Inside This Issue: CDC: Most Outdoor and Indoor Activities Considered Safe for Fully Vaccinated; FDA Expands EUA for Pfizer-BioNTech COVID-19 Vaccine; HHS and HUD Launch Effort to Increase Access to COVID-19 Vaccination; Incidence of Common STDs Reached Record Highs During 2019; and other news.
CDC: Most Outdoor and Indoor Activities Now Considered Safe for Fully Vaccinated People
On 13 May, the U.S. Centers for Disease Control and Prevention (CDC) announced new COVID-19 guidance indicating that people fully vaccinated for COVID-19 can safely resume most activities without needing to wear 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. In particular, according to CDC, fully vaccinated people can safely:
- engage in essentially all outdoor activities, including crowded outdoor events, such as live performances, parades, and sports events;
- visit a barber or hair salon;
- go to an uncrowded, indoor shopping center or museum;
- attend a small, indoor gathering of fully vaccinated and unvaccinated people from multiple households;
- go to an indoor movie theater;
- attend a full-capacity worship service;
- sing in an indoor chorus;
- eat at an indoor restaurant or bar; and
- participate in an indoor, high intensity exercise class.
In addition, CDC notes that fully vaccinated people traveling within the U.S. do not need to get tested for COVID-19 before or after travel or self-quarantine after travel. CDC considers people to be fully vaccinated for COVID-19 two weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna vaccines), or two weeks after they have received a single-dose vaccine (Johnson and Johnson vaccine).
For people who are not yet fully vaccinated, CDC continues to recommend following safety measures – wearing a mask, staying 6 feet apart, and washing hands as appropriate – when engaging in any of the activities above. CDC also advises that, “People who have a condition or are taking medications that weaken the immune system, should talk to their healthcare provider to discuss their activities. They may need to keep taking all precautions to prevent COVID-19.”
FDA Expands EUA for Pfizer-BioNTech COVID-19 Vaccine to Include Young Adolescents
On May 10, the U.S. Food and Drug Administration (FDA) expanded its emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to include adolescents 12 to 15 years old. This was an amendment to the EUA that FDA issued in December 2020 that authorized the vaccine’s use in persons aged 16 years or older.
CDC has also adopted the recommendation of its Advisory Committee on Immunization Practices endorsing the safety and effectiveness of the Pfizer-BioNTech vaccine in 12- to 15-year-olds. CDC’s recommendation clears the way for providers to begin vaccinating younger adolescents right away.
CDC statistics indicate that there were approximately 1.5 million COVID-19 cases in children and adolescents 11 to 17 years old between March 1, 2020 and April 30, 2021. Children and adolescents generally have a milder COVID-19 disease course as compared to adults, but serious illness and death sometimes do occur. Under the expanded EUA, adolescents 12 to 15 years old will receive two doses of the Pfizer-BioNTech vaccine three weeks apart – the same dosage and dosing regimen as in older adolescents and adults.
“Having a vaccine authorized for a younger population is a critical step in continuing to lessen the immense public health burden caused by the COVID-19 pandemic,” noted Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research. “With science guiding our evaluation and decision-making process, the FDA can assure the public and medical community that the available data meet our rigorous standards to support the emergency use of this vaccine in the adolescent population 12 years of age and older.”
HHS and HUD Launch Effort to Increase Access to COVID-19 Vaccination and Other Services
The U.S. Department of Health and Human Services (HHS) and Department of Housing and Urban Development (HUD) recently announced a joint-agency effort to increase access to COVID-19 prevention and treatment services, including vaccinations and testing among disproportionately affected communities. These at-risk communities include HUD-assisted households and people experiencing homelessness.
According to HHS, the effort will leverage the Health Center COVID-19 Vaccine Program that currently provides a direct supply of vaccines to nearly 800 health centers across the United States. HHS and HUD expect this initiative to respond to and stop the spread of COVID-19 will reach over 6,000 multifamily housing properties, 6,700 homeless shelters, and approximately 7,500 public housing properties.
“More than 100 million Americans are now fully vaccinated. Yet there are many others who still need help getting the vaccine. To raise our vaccination numbers even higher, we must continue to center our efforts around the guiding principle of equity,” said HUD Secretary Marcia Fudge. “Many of the people that HUD serves are among the most vulnerable in our society. They’re seniors, they’re people with disabilities, they’re people of color from households of modest means, and they’re people who are experiencing homelessness. This new partnership between HHS and HUD is about saving lives by expanding access to comprehensive COVID care for those in need. It’s about meeting people where they are – and about bringing health care home.”
