Tune into Safe Healthcare: 2024-2025 Respiratory Virus Season Updates for Long-Term Care Providers.

hello everyone um welcome to the CDC division of healthc Care Quality promotions tune in to Safe healthc Care webinar on the 2024 2025 respiratory virus season updates for long-term care providers our presenters today will be Dr Evelyn Twyman who's a senior adviser for vaccine strategy for the immunization services division in the National Center for immunization and respiratory disease is Dr pregnant Patel chief medical officer for the Corona virus and other respiratory viruses division in National Center of immunization and respiratory diseases Dr Erica Wallander a medical officer that's me in the division of healthc Care Quality promotion in the National Center for emerging and zoonotic infectious diseases and our Q&A moderator today is Dr Cara Jacob slifka the long-term care team lead in the division of healthcare quality promotion in the National Center for emerging anduo infectious diseases before we begin I have three disclosure slides to show related to the C that's being offered through cdc's train Learning Network we will advance through them slowly to allow you time to read the first is the following accreditation statement this webinar is accredited for several types of CE including CME C NE CE C hes or M CES CP and cph I will now share with you the following disclosure statement please take a moment to read and this is the joint accreditation statement for pharmacy education again please take a moment to read and that concludes our CE disclosure slides and we'll jump in with resp some background on respiratory viruses in long-term care we wanted to start our presentation today by recognizing how covid-19 caused unprecedented losses of life and sacrifices by residents their loved ones staff and facilities in those first years of the pandemic as you well know the weekly deaths among nursing home residents related to covid-19 reached over 6,000 per week nationally in December of 2020 and through the efforts of so many and the evolution of the pandemic we have seen the burden of covid-19 related deaths among nursing home residents decreased dramatically though it hasn't disappeared during last year's respiratory virus season weekly deaths among nursing home residents with a recent positive SARS K2 test peaked at 339 in November of 2023 in addition while other respiratory viruses diminish it during our isolation in the earli years of the pandemic we have seen viruses like influenza and RSV return and now although nursing home and assisted living residents make up just 2% of the US population that's over 65 years of age at any given time last respiratory virus season nearly 20% of Hospital admissions captured in our covid and RSV surveillance systems were among longterm care residents and in the National Health surveillance network data nursing home residents had up to eight times greater rate of covid-19 related hospitalizations compared to us residents 70 years of age and old older we also know that individuals over 65 years of age have the highest risk of influenza hospitalization what is contributing to this disproportionate risk well we know long-term care residents are at high risk of respiratory virus infection due to living in group settings with communal activities and long-term care residents more commonly have risk factors for severe respiratory illness such as older age in particular those over 75 diabetes IES chronic kidney disease chronic lung disease coronary artery disease and stroke based on the data available we are able we are predicting a US respiratory virus season for 2024 to 2025 to have a similar severity to last year since covid-19 continues to circulate we expect the burden of severe disease due to respiratory viruses to continue to exceed the levels of pre in the pre pandemic years and as we still have regularly reported data on covid-19 related hospitalizations among nursing home residents we do see that similarly to last year hospitalizations among residents with a positive SARS CO2 test have already beun increasing this year with similar to higher numbers of hospitalizations in July and August of this year compared to the same months last last year since we expect long-term care residents will remain at higher risk of severe respiratory illness this fall and winter our objectives today are to share the tools we have to prevent severe respiratory infections among long-term care residents and we aim to describe the eligibility criteria for the 2024 2025 covid-19 our seasonal influenza and the RSV vaccines communicate key benefits and side effects of each respiratory virus vaccine identify eligible individuals for covid-19 and influenza treatment and summarize key infection control and prevention actions and now I'll hand it over to Dr Twyman to discuss respiratory virus vaccines thank you so much Dr wender my name is eelyn 20 minut and I'm super happy to be here speaking with you all today I am so grateful for the work that you all do to keep long-term care facility residents healthy I'm sure you all have heard this about a million times before but seriously you are the public health Heroes here in your dedication to your populations and your determination to get the people you serve really protected as we head into another respiratory virus season so truly thank you for all of the work that you do first and foremost now what I'm going to do here with you all today is to discuss our respiratory virus vaccines what we'll disc discusses first our recommendations in other words who should receive what vaccines and when why respirator why vaccination against respiratory viruses is so important and then thirdly what we can do together to encourage long-term care facility residents to get vaccinated and uh next slide please thank you I do want to start with a headline here though we're talking about these vaccines here today because these