By January 20, 2023, it is estimated that >90% of the SARS-CoV-2 variants that are still in circulation in the country, specifically the Omicron BQ.1, BQ.1.1, XBB, and XBB.1.5 sublineages, won't be susceptible to the monoclonal antibodies tixagevimab and cilgavimab (Evusheld), which are used for preexposure prophylaxis against SARS-CoV Evusheld is not yet approved for preexposure prophylaxis against SARS-CoV-2 infection in the United States, the Food and Drug Administration stated on January 26, 2023. People who are moderately to severely immunocompromised, those who may not have had a sufficient immune response to COVID-19 vaccination, and those who have medical conditions that make receiving COVID-19 vaccines contraindicated should use caution and be aware of the need for additional preventive measures (Box). In addition, persons should have a care plan that includes prompt testing at the onset of COVID-19 symptoms and rapid access to antivirals if SARS-CoV-2 infection is detected.
Getting vaccinated against COVID-19 is still the best defense against major disease, hospitalization, and death brought on by SARS-CoV-2. Everyone should maintain current on their COVID-19 vaccinations and obtain the latest (bivalent) booster dosage when appropriate, including immunocompromised individuals, their family members, and close contacts. Having a current COVID-19 immunization does offer some protection, even if those who are moderately to severely immunocompromised might not produce a robust vaccine-mediated immune response. A recent CDC assessment of early data revealed that among immunocompetent individuals who had previously received 2, 3, or 4 monovalent vaccination doses, a bivalent booster dose offered increased protection against symptomatic SARS-CoV-2 infection.
Despite proof of the vaccine's efficacy, just a small portion of Americans have received the bivalent booster shot. A bivalent booster dose had been administered to 15.3% of people under the age of five as of January 18, 2023. All eligible individuals above the age of six months are advised to obtain one bivalent booster dose. People who are between the ages of 6 months and 5 years old and who have finished the Moderna COVID-19 main series within the previous two months are eligible for a bivalent booster dose. People between the ages of 6 months and 4 years who have had a 2-dose Pfizer COVID-19 main series during the previous 8 weeks may get the bivalent booster as their third dose.
In addition to receiving a bivalent booster dose, prevention measures such as the use of a high-quality and well-fitting mask, keeping a physical distance from others (6 ft [1.8 m]), improving indoor ventilation, regularly washing one's hands, and creating a care plan should be taken into account among people with immunocompromise, their family members, and close contacts. If it is impossible to avoid busy interior settings, it is crucial to wear a mask and keep your distance from other people. Simple measures should also be employed to increase ventilation in buildings and reduce the spread of SARS-CoV-2 by increasing air movement. The CDC has created interactive tools to assist in determining how to enhance ventilation in the house. To inactivate SARS-CoV-2 as air flows through the system, in-duct UV germicidal irradiation lamps can also be added to residential heating, ventilation, and air conditioning systems. In most cases, regularly washing your hands with soap and water is the best approach to get rid of germs. An alcohol-based hand sanitizer with a concentration of around 60% alcohol is an acceptable substitute if soap and water are not easily accessible. Additionally, it's crucial for immunocompromised individuals to create a treatment strategy with their doctor in case they contract COVID-19.
People who have mild to moderate COVID-19 symptoms and who are 1) older than 50 years old, 2) unvaccinated, or 3) have an underlying medical condition (particularly moderate to severe immunosuppression) are at risk for serious COVID-19-related consequences. Symptomatic immunocompromised individuals, members of their households, and close contacts should all be tested for SARS-CoV-2 infection as soon as feasible and treated within 5-7 days of symptom onset regardless of vaccination status. Early outpatient treatment of mild to moderate COVID-19 with the second-line drug molnupiravir (Lagevrio) or the first-line drug ritonavir-boosted nirmatrelvir (Paxlovid) or remdesivir (Veklury) has been demonstrated to lower the risk for severe COVID-19, including hospitalization and death. These drugs are readily accessible and are anticipated to maintain activity against the current circulating Omicron sublineages.The necessity for people to maintain current COVID-19 immunizations, which are very effective in preventing COVID-19-related morbidity and mortality, does not outweigh the availability of COVID-19 therapy.