (1) supporting primary prevention by eliminating unnecessary initial prescription drug exposure and inappropriate prolonged prescribing; (2) encouraging harm reduction through innovation and education; (3) advancing development of evidence-based treatments for substance use disorders; and (4) protecting the public from unapproved, diverted or counterfeit drugs presenting overdose risks.

DPH Re-Accredited as Nationally Accredited Public Health Agency

The Delaware Division of Public Health (DPH) is announcing that it has been re-accredited by the national Public Health Accreditation Board (PHAB). The Board formally issued Delaware’s continued accreditation status on Aug. 18. In maintaining its accreditation status for another five years, DPH has demonstrated that it meets PHAB’s quality standards and measures. Delaware is among only 22 percent of the accredited public health departments in the country to earn continued accreditation this year. PHAB's accreditation program, which receives support from the Centers for Disease Control and Prevention (CDC) and the Robert Wood Johnson Foundation, sets standards against which the nation’s governmental public health departments can continuously improve the quality of their services and performance.

Program Ending This Friday

Because Congress has not provided additional funding to replenish the stockpile of tests, the government will end its free at-home rapid coronavirus test distribution program on Friday as communicated on the covid.gov website. It was hoped that free and accessible testing would help slow the spread of the virus. When the program ends, access to free testing will be available in other ways, including 15,000 federally-supported community sites, such as libraries and pharmacies, community health centers, and insurance reimbursement.

Transition Sale of Vaccines, Therapeutics to Commercial Market

The U.S. government anticipates that it will stop purchasing and providing COVID-19 vaccines as soon as January due to a lack of funds. Americans would then obtain vaccines through insurers or pay for them out-of-pocket. Federal health officials convened a meeting on Tuesday to discuss the government’s plans to transition sales of COVID vaccines and therapeutics to the commercial market.

Delaware Medicare Advantage to be Offered

Highmark has been awarded the exclusive contract for the State of Delaware retired employee population. Approximately 30,000 retired employees will start their coverage with Highmark (Delaware Medicare Advantage) on January 1, 2023. Highmark is currently running town-hall style meetings with this population to answer any questions they may have about their benefits for next year. Town hall meetings for physicians will be scheduled beginning in the fall of this year. To participate in this program and to treat this population, physicians will need a separate contract with Highmark. Physicians should also be aware that this plan does require prior authorization for some services, but no referrals. For more information about the program or contracting, contact Kevin O’Hara (kevin.ohara@highmark.com).

Governor Carney Signs HB 375 and SB 277

On Tuesday, Governor Carney signed several pieces of legislation, surrounded by advocates and members of the General Assembly. 

House Bill 375 establishes the Racial Equity Consortium for the purposes of studying and making recommendations to address the disparities and inequities faced by persons of color in the State of Delaware.

Senate Bill 277 increases opportunities for federally qualified health centers (FQHCs) and government-operated dental clinics to serve the indigent and other underserved communities with dental care and improves flexibility with updated provisional licensing processes for FQHC and government-operated dental clinic applicants. This legislation also creates the Dental Care Access Task Force. 

September 21 - MSD Presidential Reception, 6:00 p.m., JD Shuckers, 21710 Roth Ave, Georgetown.

September 22 - MSD, MSDIS, USI, Diamond State Financial Group, Cover & Rossiter "Thinking of Retirement...Mastering Your Financial Plan," 6:00-7:30 p.m., virtual session.

October 11 - MSD's Pubs and Politics, University & Whist Club, 805 N. Broom St., Wilmington, 5:30-8:00 p.m. Registration deadline October 3.

November 5 - We are excited to announce our Annual "Superhero for Hope” 5K Run/Walk is happening again this year! The Medical Society of Delaware will host its 5th Annual Campaign for Kids..."It's OBVIOUS" 5K Run/Walk on Saturday, November 5, 2022, at Rockford Park, Wilmington. This family-friendly event is being held in conjunction with a Community Health and Wellness Fair, co-hosted by MSD, Mom's House, and Vision to Learn. Registration begins at 8:00 a.m. Back by popular demand is the "Oat Bowl" featuring a make-your-own oatmeal bowl with a variety of fixings. Race participants will also enjoy t-shirts and other post-race food and refreshments.

What You Need to Know: TB Infection, Reporting, Delaware's Plan of Action

Registration is now open for the 2022 Delaware TB Symposium, scheduled for October 11 and 18 from 10:00 a.m. - 12:00 p.m. via Zoom. This is the first Delaware TB Symposium and will cover a variety of topics including, TB transmission and pathogenesis, epidemiology of TB in Delaware, testing for TB infection, treatment of TB infections, TB reporting and referrals, perspectives from a patient, and Q&A sessions. Representatives from the Delaware Division of Public health (DPH) and TB experts from the Global TB Institute will lead the sessions.