vaccines cut the risk of severe Disease by half or more covid-19 and influenza vaccines cut the risk of hospitalization in half in all ages and additionally covid-19 vaccines are the best available protection against long Co RSV vaccines prevent older adult RSV hospitalizations and result in more than three times lower risk of those hospitalizations so if you can get your residence these vaccines that's a huge win that you've accomplished next slide please okay let's start with recommendations who needs what vaccines for Co and flu this is super simple everyone ages 6 months and older needs a covid and an influenza vaccine every year our adults over age 65 can also benefit from higher dose or agented flu vaccine if they're available and then for RSV we protect our infants through either infant immunization with nurfa map or maternal vaccination with RSV vaccine adults ages 18 to 59 who are not pregnant don't need an RSV vaccine but those ages 60 years and older with risk factors and we we'll show you what those are do benefit from a lifetime dose of RSV vaccine and all adults ages 75 and older are recommended to receive one lifetime dose of RSV vaccine next slide please this slide shows you the recommended timing for each of these vaccines but let me give you just the headline here for older adults the time for covid influenza or RSV vaccines is now go time is now to get our older adult residents protected against these viruses if you have residents that either can't or won't be vac vacinated now or as you admit new residents who haven't had these vaccines do continue to offer them throughout the year next slide please here are the risk factors that indicate recommendation for your residents over the age of 60 to get RSV vaccine as you can see almost any chronic condition associated with IND organ damage indicates that they could benefit from these RSV vaccines as well as residents in a nursing facility which is certainly relevant to folks on this call as well as moderate or severe amuno compromise or other factors that you think could increase risk of severe disease such as Frailty next slide please before we move on from our recommendations I do want to mention that older adult populations also need to be protected against other diseases like shingles and pacal disease in the US about a million people have shingles every year and one in three people overall will have shingles in their lifetime and unfortunately those complications increase with age so all adults ages 50 years and older should get two doses of the sh vaccine and then on uh the pacal disease side pumac cacus is a leading bacterial cause of pneumonia in adults with more than 100,000 us adults hospitalized every year adults with certain medical conditions like chronic heart or lung or renal disease are at higher risk so overall those adults ages 65 plus and those with risk factors should get a pacal conjugated vaccine next slide please so now that we've covered our vaccine recommendations let's turn to why we recommend these vaccinations and why they're so important for your residents first we'll discuss all respiratory virus disease uh vaccines together and then we'll discuss the importance of covid flu and RSV vaccines individually next slide please we immunize because it's our best defense against viruses that can cause serious illness thousands of people are hospitalized for covid-19 flu and RSV each year adult ages 65 plus are four to nine times more likely to be hospitalized for covid flu and RSV than those under age 65 but fortunately covid-19 and influenza vaccines cut that risk of hospitalization in half and RSV vaccines are more than 70% effective at preventing older adult RSV hospitalizations next slide please now let's discuss the importance of covid-19 vaccine specifically what you're looking at here is the percentage of hospitalization with covid-19 by vaccination status and by age group the yellow bars jump out at us here because unfortunately that's the higher risk group those without the protection of the covid-19 vaccine so we encourage you to encourage your residents to reduce their risk of hospitalization with covid-19 by getting a vaccine next slide please in addition to the risks of hospitalization and death from respiratory viruses long covid is a chronic condition lasting three months or longer this can develop after infection with SARS k 2 the virus that causes covid-19 overall 3.4% of adults reported long covid in 2022 with a quarter of those individuals continuing to experience impacts in their daily lives we know that long Co occurs more frequently among groups at risk for severe illness and individuals without the covid-19 vaccine so this is another really good reason to get the covid-19 vaccine next slide please we also wanted to offer you some points for your residents about why to get another covid-19 vaccine this year in case that is a question that comes up to you from them okay here's the problem the virus that causes covid-19 is always changing fortunately this is also why we make sure the vaccine is updated every year so your residents protection is best if they've received the vaccine most updated for the most recent version of the virus that causes covid-19 additionally protection of these vaccines wains over time so we want to boost that protection every year and we see that this works people who received L Seasons vaccines saw greater protection against illness and hospitalization than those who didn't receive that vaccine and to provide just some important reassurance getting another covid-19 vaccine this year is safe hundreds of millions of people have safely received these vaccines under the most intense vaccine safety monitoring program in US history okay having discussed Co let's move on to flu next slide please perfect so as you can see older adults also have a much higher rate of hospitalization with flu and as we've discussed flu vaccine is our best protection