Sexually Transmitted Diseases
Incidence of Common STDs Reached Record Highs During 2019
The reported U.S. cases of chlamydia, gonorrhea, and syphilis increased for the sixth consecutive year in 2019 – reaching an all-time high of about 2.5 million total cases, according to Sexually Transmitted Disease Surveillance 2019, a recent CDC report. Here are a few selected highlights from the report.
Chlamydia: In 2019, about 1.81 million cases of Chlamydia trachomatis infection were reported to the CDC, making it the most common notifiable sexually transmitted disease (STD) in the U.S. This corresponds to a rate of 552.8 cases per 100,000 population, an increase of 2.8% compared to the rate in 2018. Since 2014, the annual number of chlamydia cases has risen 25%.
Gonorrhea: A total of 616,392 cases of gonorrhea were reported in the U.S. during 2019, making it the second most common notifiable STD. This corresponds to a rate of 188.4 cases per 100,000 population in 2019, an increase of 5.7% compared to the previous year. The total annual U.S. cases of gonorrhea has doubled since 2010. CDC estimates that more than half of all gonorrhea infections during 2019 were resistant to at least one of the antibiotics that could be used to treat it.
Syphilis: In 2019, 129,813 cases of all stages of syphilis were reported, including 38,992 cases of primary and secondary (P&S) syphilis, the most infectious stages of the disease. Since reaching historic lows of about 6,000 cases in 2000 and 2001, the rate of P&S syphilis has increased nearly every year – rising 11% from 2018 to 2019 and nearly doubling since 2014. In 2019, men who have sex with men (MSM) accounted for over half (56.7%) of all P&S syphilis cases.
Although rates of P&S syphilis are lower among women than men, women’s rates have been rising quickly in recent years – up 30% between 2018 and 2019 and nearly 180% since 2015. This suggests a rapidly growing heterosexual syphilis epidemic, according to CDC.
Of great concern is a resurgence in cases of syphilis among newborns, with the total number of cases doubling from 941 in 2017 to 1,870 in 2019. The national rate of congenital syphilis has quadrupled since 2014, reaching 48.5 per 100,000 live births in 2019. Stillbirths and infant deaths related to syphilis rose from 94 in 2018 to 128 in 2019.
CDC Commentary: In an announcement accompanying the release of the 2019 STD data, CDC noted, “Social inequity often leads to health inequity and, ultimately, manifests as health disparities. Even when STI rates reached historic lows, disparities have persisted because of the social, cultural, and economic conditions that make it more difficult for sexually active people to stay healthy. And while reported STDs have once again become increasingly common, racial and ethnic minority populations, adolescent and young adults, and gay and bisexual men still bear the brunt of these deeply entrenched social determinants of health.”
“Less than 20 years ago, gonorrhea rates in the U.S. were at historic lows, syphilis was close to elimination, and advances in chlamydia diagnostics made it easier to detect infections. That progress has been lost, due in part to challenges to our public health system.”
HIV and COVID-19
PEPFAR Guidance on HIV Response During the COVID-19 Pandemic
The President’s Emergency Plan for AIDS Relief (PEPFAR) has established four priority goals to guide its HIV response activities during the COVID-19 pandemic: ensuring continuity of care for people living with HIV; leveraging PEPFAR-supported health systems and infrastructure; reducing exposure of staff and HIV and HIV clients to health care settings that may be overburdened and/or sources for potential exposure to COVID-19; and providing flexibility for PEPFAR programs in how to optimally service clients with HIV in areas affected by COVID-19.
In support of these efforts, the U.S. State Department has developed the PEPFAR Technical Guidance in Context of COVID-19 Pandemic, which was updated earlier this month. The document provides extensive information and guidance about PEPFAR’s ongoing activities during the COVID-19 pandemic, including:
- HIV prevention services, such as pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision;
- HIV testing;
- HIV treatment;
- integrated women’s health services;
- maternal child health services;
- gender-based violence and child protection services;
- services for orphans and vulnerable children;
- tuberculosis services; and
- services for key populations, including sex workers, gay men and other men who have sex with men, transgender people, people who inject drugs, and people in prisons.
