SASKIA V. POPESCU, PHD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in infection control and has worked in both pediatric and adult acute care facilities.

Saskia v. Popescu, PhD, MPH, MA, CIC

Will Vaccinated Children Spell the End of COVID-19?

 for vaccines in children aged 5-11 has occurred. The Pfizer vaccine has just gained authorization and approval from the Food and Drug Administration (FDA) and recommendation from Rochelle Walensky, MD, of the Centers for Disease Control and Prevention (CDC). It became available over the weekend with a reduced dose of two 10-microgram shots given 21-days apart. As reported by CIDRAP, Walensky noted that “we have second graders who have never known a normal school year, middle schoolers who have missed out on sports. In the nearly 12 months since this group approved the use of vaccines in those 16 and older, we have been wondering when children vaccines were approved for younger children.”

 of pediatric vaccines is also being presented as a way to return to some sense of normal after two years of a pandemic. Over 6.4 million children have been infected with COVID-19 and over 101,000 cases occurred in the week from October 21 to 28. This is especially concerning as cases are on the rise across the United States—up in 23 states as 72,754 new cases were reported. President Biden has also noted that vaccine mandate for private-sector workers will begin January 4.

If you’re interested in a review of college football and COVID-19 transmission, check out this 

 regarding player contact events. Such interactions and the analysis for transmission-based studies are especially interesting in the world of health care and infection prevention and control. The authors note that “between September 26 and December 19, 2020, 1190 college football athletes had 109,762 opposing-player interactions over 64 SEC regular season games. Interactions were fleeting (median length, 6 seconds [range, 1-380 seconds]), and most (104 274 [95%]) were briefer than 26 seconds.”

 the first COVID-19 antiviral pill for treatment, Reuters reports. “Britain’s Medicines and Healthcare products Regulatory Agency (MHRA) 

 the drug, molnupiravir, for use in people with mild to moderate COVID-19 and at least one risk factor for developing severe illness, such as obesity, older age diabetes, and heart disease. It will be administered as soon as possible following a positive COVID-19 test and within 5 days of the onset of symptoms, the regulator said, citing clinical data.”

Giving thought to this rather unknown holiday season—now is the time to have conversations with staff about what can increase or decrease risk of COVID-19 during the holidays. These are especially important as more are getting boosters but may not necessarily realize that doesn’t suddenly make them Superman. As Katherine Wu, MD, 

, “for months, the CDC has been updating its 

Pfizer or Moderna dose, or two weeks after the one-and-done Johnson & Johnson). But no such instruction manual exists for the pre-to-post-boost transition, which 

 will be eligible to make in the next few months. I asked the CDC if those recommendations might appear soon. ‘Not at this time,’ Kristen Nordlund, an agency spokesperson, told me in an email. For now, ‘people who have received a booster should continue to follow CDC’s fully vaccinated guidance.’ (Nordlund did clarify that people shouldn’t consider themselves boosted until two weeks post-jab. They just aren’t being told to, you know, 

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The availability of pediatric vaccines is being presented as a way to return to some sense of normal after two years of a pandemic.

Hot Topics in Infection Prevention: Vaccinate Children, Take Care Over the Holidays

The Food and Drug Administration just announced authorization for Moderna and Johnson & Johnson booster shots and the mix-and-match strategy in the wake of debates and research regarding waning immunity and the longevity of protection. “

 was authorized for anyone 18 and over—a broad eligibility criteria reflecting the lower protection of the initial single-shot regimen when compared with other coronavirus vaccines. The Moderna booster, a half-dose of the original shot, was authorized for people 65 and older, or adults at risk of severe illness or complications because of underlying medical conditions or exposure on the job.” Speaking of vaccines—

 that two new studies were just published that show pretty impressive efficacy of the vaccines against the Delta variant—

 in Israel from the Clalit Research Institute and a partnership with Harvard University, estimated a 93% efficacy of the Pfizer vaccine against symptomatic infection in teenagers. The authors noted that “The results show that in fully vaccinated adolescents (7 to 21 days after the second dose), the risk of symptomatic COVID-19 decreased by 93% compared with the unvaccinated, while the risk of documented infection decreased by 90%. In the period immediately preceding the second dose (days 14–20 after the first dose), vaccine effectiveness was lower, but still substantial—the risk of symptomatic COVID-19 decreased by 57% in vaccinated individuals, and the risk of documented infection by 59%.”