against hospitalization with flu so let's get those ones made too next slide please and why vaccinate older adults against RSV because their risk of hospitalization with RSV Rises with age and you can see this really steep rise in adults ages 75 years and older but having received the RSV vaccine Cuts this risk for them next slide please and I can't conclude our discussion of the importance of these vaccines without saying that unfortunately despite these benefits many residents are missing out by the end of last year's respiratory virus season fewer than half of them had received at least one covid-19 vaccine fewer than a quarter of them had received an RSV vaccine and just under three4 had received a flu vaccine and keep in mind that this is despite the universal recommendations for annual covid-19 and flu vaccines so we have a ways to go next slide please so given that ways to go what can we do to encourage vaccination next slide please well to start with we can start by thanking you for the enormously beneficial influence that you can have on your residents if you're a healthare provider working in a long-term care facility or otherwise serving long-term care facility residents just know that you are your residents most trusted source of information on vaccines they care what you think and we know that you care about them because you're here today so thank you for everything that you're doing to encourage their vaccination next slide please strong provider recommendations in other words recommendations from you can increase resident confidence in vaccines in making your recommendations you can be specific be clear be attentive to their concerns and if they don't accept vacc after one discussion don't give up try again later if a resident or family member declines vaccines once it doesn't guarantee they always will continue the conversation next slide please here we're showing you the benefit of continuing the conversation this study that we're showing you right here showed us that some patients needed to be offered the covid-19 vaccine up to 11 times before they decided to be vaccinated so don't give up continue that conversation and it can have benefit for your residents next SL and now let's consider some logistically beneficial strategies you can definitely co-administer these vaccines you can give them at the same time residents may experience more mild side effects such as fever and fatigue but these are usually mild or moderate and last just one to two days and if a resident prefers to wait to receive these vaccines during different visits with you just rest assured that there's no minimum waiting period between vaccin doses next slide please lastly we just wanted to leave you with some resources toward ordering and offering vaccines in your facility recommending these vaccines and offering early treatment for covid-19 to your residents at risk so thank you again so much for your time for your attention your work to protect your residents through this respiratory virus season and speaking of treatment I'd like to turn the floor to Dr pragna Patel to discuss testing and treatment Dr Patel over to you thank you so much Dr twinman so we're going to shift a little to testing and treatment next slide and in the interest of time I'm not going to delay um uh going through these so basically I'm showing this slide because we've done some data analysis uh looking at use of antivirals and monoclonal antibody treatments in nursing homes and what we're seeing if you look at the graph on the left that orange line is basically showing the residents that have covid-19 cases and the gray green line is showing how many of those residents received treatment and so overall the treatment rate was about 18% it peaked at 33% in November just after Thanksgiving of 2021 but you can see that this uptake is incredibly low and if you just look at the slide on the right this is basically basically showing you what kind of treatments were used among residents and and you'll see looking at that um gray green line that nurmatov ritonavir was overwhelmingly the most common treatment that was prescribed at 60% and about 18% receive Malu pravir so there is a lot of room to increase uh the use of treatment and in a little bit I'll go over why this is so important next slide there have also been other studies in other populations that have shown um underutilization of antivirals and I just wanted to share th a few of those studies here with you um there was one that was published in the mmwr that looked at um veterans and they reported that about 25% to 30% of veterans who are eligible for treatment are actually receiving treatment and then there was another mmwr that looked at the general population and found there was low levels of uptake especially in socially vulnerable groups and then for flu we're noticing that in the Pediatric population um there's a low uptake of treatment next slide and so this slide is a little bit busy let me take a minute to orient you if you look at these graphs on um the Y AIS we're really looking at the reduction in hospitalization and I want to just point your attention to the slope of these lines because each line basically represents different uptake of nurat ritonavir which is commonly known as Pax lovid and what this modeling study showed was an increase of uptake of antiviral use to 80% um which is that light gray line at the top with the steepest slope resulted in reductions in hospitalizations and deaths by 42% and 51% respectively so you can see that if we can increase um treatment uptake among residents above 30% model 7 which is the next line the gray green line is PAX lovit uptake of 40% still a nice increase in slope for both hospitalizations and deaths we really could increase um uh decrease the number of hospitalizations and deaths among residents and I will say that the modeling group did look at nursing home residents separately and they they saw