Bayhealth

The COVID-19 pandemic highlighted the need for superior health care in convenient locations for our residents. To that end, the federal government set up the American Rescue Plan Act (ARPA) to provide grants, which were then distributed by local governments. Bayhealth requested that Sussex County ARPA funds be granted to help build the new Bayhealth Total Care Facility on Rt. 9 and Hudson Road. The Sussex County Council approved funds in the amount of $615,000 to assist Bayhealth in the construction of this much needed state-of-the-art health facility, specifically to provide a portion of the nearly $6.5 million of equipment that will be employed in the facility. The Bayhealth Total Care facility will provide an emergency and walk-in center as well as primary and specialty care professionals to Southern Delaware, where there has been a shortage of available doctors for some time. The 48,500 square-foot facility will accommodate an onsite lab and imaging department and provide care in neurosurgery, cardiology, orthopedics surgery, oncology and more. There will also be five primary care physicians onsite to meet patients’ needs. The facility is scheduled to open in the spring of 2023.  

Beebe Healthcare 

The American Heart Association and American Stroke Association has partnered with Beebe Healthcare to bring the first-ever statewide Stroke Summit to Delaware. This free educational event will be held at the Fairfield Inn (19113 Coastal Hwy, Rehoboth Beach, DE) from 9 a.m. to 3 p.m. on Saturday, Sept. 10. Secure sign up can be accessed at: https://tinyurl.com/yj7edb8n. Registration is required. The Summit will feature a series of presenters to educate and inform local residents about the risk factors of stroke, the warning signs of stroke, the latest information on prevention, treatment and care, the latest advances in research and more.

Richard F. Brams, M.D.

Long time MSD member, Richard F. Brams, MD, passed away on August 25, 2022, at the age of 94. Dr. Brams earned his medical degree from Jefferson Medical College. He moved to Dover and practiced medicine with the US Air Force. Following that, a family move showed Dr. Brams practicing in Wilmington as a family physician then opening a practice limited to allergy. His spouse, Renee, worked as the practice's office manager since its opening in 1967 to the couple's retirement in 1996. He had many hobbies over the years, among them photography, gardening, baking, golfing, and painting. Funeral arrangements are private. In lieu of flowers, the family suggests that you consider donating to Oligo Nation (www.oligonation.org). Richard’s son Robert has a rare brain cancer known as an Oligodendroglioma. Read obituary.

• DPH Hotline - (866) 408-1899 (Monday -Friday, 8:30 a.m. to 4:30 p.m.) or DPHCall@delaware.gov
• Reporting suspected monkeypox rash in Delaware: Contact DPH Office of Infectious Disease Epidemiology (OIDE), at 302-744-4990 (business hours) or 1-888-295-5156 (after hours).
• Delaware health care facilities that require specimen collection kits can order through OEMS@delaware.gov using a SHOC Request form.
• DPH website: de.gov/monkeypox
• DPH Social Channels: Facebook (@DEPublicHealth), Instagram (@depublichealth), DHSS Twitter (@Delaware_DHSS)
• FDA Monkeypox Response Website
• CDC Monkeypox Website
• CDC Case Definitions for 2022 Monkeypox Response
• CDC Considerations for Monkeypox Vaccination for the recommended use of vaccine in the U.S.
• CDC Monkeypox Treatment Information for Healthcare Professionals
• Specimen collection: Follow Lab Advisory: CDC Updates Specimen Collection Guidelines for Monkeypox Virus 

• Federal website for information on navigating COVID: COVID.gov
• CDC COVID-19 Quarantine and Isolation Calculator
• COVID-19 Treatment Options
• Medical Provider Guidance for Administering Therapeutics
• COVID-19 Therapeutics Locator
• For testing flyers (available in English, Spanish, Haitian Creole): https://covidmaterialsde.com/resources/community-organizer
• For all testing site referral locations, visit: de.gov/gettested
• For vaccination site referral locations, visit: de.gov/getmyvaccine
• Pfizer/Moderna pediatric vaccine information: de.gov/youthvaccine
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Know the COVID-19 Community Level where you live
• DPH COVID-19 Vaccine Fact Check Page
• Subscribe to the COVID-19 Update podcast - on Apple Podcasts or Simplecast.  

Valerie Lim, MD - Internal Medicine/Pediatrics Resident, ChristianaCare

MSD members are afforded a seven-day review period from the date of this publication to comment regarding applicants for membership. Please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any comments on the current pending member listed above.