One of the more interesting studies that’s been released in recent weeks (and there are many) has been a 

 from the Centers for Disease Control and Prevention regarding multicomponent strategies for prevention across several youth summer camps. This 

 was fascinating in that compliance can be tricky in these environments—long periods of time in cabins around others, physical activities, and thousands of individuals. In this report, they found that through screening, vaccination coverage, and other interventions, they could reduce transmission. The authors noted that “frequent testing was coupled with multiple prevention strategies, including podding, masking, physical distancing, and hand washing. A pod began as a group of campers and staff members who were in the same cabin. Pod residents were allowed to interact with each other without masking or physically distancing. Camps merged pods in stages, growing from one cabin to multiple cabins, to age groups. Each session required new campers and staff members to follow the same podding protocol. Three camps reached campwide pod expansion. The decision to end indoor masking at each pod expansion stage was predicated on all persons having a negative test result, unless state or local regulations prevented this (one camp). Staff members were permitted to remove masks when they were among other vaccinated staff members and separated from unvaccinated persons.” Understanding effective strategies for not only these environments, but also those for school-age children is a beneficial lesson in community and even hospital infection prevention.

More cases have been identified in the latest Ebola virus disease outbreak in eastern Democratic Republic of Congo (DRC). The World Health Organization (WHO) African Region just 

 – noting 5 confirmed cases and three deaths. Currently, there are 386 contacts identified and 322 being monitored. Reuters reports: “

 the latest flare-up of the virus appeared to be linked to the massive 2018–20 outbreak, which killed more than 2200 people and infected more than 1000 others. The cases were detected on Saturday in the health district of Butsili, close to the city of Beni where the last outbreak was centered, the WHO said in a statement. Three people out of the five confirmed cases have died. This latest outbreak has continued to emphasize the need for survivor research and ongoing surveillance.””

There’s been a lot of activity on the COVID-19 vaccine front thanks to research regarding waning immunity. A mix-and-match strategy seems to be emerging.

Hot Topics in Infection Prevention: Vaccines, Vaccines, Vaccines; Containing COVID-19 at Summer Camp; Ebola Outbreak

Unvaccinated Teachers Make Children Vulnerable to COVID-19

 from the Center for Disease Control and Prevention (CDC)’s 

 (MMWR) are shedding insight into transmission within school settings. In one cluster within Marin County, California among elementary school students and their contacts, researchers learned the exposure was due to an unvaccinated infected teacher. The attack rate within the classroom was 50%. Despite high rates of masking and distancing guidance within the school, “the teacher was reportedly unmasked on 

occasions when reading aloud in class.” While this cluster demonstrated the efficacy of vaccines in COVID mitigation, the researchers emphasized that “this outbreak of COVID-19 that originated with an unvaccinated teacher highlights the importance of vaccinating school staff members who are in close indoor contact with children ineligible for vaccination as schools reopen. The outbreak’s attack rate highlights the Delta variant’s increased transmissibility and potential for rapid spread, especially in unvaccinated populations such as schoolchildren too young for vaccination. However, transmission to community contacts appeared lower than that of some previously reported Delta variant outbreaks. Further transmission might have been prevented by high levels of community vaccination; at the time of this outbreak, approximately 72% of eligible persons in the city where the school is located were fully vaccinated.” This was followed by another 

 on transmission rates in a K–12 school in Los Angeles, California. In this case, the research team assessed 463 school-associated cases from September 1, 2020–March 31, 202, 

 that “the level of protection appears to be higher in children and adolescents than in adults, which is promising for children aged <12 years because no COVID-19 vaccine is currently authorized for this age group. In schools with safety protocols in place for prevention and containment, case rates in children and adolescents were 3.4 times lower during the winter peak compared with rates in the community. This analysis reflects transmission patterns before the more transmissible SARS-CoV-2 B.1.617.2 (Delta) variant became predominant in the United States.”

New South African May Be Highly Transmissible

These findings are particularly important as half of U.S. 12–17 year-olds have received their first dose of the COVID-19 vaccine. This will be increasingly necessary as schools go back into session and growing concerns of Delta amplifying transmission in these settings. A new variant identified in South Africa, C.1.2., is also sparking much conversation about transmissibility and mutations. Identified in May, 

 has now been found across 6 of the 9 South African provinces. While a more transmissible variant isn’t entirely unexpected (ahem Delta), it’s important to take a measured approach about what we’re actually seeing for C.1.2. as these findings were based off a single paper. Per the 

 “The mutations on the virus ‘are associated with increased transmissibility’ and an increased ability to evade antibodies, the scientists said. ‘It is important to highlight this lineage given its concerning constellation of mutations’.” More information will surely be coming regarding this new variant, but in the meantime, it reinforces the importance of global vaccine distribution and non-pharmaceutical interventions (NPIs) that are an effective and complementary tool.