that the improvements were even higher when you just focused on nursing home residents next slide please so I just wanted to talk a little bit about testing because testing can be very important one it can increase access to treatment getting tested can help you get treated sooner and treatment is likely to be effective when started early uh so it's really most important for people who are at higher risk of severe illness such as older adults and residents of nursing homes to get tested when they do have respiratory symptoms and they're worried about either influenza or covid-19 I just want to reiterate that a documented positive tests for SARS K2 and for flu are not required to initiate treatment and I'm pointing this out because when the covid-19 antivirals were under authoriz ation a positive test was required but since nurmatov ritonavir and ravir have been approved and a positive test is not required and then just to let everybody know that us households will be again eligible to receive free covid-19 tests starting in late September so very soon and CDC has a program called IAT which is offering free testing to people who are underinsured uninsured and so we do encourage folks to look at the IAT website to see where they can go to get a free test if they need one next slide and I wanted to just talk a little bit about testing and treatment and models for testing and treatment because these have been shown to be very effective in other settings and could be models that could be implemented in nursing homes um particularly during respiratory virus season just to help residents get treatment as soon as possible to keep them out of the hospital so essentially if an individual has respiratory disease symptoms we're encouraging you to think about covid-19 and influenza and RSV we have treatments for covid-19 and influenza and so it's really important to at least test for these two pathogens there are singleplex tests available and Multiplex tests available and I'll talk a little bit more about those Multiplex tests in a little bit and we encourage patients who test positive for either SARS K2 or influenza to be evaluated for their eligibility for treatment and ensure that patients who do test positive and who are eligible get treated as soon as possible next slide and so let's just talk a little bit about Multiplex testing so essentially Multiplex tests simultaneously analyze samples for multiple pathogens and there are many SARS K2 influenza Multiplex tests available now um most of them are lab based but there are some over-the-counter tests that have been authorized for home use and the link at the bottom of the page can give you more information about these tests and we think that they can be a really powerful tool for uh for treatment because patients do present with similar symptoms um if they're infected with SARS K2 and influenza and knowing which pathogen uh they are infected with can help guide specific antiviral treatments and then there's the added benefit of early detection um helping to reduce further transmission particularly within nursing homes where outbreaks tend to happen next slide so what are the advantages and disadvantages of different tests so just drawing your attention to the column on the left there are two main types of tests there are nucle nucleic acid amplification tests that are often also referred to as molecular tests also uh PCR tests are the most common type of um Nat tests and then there are antigen tests and those are the tests that we can use at point of care and at home and the advantage of the natat tests are they're they're really the most sensitive tests available they they um give you uh probably the best results they're considered a gold standard and you don't need to repeat this test confirm the results because of that the antigen tests um are advantageous because of the short turn turnaround time but also you can perform them pretty much anywhere and they're more cost effective the disadvantage of the nucleic acid tests are they they do require a longer turnaround time one to three days so that could shorten the time to get treatment that could lengthen the time to get treatment they they cost more and for SARS K2 specifically they can stay positive for a very long time in certain patients uh the disadvantage of the antigen tests are that they're less sensitive and more false negative results can occur with antigen tests and so if you do have a high index of Suspicion for SARS K2 among a patient who tested negative with an antigen test that test should either be confirmed by a knat test or repeated and the FDA does uh recommend repeat testing and I've provided the link where you can get more specifics about that here next slide so moving on to antiviral therapy it's really an important tool for clinical management as I've said before it can reduce the risk of hospitalization for covid-19 significantly and it can reduce the risk of influenza complications as well as uh reduce the severity and duration of illness decisions to start treatment are usually based on risk for severe disease and I want to just call your attention to the slide that Dr 20an showed about risk for RSV the same factors are usually considered for risk of severe disease due to influenza and covid-19 and it's not necessarily symptom severity that um we look at when we decide who to treat so for covid-19 especially if someone presents with a mild illness we encourage you to definitely think about treating them and for influenza if somebody is at high risk and has mild uh symptoms you should certainly think about treating them and again it's recommended as soon as possible for any patient with suspected or confirmed covid-19 and flu uh who have higher risk of complications and when I say suspected uh covid-19 I mean somebody who does have symptoms and has a history of an exposure I want to point out that um nmat ritonavir is not approved for postexposure