With inputs from Dr Monica Vasudev

Survey on CDC’s updated guidelines on use of masks for fully vaccinated

Early in May this year, the US CDC had relaxed its guidelines on the use of masks for fully vaccinated people stating that “Fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.” However, those who have symptoms should still wear masks, and those who are immunocompromised should talk to their doctors for further guidance. 

According to the CDC, people are considered fully vaccinated:  

• 2 weeks after their second dose in a 2-dose series (Pfizer or Moderna vaccines), or
• 2 weeks after a single-dose vaccine (Johnson & Johnson’s Janssen vaccine)

Results of a new WebMD/Medscape poll have shown that many doctors and nurses disagree with the CDC on this; 57% of the 660 US doctors surveyed in the poll said that “the CDC jumped the gun by easing restrictions prematurely”; 63% of 1,330 nurses agreeing the mask shift came too soon.

This guidance has also left the non-medical professionals divided. “Of 2,140 WebMD readers, 49% said the changes came too early, and 51% said they would continue to wear masks in all indoor public spaces. A total of 19% said they would not wear masks at all in public – coincidentally the same percentage of respondents who expressed no interest in receiving a COVID-19 vaccine.”

National Nurses United, the largest union of registered nurses in the United States, released a statement saying the shift puts people, especially front-line workers, in danger. "This newest CDC guidance is not based on science, does not protect public health, and threatens the lives of patients, nurses, and other frontline workers across the country. Now is not the time to relax protective measures, and we are outraged that the CDC has done just that while we are still in the midst of the deadliest pandemic in a century."

(Source: Doctors, nurses blast CDCs guidance change - Medscape - May 28, 2021)

Prior dengue infection doubles the risk of clinically apparent COVID-19

Patients with symptomatic COVID-19 infections were twice as likely to occur in people who had prior dengue virus (DENV) infection, according to a study from Brazil published May 6 in the journal Clinical Infectious Diseases. The type of interaction between two infections like dengue and COVID-19 is called a "syndemic," which the CDC defines as "synergistically interacting epidemics." 

The study analysed sequential blood samples from 1285 residents of Mâncio Lima, a town in the Amazon region of Brazil. 

• Anti-DENV IgG was found in 37.0% of 1,285 cohort participants (95% confidence interval [CI], 34.3% to 39.7%) in 2019, with 10.4 (95% CI, 6.7 to 15.5) seroconversion events per 100 person-years during the follow-up. 
• In 2020, 35.2% of the participants (95% CI, 32.6% to 37.8%) had anti-SARS-CoV-2 IgG and 57.1% of the 448 SARS-CoV-2 seropositives (95% CI, 52.4% to 61.8%) reported clinical manifestations at the time of infection. 
• Participants aged >60 y were twice more likely to have symptomatic COVID-19 than under-five children. Locally circulating SARS-CoV-2 isolates were assigned to the B.1.1.33 lineage. 
• Contrary to the cross-protection hypothesis, prior DENV infection was associated with twice the risk of clinically apparent COVID-19 upon SARS-CoV-2 infection, with P values between 0.025 and 0.039 after adjustment for identified confounders.

Higher risk of clinically apparent COVID-19 among individuals with prior dengue has important public health implications for communities sequentially exposed to dengue virus (DENV) infection and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

(Source: Dengue may double the risk of symptomatic COVID-19 - Medscape - May 24, 2021; Clinical Infectious Diseases, May 6, 2021)

Patients with immune-mediated inflammatory diseases may have weaker vaccine response to Covid-19 vaccine 

Ten percent of patients with immune-mediated inflammatory diseases (IMIDs) fail to respond properly to COVID-19 vaccinations regardless of medication. Small new studies suggest those on methotrexate and rituximab may be especially vulnerable to vaccine failure. The findings appear in a trio of studies in Annals of the Rheumatic Diseases. 

• The most recent study, which appeared May 25, 2021 (Haberman RH, et al. Ann Rheum Dis. 2021 May 25), found that more than one-third of patients with IMIDs who took methotrexate didnt produce adequate antibody levels after vaccination versus 10% of those in other groups. (P < .001) 
• A May 11 study (Spiera R, et al. Ann Rheum Dis. 2021 May 11) found that 20 of 30 patients with rheumatic diseases on rituximab failed to respond to vaccination. 
• And a May 6 study (Simon D, et al. Ann Rheum Dis. 2021 May 6) reported that immune responses against SARS-CoV-2 are "somewhat delayed and reduced" in patients with IMID, with 99.5% of a control group developing neutralizing antibody activity after vaccination versus 90% of those with IMID (P = .0008).

Rheumatologist Anne R. Bass, MD, of Weill Cornell Medicine and the Hospital for Special Surgery, New York said, “Even so, its still crucially vital for patients with IMIDs to get vaccinated and for clinicians to follow recommendations to temporarily withhold certain medications around the time of vaccination.” 

(Rheumatology News, May 25, 2021)