The outbreak underscores the Delta variant’s potential for rapid spread especially in schoolchildren who are too young to be vaccinated.

Hot Topics in Infection Prevention: Unvaccinated Teachers Infect Unvaccinated Children, New South African Variant

Actions Taken to Beat Back Latest COVID-19 Surge

COVID-19 cases in the United States are on the rise and back to pre-vaccination levels, which means we’re still struggling to learn lessons from the past. Forty-six states across the US have cases on the rise and the 7-day average is over 130,000 daily cases. As Stephanie Soucheray of 

, “For the first time since February, the United States reported more than 900,000 COVID-19 cases last week—with the country represented 20% of global cases—a sign the pandemic surge caused by the delta (B1617.2) variant has stalled the progress made by an aggressive vaccine rollout that dampened cases this spring and summer.”

Beyond the US, the world is struggling with COVID-19. Japan has extended their state of emergency. Even our own National Parks Service is requiring all visitors and employees to wear a mask indoors, in shuttles, and at crowded outdoor spaces.

This all comes as the US announced plans for a booster program, which would begin on September 20. Citing concerns for vaccine efficacy, waning protection, and the delta variant, the White House announced this strategy to improve immunity during this significant surge. 

 that you go out and get a booster today,” said Vivek Murthy, MD, the US Surgeon General, according to CIDRAP, which is a publication out of the University of Minnesota.

Murphy stressed that the booster shots effort shouldn’t detract from 2 other important goals: the global distribution of vaccines and encouraging vaccine hesitant Americans to get the vaccine. “I do not think we have to choose between vaccinating Americans and the world, but we have to act based on the data we have,” Murthy said.”

This decision is somewhat controversial, however, as many researchers have cited limited evidence to support this policy, but also that it still has to go through review/approval process of the Food and Drug Administration. Moreover, the notion of boosters when the rest of the world is struggling to merely gain access to first and second doses of vaccines is a huge concern for many, including the World Health Organization. While the US significantly struggles against this fourth COVID-19 wave, it’s critical we communicate that the vaccines are just 1 strategy—not the only strategy. They are done in complement of other non-pharmaceutical interventions, like masking.

Ebola and Marburg Once Again on the March

COVID-19 isn’t the only pathogen we need to be concerned about. We’re now seeing viral hemorrhagic fevers in West Africa. Last week, Guinea confirmed its first Marburg case. More recently though, the West African country of Cote d’Ivoire declared an Ebola virus disease outbreak on August 14. This is a startling turn of events as the last Ebola outbreak was declared over in June in Guinea. As a result, Cote d’Ivoire has announced and launched a vaccination program for health care workers, first responders, and high-risk populations. The World Health Organization said on August 17 

 “the vaccine deployment from Guinea included 2000 doses from Merck that are being used under the ‘ring strategy’ where people who have come into contact with a confirmed Ebola patient are given the vaccine, as well as first responders and health workers. In addition, Guinea sent around 3000 vaccine doses manufactured by Johnson & Johnson which are to be used to boost the vaccination in areas not experiencing active transmission.”

While the US significantly struggles against this fourth COVID-19 wave, it’s critical we communicate that the vaccines are just 1 strategy—not the only strategy.

Hot Topics in Infection Prevention: Booster Shots, New COVID-19 Surge, Ebola Erupts

As COVID-19 cases continue to surge in the United States surges and states like Florida and Louisiana report some of their highest case counts of the entire pandemic, we’re still struggling to vaccinate people. In the past two weeks, the US has seen an 

 and a surge in hospitalizations is probably fast approaching. Children are being hospitalized more now than we anticipated and the delta variant is taking advantage of opportunities presented by some Americans who resist getting vaccinated and masking up. One particular question we’ve been facing is that of 

: Will they happen? When? And for whom? A new study cited by CIDRAP, a publication of the University of Minnesota, is shedding some 

light on a high risk population–organ transplant recipients.

