WHO supports 1-dose HPV vaccine strategy

News brief

The World Health Organization (WHO), in a revised position paper, has updated its human papillomavirus (HPV) vaccine recommendations to include a single-dose schedule, an effort to expand vaccination amid a worrying global decline in coverage.

Earlier this year, WHO vaccine advisers endorsed the one-dose strategy as an alternative to the standard three-dose regimen.

In a statement yesterday, the WHO said a new position paper released last week states that a single-dose schedule can provide comparable efficacy and durability of protection to a two-dose regimen. It said the change is timely, due to a deeply concerning drop in coverage. Between 2019 and 2021, first-dose coverage dropped by 25% to 15%. "This means 3.5 million more girls missed out on HPV vaccination in 2021 compared to 2019," the WHO said.

The document replaces the WHO's 2017 position paper on HPV vaccines.

An optimized one-dose strategy would expand access and offer countries an opportunity to expand the number of girls who can be vaccinated, while reducing the burden of follow-up needed to complete the multidose series, according to the WHO.

The agency now recommends a one- or two-dose series for girls ages 9 to 14, one or two doses for girls and women ages 15 to 20, and two doses given 6 months apart for women older than 21. HPV vaccine campaigns are designed to reduce the burden of cervical cancer, which is the fourth leading cancer in women.

SHEA advises against COVID screening of patients with no symptoms

News brief

Today the Society for Healthcare Epidemiology of America (SHEA) published a recommendation against universal COVID-19 screening of asymptomatic patients before healthcare facility entry and surgical procedures.

In the guidance, published in Infection Control & Hospital Epidemiology, members of SHEA's board of directors said that testing asymptomatic patients "has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls."

Reduced patient access, high cost

Facilities that require a negative COVID-19 test before providing care may also unintentionally reduce access for disadvantaged groups who already have limited access to care and testing, the authors said. They also cited the unlikely benefit of presurgical screening, a setting in which other infection-prevention measures are already in place.

The guidance notes the logistical challenges and costs of screening programs and data on the lack of substantial aerosol production during elective controlled intubation, extubation, and other procedures. It also cites research showing that COVID-19 testing added 1.9 hours to emergency department visits in one health system and cost a hospital more than $12,500 to identify one asymptomatic infection.

"The adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention," they wrote. They added that SHEA "recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities."

SHEA acknowledged that COVID-19 screening at facility admission may help curb spread in areas with limited infection-control strategies, such as behavioral health, congregate care, or shared patient rooms.

The adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention.

Lead author Thomas Talbot, MD, MPH, of Vanderbilt University, said such screenings carry the risk of harms from delays in procedures, patient transfers, and burdens on lab capacity and staff. "Since some tests can detect residual virus for a long period, patients who test positive may not be contagious," he said in a SHEA press release.

Rather, healthcare facilities should consider the use of N95 respirators for staff performing high-risk procedures, clinician screening, reduction of shared patient spaces, and better ventilation, they said.

HHS expands access to scarce flu antiviral drug Tamiflu

News brief

Amid shortages of the antiviral drug oseltamivir, the US Department of Health and Human Services (HHS) announced today that it is expanding access through stockpiles that had been reserved for use in a future flu pandemic.

The shortage, spurred by increased demand from an early surge of influenza, prompted the Centers for Disease Control and Prevention (CDC) to issue guidance on the use of generic oseltamivir (also sold under the brand name Tamiflu) on Dec 16.

HHS, through the Administration for Strategic Preparedness & Response (ASPR), said that states, territories, and tribes can work through their ASPR regional teams to access Tamiflu supplies from their state stockpiles and then, if those supplies are exhausted, through the Strategic National Stockpile (SNS).

"Last week, ASPR extended flexibility to states to use Tamiflu in state stockpiles that was previously reserved for a pandemic flu—making millions of treatment courses available to keep people healthy this winter," HHS said.

ASPR extended flexibility to states to use Tamiflu in state stockpiles that was previously reserved for a pandemic flu.

The statement urged Americans not to hoard the medication. "Manufacturers continue to report that they are running manufacturing facilities 24-7 to address high demand and have encouraged the public to only buy what they need," the statement said.

Certain formulations available

According to ASPR, governments can dispense certain lots of 30-, 45-, and 75- milligram (mg) formulations of Tamiflu from their stockpiles and, if they exhaust their supplies, can request the 75-mg formulation from the SNS.

The "drug lots that have been extended by the Food and Drug Administration for up to 20 years beyond their original manufacture date, provided they have been stored under labeled storage conditions," ASPR said. "These lots have not been relabeled with new expirations, and healthcare providers and recipients should be notified of the 20-year extension."

Earlier this month, HHS Secretary Xavier Becerra sent a letter to governors on flu resources, including CDC funding, Centers for Medicare and Medicaid Services (CMS) waivers, telemedicine flexibilities, and ASPR surge resources.

UK H5N1 avian flu assessment finds no increased risk to human health

News brief

Following an initial assessment for the threat of the Eurasian H5N1 avian flu strain to human health in November, UK health officials today published a more detailed assessment, which found no increasing risk, though the level of confidence is low and the situation requires regular review because of ongoing high transmission in poultry.

The new assessment from the UK's Health Security Agency (HSA) defined six levels of transmission to gauge the threat, putting the United Kingdom at level 3, meaning evidence of virus genetic changes that provide an advantage for adaptation to mammals.

Also, the HSA said it is investigating a small number of flu virus samples that can't be subtyped, but it added there is no evidence they are H5N1 avian influenza. HSA experts document nearly 2,100 human H5N1 exposures during the current reporting year, which began on Oct 1. No infections have been reported. Britain had earlier reported one human H5N1 infection in the previous reporting year involving a person who had close contact with domestic poultry.

Globally, four human H5N1 infections have been reported related to the surge in circulation in poultry and wild birds. One in the United Kingdom, two in Spain, and one in the United States.

More virus in US poultry and wild birds

In US developments, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported one more outbreak in poultry, which occurred in a noncommercial flock of 20 birds in California's Mendocino County.

Also, APHIS reported 221 more H5N1 detections in wild birds, raising the total to 5,221. Many of the latest detections involved snow geese found dead in multiple states. There were also several black vultures found dead in a handful of states.

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