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Health Advisory: COVID-19 treatment options for moderately or severely immunocompromised patients

Health Alerts Posted on September 23, 2022

Health Advisory: COVID-19 treatment options for moderately or severely immunocompromised patients

September 23, 2022

Action requested:

  • Be aware of treatment options including monoclonal antibodies or MAbs, as well as oral antivirals. Make a plan with your moderately or severely immunocompromised patients including where they can be promptly tested, evaluated for and access treatment in the event they become infected and are eligible.
  • Be aware of pre-exposure prophylaxis resources and recommendations for moderately or severely immunocompromised patients
    • Tixagevimab plus cilgavimab (Evusheld) is currently the only product authorized for PrEP
    • On June 29, 2022, the FDA made a recommendation for the repeat dosage of EVUSHELD in adults and pediatric individuals (12 years of age and older weighing at least 40 kg) is 300 mg of tixagevimab and 300 mg of cilgavimab be administered every 6 months.Further information can be found on the WA DOH therapeutics web page as well as through NIH and IDSA:
    • With regard to prioritization and timing ideally patient would receive their bivalent booster prior to receipt of Evusheld should be delayed until at least 2 weeks after last COVID-19 vaccine administration.
    • The following page details how providers and institutions can obtain access to monoclonal antibody (MAb) and oral antiviral therapeutics (molnupiravir & ritonovir- boosted nirmatrelvir [Paxlovid]) and Tixagevimab plus cilgavimab (Evusheld) PrEP: Overview of WA State Order Process for COVID-19 Therapeutics
    • This page can guide you to organizations that currently have access to MAb, including Tixagevimab plus cilgavimab (Evusheld), and oral antiviral therapeutics nationally and locally: COVID-19 Therapeutics Locator
    • If your organization does not have the capacity to administer Evusheld, there are infusion companies which some providers may have access to that can assist with Evusheld administration. For some patients with insurance coverage this may be an option. Please check with your organization leadership to determine what infusion companies your organization might work with.
    • Providers can also submit referral orders to Bird’s Eye Medical (BEM). 
      • BEM is contracted by WA DOH for provision of testing and treatment for COVID-19 free of charge to patients, by faxing a copy of this form to (360) 878-8330 they will work with your patient to set up Evusheld infusion. BEM does take insurance information when available but is not necessary.
        • Bird’s Eye Medical will also accept referrals in any format if more convenient as long as they contain the following information:
          • Patient Last name
          • Patient First name
          • DOB
          • Sex at birth
          • Contact Phone
          • Address(preferred)
          • Indication for Evusheld
          • Provider Order, including dosage
          • Provider NPI#
        • You can also refer patients to the Bird’s Eye Medical website or to call (360) 688-7044 where they can schedule a EVUSHELD appointment after you provide a referral.
        • Bird’s Eye Medical has multiple locations in the Puget Sound region currently operating, but none are in Snohomish County at this time. Once they receive a referral, they will contact patients directly to schedule them at a clinic and time that works best with their schedule.
  • Be aware that post-exposure prophylaxis is not currently recommended as all products authorized for this use are not effective against the predominant Omicron variant.
  • Be aware of testing locations and resources in Snohomish County

Background:

Moderately or severely Immunocompromised patients are at increased risk for severe disease, hospitalization, and death from COVID-19. Many conditions and treatments can cause a person to be immunocompromised including immunosuppressive medications for cancer or autoimmune disease, solid organ or bone marrow transplants, and infections like HIV. It is very important for immunocompromised patients to continue to use layered COVID-19 prevention measures including staying up to date with vaccinations (including extra dose of primary series and boosters when eligible), pre-exposure prophylaxis (PrEP), masking with high-quality masks (e.g., N95, KN95, KF94), avoiding crowded indoor settings, social distancing, and testing when appropriate after exposure or when symptomatic.

Given that moderately or severely immunocompromised patients have increased risk for severe disease, hospitalization, and death with COVID-19 infection, even when up to date with vaccination recommendations, it is important for healthcare providers to be aware of resources for vaccination, PrEP, testing, and treatment so these patients can rapidly access these lifesaving interventions.

Resources:


  1. Public Health always working for a safer and healthier snohomish county
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  2. 3020 Rucker Avenue
    Everett, WA  98201
    Phone: 425-339-5200

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