prophylaxis so if a patient has a known exposure but no symptoms they're not eligible for antiviral therapy for covid-19 next slide so who's at risk for covid-19 and influenza so you'll see the list is fairly similar to RSV the age cut offs are a bit different but essentially older adults especially adults greater than 65 years of age younger children um especially those who are less than two years of age people with weakened immune systems people with any chronic conditions such as heart and lung disease people with disabilities pregnant people some racial and ethnic groups because of many factors and that really involves limited access to vaccines and health care and then of course uh residents of nursing homes and long-term care facilities who also tend to be older next slide so just a brief overview of uh covid-19 treatment I'm focusing here on Outpatient Therapy we're not going to go through inpatient therapy today um there are two main recommended antivirals for covid-19 nmat ritonavir also known as PID and remes also known as theuri there's an alternative therapy Malu pravir um if these two are not available so the age for PID is 12 years and above and remir 28 days and above and um the main reason that nmat ritonavir is used most commonly is because it's the only oral uh recommended um antiviral that's available and U REM dese having an IV Administration does create some complications the other thing to note about um nmat ritonavir is that it's not recommended with severe kidney or liver disease so it's important to know what a patient's kidney and liver function is and you do need to check for drug drug interactions which may be very important in older populations who are residents of nursing homes next slide and then just briefly wanted to also go over the recommended influenza treatment for outpatient therapy um osel Tamir has been around for a very long time it is available for persons of all ages and Bak severe is available for patients who are um healthy and five years and older and then also high-risk patients who are uh 12 years and older and both of these are the recommended oral influenza treatments that are available uh one thing to note about baloxavir though is that it's not recommended for pregnant people or postpartum persons and then there are two other options that are less commonly used um in the outpatient setting panav and zenam mainly because of the route of administration next slide so also I wanted to just share some resources with you next slide CDC conducted some um surveys and found that um low uptake was due to some concerns about drug interactions with um nurat ravir in particular so I wanted you to be aware that we do have some resources that help clinicians understand which drugs can be safely used with nurmatov ritonavir this Liverpool um drug interaction database is a really nice and easy way to check for interactions and then the FDA does have some web website resources that I'm sharing with you here next slide uh the CDC did write in mmwr about rebound because there were concerns both from patients and providers about rebound we want you to know that um rebound should not be a reason to withhold antiviral treatment among high-risk individuals uh for covid-19 next slide and then here are some resources um for how you can get the covid-19 antivirals I know people have a lot of questions about this because these medications were just recently commercialized there are a number of patient Assistance programs including a US Government patient assistance program and everyone should be able to access these medications if they need them and so I hope you find these resources helpful next slide again a few links that uh you can refer to when you have more time and next slide and now I think I'm passing the mic over to Erica Wallander who's going to talk to us about infection prevention and control over to you Dr Wallander thank you so much so infection prevention and control will shift gears like Dr Patel mentioned uh to IPC and IPC measures help prevent the spread of infections when someone with a respiratory virus infection coughs sneezes talks or breathes they releas relase viruses which can be spread to others through the air when they're inhaled and deposited along the respiratory tract viruses can also land on surfaces or objects and people can become exposed if they touch those surfaces and then touch for example their mouth nose or eyes without cleaning their hands unfortunately some respiratory viruses can spread even when a person with the infection does not have any symptoms IPC measures reduce respiratory virus spread by preventing contact with viruses and important IPC measures for Respiratory viruses include practicing respiratory hygiene and cough etiquette which includes wearing a mask for Source control or covering your cough if a mask can't be worn and frequent hand cleaning use of appropriate personal protective equipment or PPE based on standard and transmission-based precautions staying away from others when you are ill and ventilating shared spaces and regularly cleaning and disinfecting surfaces in the environment within a facility IPC resources policies and education are needed to help protect resident staff and visitors from respiratory virus infections today we'll talk about how facilities and providers can prepare for increased use of respiratory virus IPC measures during fall and winter by alloc ating resources for IPC educating resident staff and visitors monitoring Community spread and ensuring appropriate facility ventilation we'll then talk about how to respond when a resident develops respiratory symptoms including use of transmission-based precautions testing and treatment and contact investigation and finally we'll briefly cover some Tim limited enhanced IPC measures that can be used when they're spread within the facility starting with preparation during fall and winter months we know respiratory virus