Updates to seasonal influenza vaccine practices during the COVID-19 pandemic

The ACIP and CDC released this recommendation on August 21, 2020 that updates the 2019-2020 recommendations of the ACIP regarding the use of seasonal influenza vaccines in the U.S. As always, the routine influenza vaccine is recommended for all people 6 months and older who do not have contraindications. Changes for the upcoming flu season include: the composition of the 2020-21 U.S. influenza vaccine includes updates to the influenza A (H1N1)pdm09, influenza A (H3N2), and influenza B/Victoria lineage components; and recent licensures of two new influenza vaccines, Fluzone High-Dose Quadrivalent and Fluad Quadrivalent. Updates to the contraindications and precautions to vaccination are included. The discussion also includes discussion on the groups for whom vaccination is recommended, timing of vaccination, guidance for use in specific populations and situations, and discussion regarding those who have concurrent influenza and COVID-19 infections. Vaccinating for influenza is not recommended while a patient has acute/active symptoms of COVID-19 and should be delayed until the patient is no longer acutely ill. This is a wealthy article which contains many important topics for discussion regarding the upcoming influenza season and how to handle this seasonal influenza vaccination during the pandemic.

Strategies for routine immunizations and vaccine during the pandemic

In this article, the authors discuss the impact of that COVID-19 has had on delayed immunizations among all age groups, and more specifically, the impact on routine childhood vaccines. With the quarantine in place, vaccination rates plummeted and there is concern for a great increase in vaccine preventable disease (VPD’s) due to these delayed, interrupted, and suspended vaccines. The authors stress the importance of catching up immunizations and monitoring for consequences of missed doses by using mass vaccination campaigns, increasing surveillance for VPD’s, and amping up vaccination clinics.

Vitamin D levels related to COVID-19 susceptibility?

This article acknowledges the global issue of Vitamin D deficiency among all age groups, especially during winter months. With the ongoing global pandemic, the authors aim to correlate the risk of COVID-19 with vitamin D deficiency. The authors examined studies that indicated Vitamin D deficiency predisposes elderly individuals and those with comorbidities to an increased risk for lung damage related to COVID-19. The authors encourage further studies of using Vitamin D as a prophylactic and conclude that there is correlation between decreased Vit D levels and increased risk of COVID-19.

Use of Bacillus Calmette-Guerin (BCG) to reduce COVID-19

The well-known Tuberculosis vaccine, BCG, has been used to prevent TB and has been shown to induce an adaptive immune response in the body which fights bacteria, parasites, and viruses. This article proposes that the same vaccine used to prevent TB may also offer protection against severe SARS-CoV-2. Authors note that some pre-print articles have found countries with mass BCG immunization rates seem to have lower incidence of COVID-19 when compared to those countries who do not regularly use the vaccine. The authors also state that the World Health Organization is currently testing this theory with clinical trials on selected cohorts, however, other experiments to support the theory are lacking. It is important to note that the use of BCG vaccine for this purpose should only be done under supervision and in RCT’s until further evidence is uncovered.

Postmortem findings in COVID-19 positive decedents

This interesting read discusses three autopsy cases with postmortem diagnosis of SARS-CoV-2 infection, with detailed macroscopic and microscopic examination of organ tissues collected during the process. The lungs of these three patients appear to be the center organ of invasion and pathogenesis of the COVID-19 virus. Diffuse areas of condensation, subpleural retraction zones were present, however, the there were differences from classic bacterial pneumonia present. Interestingly, clusters were identified which mimicked multinucleated giant cells within the pneumocytes. Destruction of the alveolar wall and hyaline membranes were present as well as microthrombi within small blood vessels were found in all three cases. In addition, the spleens were atrophied, but no other signs of viral infection were present in the myocardium or other organs. The authors include cellular images and macroscopic photographs which support the findings.