New AIDSVu and CHLP Resources Focus on HIV Criminalization
The term “HIV criminalization” refers to the use of specific or general criminal laws to prosecute an individual based on their positive HIV status. In 2020, more than two-thirds of people with HIV in the U.S. lived in the 32 states and two U.S. territories that have laws that criminalize specific acts by people with HIV. To increase understanding of HIV criminalization, AIDSVu and the Center for HIV Law and Policy (CHLP) have developed a set of resources on this topic. These resources include a web page titled Deeper Look: HIV Criminalization, which provides an overview of the history and current state of HIV criminalization in the U.S., the legal landscape, and recent steps some jurisdictions have taken to reform or repeal HIV criminalization laws. The AIDSVu site also has two new blog items written by legal experts and advocates – HIV Criminalization in the United States and HIV Decriminalization Advocacy – as well as a series of infographics focusing on specific laws and enhanced sentencing affecting people with HIV.
HIV Care Tools App from AETC NCRC
The AETC National Coordinating Resource Center (NCRC) recently released a free HIV Care Tools app designed to provide immediate access to information on HIV screening, prevention, and care. The app features evidence-based guides; clinical calculators; screening tools; and one-touch access to phone-based expert clinical consultation. It is designed for use by providers who serve people with, or at risk for, HIV infection, including clinicians, clinic staff and care team members, pharmacists, and health profession students, residents, and fellows.
The app was supported by Ending the HIV Epidemic initiative funds, and includes resources to support all four pillars of the initiative. It is available for both iPhone and Android-based devices and can be downloaded from the Apple App Store and Google Play Store.
HIVMA and IDSA Issue Briefs on COVID-19 and Health Disparities
The HIV Medicine Association (HIVMA) and the Infectious Diseases Society of America (IDSA) have produced a series of issue briefs focusing on COVID-19 and health disparities generally, as well as population groups and settings disproportionately affected by COVID-19. Many of these groups and settings are also heavily impacted by HIV. The issue briefs include the following:
- COVID-19 and Health Disparities in the United States
- The Impact on Rural Communities
- Disparities Among Immigrant Populations
- The Impact on Native American Communities
- The Impact on Black/African American Communities
- The Impact on Latinx Communities
- Strengthening the Response to COVID-19 in Correctional Facilities
HIVMA also recently published the issue brief HIV & STD Prevention and Care During COVID-19: Summary of Key Policies to Address Health Inequities, which focuses on policies and innovations in care delivery designed to reduce health inequities and improve health outcomes. This includes sections about telemedicine, the Ryan White HIV/AIDS Program, prescription drug access, pre-exposure prophylaxis, public health workforce, new models of care and delivery, and housing.
Other COVID-19 News
Recent COVID-19 Research Published in MMWR
CDC’s Morbidity and Mortality Weekly Report (MMWR) is providing continuing coverage of COVID-19-related research. CDC is archiving the MMWR reports on a page devoted to studies about COVID-19. For your convenience, we have compiled links to recent MMWR papers below:
- Community-Based Testing for SARS-CoV-2 – Chicago, Illinois, May-November 2020
- Diagnostic Performance of an Antigen Test with RT-PCR for the Detection of SARS-CoV-2 in a Hospital Setting – Los Angeles County, California, June-August 2020
- Demographic and Social Factors Associated with COVID-19 Vaccination Initiation Among Adults Aged ≥65 Years – United States, December 14, 2020-April 10, 2021
- Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years – United States, January-March 2021
- Safety Monitoring of the Janssen (Johnson & Johnson) COVID-19 Vaccine – United States, March-April 2021
- Anxiety-Related Adverse Event Clusters After Janssen COVID-19 Vaccination – Five U.S. Mass Vaccination Sites, April 2021
- Identification of and Surveillance for the SARS-CoV-2 Variants B.1.427 and B.1.429 – Colorado, January-March 2021
- Rapid Emergence and Epidemiologic Characteristics of the SARS-CoV-2 B.1.526 Variant – New York City, New York, January 1-April 5, 2021
- Modeling of Future COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Rates and Nonpharmaceutical Intervention Scenarios – United States, April-September 2021