infection risk increases for everyone having adequate accessible supplies of PPE will make it easier to adjust PPE for Resident care when new symptoms developed adequate stock of face masks n95 respirators gowns gloves and hand sanitizer are examples of necessary IPC supplies PPE and hand sanitizer should be accessible throughout the facility on both day and night shifts in addition staff should be properly fitted for n95 respirators via annual respiratory fit testing to maximize their protection in addition to stocking PPE it is important to identify how respiratory virus and other laboratory tests such as blood tests for kidney function can be collected and results available within 24 hours rapid test results will only be Ben will be most beneficial when the pharmacy connections are also in place to ensure rapid antiviral access for a resident with covid-19 or influenza although we've been dealing with covid-19 for the last several years and are pretty familiar with the recommendations we understand that each day there can be many competing priorities for facilities and staff from implementing enhanced barrier precautions to sepsis awareness for example as a result it is important to remind everyone who enters the facility about recommended respiratory virus prevention policies this can include hanging posters describing respiratory hygiene and cough etiquette or signs indicating when Universal masking is in place annual staff refresher trainers refresher trainings around respiratory virus IPC measures like hand hygiene and proper PPE use can help ensure everyone feels comfortable implementing the recommend Ed IPC measures another important aspect of preparation is to know when there is an increased risk of infection risk can vary geographically and by facility population for example regularly monitoring local indicators of increased Community or facility respiratory virus spread can help you increase prevention efforts when the risk is highest your local and State Health Department can help you determine which indicators best represent present increased spread in your community some examples of indicators could include the number of facility cases in a week the percent of emergency room visits for acute respiratory illness in your county the number of respiratory virus cases hospitalizations or outbreaks among the state's nursing home residents or other local indicators when a community when Community or facility spread increases action steps might include Universal masking supplemental measures to improve ventilation or increased surveillance among residents and staff for Respiratory illness finally it is important to consult with your facility Engineers to improve ventilation in Resident and staff areas including break rooms this can include achieving five air changes per hour developing policies around changing fan settings in rooms and clearing blocked bents now that the facility prepared for this season will move on to responding to a resident's new symptoms starting with a case example Mr Jones is an 85-year-old man with the history of Alzheimer's and Insulin dependent diabetes he lives in a nursing home and shares a room with the roommate who also has dementia it's January and today Mr Jones's Aid notices he feels warm and has a new cough no one else on the floor has symptoms as soon as the resident's new symptoms are ident identified several steps can prevent further spread this includes placing the resident on appropriate transmission based precautions even before testing occurs as part of transmission-based precautions move the resident to a single room or if a single room is not available take steps to limit Transmission in the room an ill resident should not be placed with a new roommate unless both are confirmed to have the same respiratory diagnosis because a roommate could also become infected they should not be placed with a new roommate also use PPE recommended for the care of a resident with SARS K2 infection by symptoms alone we can't tell what is causing a resident's respiratory symptoms the PPE used for SARS K2 protects against most common respiratory infections and so we use that while waiting for test results all residents should remain in their room and if they have to leave the room they should wear a mask if tolerated their roommates should also be encouraged to wear a mask mask whenever they are around others just in case they also develop infection finally we want to make sure to test the resident and investigate close contact which close contacts might also benefit from testing and potentially antivirals so how could this apply to our response to Mr Jones's new symptoms first Mr Jones's facility does not have a single room available so the team places a PE a filter in the room and separates the resident beds as far as possible with a curtain placed between a transmission based precaution sign is posted outside of Mr Jones's room and a cart containing n95 respirators gowns gloves and eye protection is placed outside the door Mr Jones is tested for SARS K2 and influenza and close contacts included his roommate and his Aid are evaluated for symptoms and for future testing reassessment of transmission-based precautions contact investigation and Resident treatment should occur when test results are available for example Mr Jones is currently on precautions for SARS K2 which means his providers wear an n95 respirator goggles gown and gloves when caring for him if his influenza test is positive and his SARS k2a test is negative he will trans he will be transitioned to drop precautions which refers to use of a face mask if the resident has was coughing and sneezing then you would also wear eye protection to protect your eyes from splashes or sprays as part of standard precautions as soon as a resident develops symptoms they should be evaluated for treatment if there's a strong suspicion for either covid-19 or influenza due to a close contact or