Network researchers enrolled 120 organ transplant patients who had no history of COVID-19 infection, and who had suboptimal results from their 2 doses of Moderna vaccine. Two months after their second dose, half received another Moderna vaccine, while the remainder received a placebo. The resulting 2-month follow-up showed that patients who received a third dose had a higher likelihood of achieving satisfactory antibody levels against the SARS-CoV-2 spike protein as well as higher neutralizing antibody levels.” The authors reported that “A third dose of mRNA vaccine in transplant recipients had substantially higher immunogenicity than placebo, as determined in our analysis of both primary and secondary trial end points.” They add that “this trial had short follow-up and was not powered to detect differences in clinical outcomes. We also acknowledge that the cutoff value of 100 U per milliliter for the anti-RBD antibody level is arbitrary and is not necessarily predictive of resistance to infection.”

Vaccinations: To Mandate or Not to Mandate?

With only half the country vaccinated, we’re still racing against the spread of the 

 and the significant surge that has caused over 124,000 cases in a single day. Vaccine mandates though are a challenging problem for employers, as many now face the decision. Airlines are now considering mandating vaccines, but it’s a controversial issue.

Remember when infection preventionists and the rest of the heath care system was dealing with Ebola virus disease in 2014? Somehow that seems worlds away and yet here we are–a new outbreak of 

 (MOH) has confirmed the country’s first Marburg virus case, also marking the first in West Africa, the World Health Organization (WHO) African regional office said today in a statement.

“A few days ago, Guinea's government said the suspected case was reported from Gueckedou in the N'zerekore region near the borders of Liberia and Sierra Leone. The area—located in southern Guinea—was the epicenter of Guinea’s recent Ebola outbreak, which totaled 23 cases and 12 deaths. The event was declared over on Jun 19.” The patient sought care at a local health clinic and now is the time for control measures as viruses like Ebola can spread easily. While the world is focused on COVID-19, outbreaks like this are reminders that infectious diseases don’t stop simply during a pandemic, but rather require continued investment in public health, infection prevention, research, etc. Now is a good time to break out your Ebola plans and do a quick review of what might new updating!

The delta variant is taking advantage of opportunities presented by some Americans who resist getting vaccinated and masking up.

Hot Topics in Infection Prevention: Booster Shots, Vaccine Mandates, Ebola Outbreak

COVID-19 cases across the United States are rising. In the last 5 weeks, there has been a 300% increase in cases across the country, as the Delta variant takes hold and preys on the unvaccinated or partially vaccinated. In response to growing cases and data showing that breakthrough infections can spread SARS-CoV-2, several larger initiatives have been put into place. First, 

all civilian federal employees and contractors

19 or undergo regular testing and mask wearing. In addition, those unvaccinated will have limits on travel. As 

, a publication out of the University of Minnesota, reports President Biden “also announced a new incentive program that calls on states and territories to give the newly vaccinated $100 when they get the shot. ‘It's time to impose requirements, and incentives,’ said Biden, who said 90 million Americans are eligible for vaccination but have not yet gotten the vaccines. ‘This is an American blessing, we cannot waste it’.”

Across the United States, mask and vaccine mandates are underway as over 68 thousand cases were reported yesterday (July 29). Early this week, the Centers for Disease Control and Prevention (CDC) also changed its guidance on mask wearing and post-exposure testing for fully vaccinated people. In a stark change from the controversial May guidance, the CDC is now 

 or high transmission wear a mask when indoors in public due to the Delta variant. Moreover, the CDC is now recommending that all children and adults wear masks this fall when returning to school. Perhaps 1 of the more forgotten changes in recommendations is in regard to testing for vaccinated individuals following an exposure. The CDC now recommends—“If you’ve been around someone who has COVID-19, you should get tested 3-5 days after your exposure, even if you don’t have symptoms. You should also wear a mask indoors in public for 14 days following exposure or until your test result is negative. You should isolate for 10 days if your test result is positive.”

The issue of breakthrough infections is increasingly coming up. How frequent are they? How infectious are they? Simply put, we know the COVID-19 vaccines do not offer sterilizing immunity. They are very effective at keeping people from getting seriously ill and/or dying. In all honesty, understanding breakthrough infections will be challenging, especially if they are in asymptomatic people. Some studies have shed light on them, such as a new Israeli study which found a 

 rate in health care workers. As these infections are frequently asymptomatic and the Delta variant is much more transmissible than the alpha strain, it’s important to understand these infections and the risk they pose, which is higher for those unvaccinated or immunocompromised. Right now, though, the goal is to get a handle on the rise in cases within the US and increasing vaccination rates (globally as well!). In the last 14 days, there has been a 141% increase in cases within the US and we are still hovering at 49% of the country being fully vaccinated.

The issue of breakthrough infections is increasingly coming up. How frequent are they? How infectious are they? Simply put, we know the COVID-19 vaccines do not offer sterilizing immunity.