facility outbreak for example empiric antiviral treatment can be started before the test result results are known and then they can be stopped if the test results are negative in the case of Mr Jones if we do not have a strong suspicion for the cause of his illness we can still determine eligibility availability and dose of both covid-19 both a covid-19 and influenza antiviral treatment course and when his test results return we can start the appropriate antiviral quickly so we already know that Mr Jones's influenza test is positive the team would then start be able to start also Tam quickly and for influenza unlike for covid-19 we have an additional opportunity to use chemoprophylaxis if Mr Jones's roommate or other close contacts are asymptomatic chemoprophylaxis dose osil tamere should be started while on chemoprophylaxis Mr Jones's close contacts should be monitored for symptoms and testing performed to symptoms develop by preparing for for and quickly responding to respiratory virus illness we aim to minimize spread within a facility however when a large degree of spread occurs in a facility Tim limited enhanced IPC measures may be needed your local Health Department can help your facility determine which enhanced control measures are needed enhanced control measures might include broader testing and chemoprophylaxis cohorting staff and residents temporary modification of indoor visitation policies like encouraging in room rather than common area visitation Universal masking limiting communal activities like dining and improving ventilation we recognize the toll that any form of isolation takes on residents so any additional restrictions should be time limited and other methods to maintain connection such as video chats with families should be facilitated the extremely important work that you do is also very very hard work and in recent years recommendations for respiratory virus prevention have been changing so quickly for today's webinar we wanted to make sure that you are familiar with our current recommendations and most recent information for respiratory virus prevention so that you can continue to provide the best care for your residents and patients and also protect yourselves the strategies we discussed today do work but they only work when we use them it is our responsibility all of us to provide safe highquality care for those that that are in our care today we reviewed the residents and staff need updated covid-19 and influenza vaccines and for those eligible RSV andle vaccines we discussed how to place symptomatic residents on transmission based precautions while awaiting test results to reduce the risk of spread we re we recommend testing symptomatic residents which will inform IPC measures and treatment an reviewed how to identify and use appropriate antiviral treatments for covid-19 and influenza much of what we presented today can also be found in our viral respiratory pathogens toolkit for nursing homes which we just updated last week this web page has guidance and links to key CDC resources we also wanted to highlight the bullet here um a new tool to help providers inform residents and families about the benefits of respiratory virus vaccination it's a one-page fact sheet entitled why get vaccinated it's available in English Spanish and Chinese we've also included a few other helpful links including this um second to last bullet on how to access free weekly covid-19 antigen tests for long-term fa care facilities through asper which a program which is still ongoing and also the details for the Pais program for fee free PX loid access facilitated by the US government that's going to be available through December of 2024 and with that I'll hand it over to Cara Dr Jacob slifka for Q&A thank you so much and thank you to all of our presenters Dr tman Dr Patel and Dr Wallander and thank you also to our team of subject matter experts who have been doing their best to answer as many questions as they can um as they've been coming into our chat but we did want to we did want to start with talking about a couple of questions that have come in um about vaccines so I'm going to turn to you for these Dr 20 men uh first off are residents 65 years of age and older recommended to get more than one dose of the new covid-19 vaccine similar to last year that's a great question and the answer is no they're not right now CDC does not recommend an additional ad dose an additional dose of the 2024 2025 covid-19 vaccine for people AG of 65 years and older who are not moderately or severely imuno compromised now of course CDC and the advisory committee on immunization practices will continue to evaluate evidence discuss that publicly in our acip forums and update recommendations as needed and by the way all the recommendations for those with moderate to severe imuno compromise can be found at cdc's interim clinical considerations for use of covid-19 vaccines thanks thank you so much and since we're talking about vaccines there was a question that came in specifically asking about how long after infection someone should wait before getting a covid-19 vaccine thank you so much uh people may wait up to three months after their symptoms of active covid-19 disease resolve or up to three months after a test a positive test if they didn't have symptoms at all now that's not a requirement so no worries if a person if a resident wants to be uh vaccinated sooner but we do know that history of recent infection is associated with some protection against additional infections so those are our recommendations right now thank you so much Dr 20 let's move to a question on infection prevention and control Dr Wallander what are the current recommendations for return to work postco infection for healthcare workers thanks um so cdc's covid-19 return to work guidance for healthcare workers has is the same as last year um and those details are still available on our website though we do recognize that the URL has changed um with some recent website updates that CDC so healthc care personnel with mild to moderate illness who are not moderately to severely imuno compromised which I think is most healthcare workers um could return to work after at least seven days have passed since symptoms first appeared and if a negative test result was obtained within 48 hours prior to return to work if they're not uh testing uh return to work test is not available then the healthcare worker would um remain out of work for 10 day uh until 10 days have passed if testing isn't performed um the individual in either case should have improved symptoms and at least and it has been at least 24 hours since their last fever and additional details are available for different illness scenarios like if you have severe disease or imuno compromise on our website um and these recommendations are being reviewed by the healthc care infection control practices committee or hicpac um as part of the updates for the guidance for infection control and healthc Care personnel and the hipack updates are also available on the hipack website oh you're on mute thank you so much Dr Wallander um now shifting to testing and treatment um Dr Patel I have a question for you about testing for SARS K2 um so in this question the facility is using antigen tests for SARS kobe2 and influenza if the SARS K2 test is positive for a resident do they need to do further influenza testing if the SARS CO2 test is positive it's likely that the patient only has SARS K2 infection um it's rare for us to see co-infection with SARS K2 and influenza but it's really important to take a history and see what the patients exposures were just to make sure that there wasn't a known exposure to a patient who had influenza in which case you might also want to test for influenza and the other thing I will say is that um it would also be very important to assess the patients risk for severe disease if they do test positive for SARS CO2 because if they do have um a high risk for severe disease which is really driven by age so age greater than 50 especially 65 and older even more especially 75 and older they really should be considered for treatment as soon as possible thank you um and we've we have been hearing I think this is very important information especially as we are getting into the season where we are seeing multiple respiratory viruses or will be seeing multiple respiratory viruses in the community potentially and so potentially in our facilities um thank you Dr Patel Dr 20 man I have another question for you um this question is a vaccine specific question and asking about how long we should be waiting between giving the last 2023 2024 covid vaccine and the new covid vaccine thanks so much great question for most people the minimum interval between their last 2023 2024 covid-19 vaccine and this new one that has just been recommended is two months however there are some important exceptions including for those with moderate or severe imuno compromise so again I would encourage everybody on this call uh to refer to cdc's interim clinical considerations for use of covid-19 vaccines for those exceptions for those with moderate or severe imuno compromise otherwise two months thank you so much all right Dr patella I have another I'm G to jump back to you because this is a question regarding the use of antivirals um so it can be difficult to get blood work quickly sometimes in a in a facility in a nursing home do you have any suggestions as to how antivirals can be used quickly that require um when they require dosing based on kidney function or adequate liver function I think it's really important to assess a patient's eligibility for antivirals before they even get sick you know it would be nice if we could take the time to review a resident's U medical history and the drugs that they're taking and understand before they get sick what medication and what dosing of that medication would be best for them that would preclude the need to do any testing in terms of kidney function and liver function and also help us to start treatment soon after they become ill thank you if we have some of this information we may may when people get sick unexpectedly there may be less scrambling in that moment to figure it out and we may be more quickly able to move on to using antivirals thank you so much um now I do want to get back to a couple more questions in the the last M the last few minutes or well maybe uh one question one more question very quickly um for Dr Wallander an infection control question when can covid-19 PPE be discontinued for a symptomatic resident who tests negative for covid-19 and Dr wander you're on mute we traded places um so so uh thank you for that you know um we talked about how important it was to start covid-19 or the SARS CO2 based transmission uh PPE while we were waiting for test results if the resident had was tested with a nucleic acid amplification test so that would be like a PCR test or a similar molecular test a single negative test is usually sufficient to stop that covid-19 PPE and transition to the more likely diagnosis if an antigen test was used um a negative test should either be confirmed by a negative net or a second negative covid-19 antigen test within uh taken 48 hours after the first test before the um PPE should be discontinued um and then if influenza is circula in the community symptomatic residents should be tested for both um viruses which will dictate PPE great thank you so much for answering that and I um with this can we move on to the last slide and I want to thank again uh all of our presenters for speaking today and for answering questions this concludes our Q&A section um and so we are now showing on the screen information for our continuing education credits which will become available as soon as the webinar has completed and with that we thank you very much for attending today's webinar e e