Photo by J.E. Decourcey/Maryland State Police

Respiratory illness season is approaching in the Northern Hemisphere. COVID-19 cases are rising. The flu season has been moderately active in the Southern Hemisphere, and it won’t be long before it moves north. RSV, which stands for respiratory syncytial virus, is already active in North America. What are the discussions leaders will have with their workforces in the coming months? Where might the police be asked to work with public health organizations?

For three years, the greatest health concerns were about COVID, but the focus last year had to include the RSV burst that happened in summer and fall of 2022. There have also been global concerns about an increased threat of influenza (flu) in these post-pandemic years.

The great news is that there are vaccines and treatments that reduce risks from all of the respiratory viruses that pose the highest risks this season, including COVID-19. The Advisory Committee on Immunization Practices (ACIP) is a group of medical and public health experts that develop recommendations to the Centers for Disease Control and Prevention (CDC) on how to use vaccines. The ACIP has been busy over the last year.

After all the controversies associated with vaccinations over the last three years, the CDC is building a much more comprehensive toolbox to assist the public and health care professionals in making informed decisions about vaccines. The process is called SHARE. Law enforcement personnel can be integral to this community education process.

S – SPEAK why recommended vaccines are right for the individual. Be sure to emphasize the benefits provided by each vaccine.

H – HIGHLIGHT positive experiences with the vaccine to reinforce these benefits and strengthen confidence in the vaccine.

A – ADDRESS questions and any concerns about each vaccine.

R –REMIND people that vaccines can help protect them from illness, complications, and spreading the disease to other persons.

E – EXPLAIN the costs of vaccine-preventable illnesses, including potential long-term and serious health effects for the patient.

Respiratory Syncytial Virus (RSV)

The most exciting and timely developments are in protection from RSV, which can cause severe lower respiratory tract infections in older adults and infants, including pneumonia and respiratory failure.

Two RSV vaccines were approved by the U.S. Food and Drug Administration (FDA) in May 2023 for the prevention of these infections in adults ages 60 and older. In June, the ACIP formally recommended that people ages 60 and above may receive a single dose of an RSV vaccine. Patients 60 and over with chronic lung diseases, asthma, congestive heart failure, coronary artery disease, diabetes, chronic kidney and liver diseases, and moderate to severe immunosuppression are among those most adults likely to benefit from RSV vaccination. RSV vaccination can be offered without regard to seasonality to any unvaccinated adult who is in the target population.

For eligible adults who want to receive an RSV vaccine, now is the time for vaccination.

Infants and young children are more likely to get serious complications if they get sick with RSV. Each year, at least 60,000 to 80,000 children under the age of five become ill with RSV, and many are hospitalized. To date, there have not been methods to protect this vulnerable group from severe RSV disease.

Prior efforts to protect infants with traditional vaccines has not proven effective. So a new approach has been developed and proven effective. A new monoclonal antibody product named nirsevimab has been proven to protect infants and young children from severe RSV. It is due for release this month (October). The CDC recommends one dose of nirsevimab for all infants younger than eight months born during or entering their first RSV season. For an unfortunate group of children between 8 months and 19 months at increased risk of severe RSV disease, such as children who are severely immunocompromised, a dose is also recommended in their second RSV season. Law enforcement personnel are familiar with the use of monoclonal antibodies from the use of these products for the treatment and prevention of COVID-19. This is the first time that monoclonal antibodies will be used for a larger group of children to prevent a serious disease. The CDC is working to provide nirsevimab to about half of the children in the United States through the Vaccines for Children program.

As readers may recall, public safety personnel were essential to programs that delivered monoclonal antibodies to at-risk populations in the most difficult days of COVID-19. It is possible that public safety personnel could be asked by local public health agencies to participate in delivery of these essential RSV prevention treatments this winter.

Another approach to preventing severe infections in infants is to vaccinate pregnant women, who then produce antibodies that are passed to their newborns. This is an innovative strategy. In late August 2023, the FDA approved an RSV vaccine named Abrysvo (manufactured by Pfizer) for use in women who are 32 to 36 weeks pregnant, to protect their infant children from birth to age six months from RSV. The vaccine was generally well tolerated with minimal side effects. Information on this new type of vaccine will soon be provided to pregnant women, particularly those who are most at risk to have a compromised or high-risk baby.

Emergency personnel have for all these years watched infants struggle to breathe after they are infected with this respiratory virus. Some of those infants have been their own children. This is now a potentially preventable disease in millions of small children, and it would be well worth the effort for public safety personnel to be part of the process of ensuring these preventative measures are made known and widely used.

Prevention of RSV is not free, except for those children in the CDC program. The vaccines may be paid for by insurance companies and through occupational health programs.

Influenza

In a typical year, flu officially kills about 35,000 people in the United States—and the true toll is probably higher. The flu weakens the body in ways that make heart attacks, strokes, and other ailments more probable and more likely to be fatal.

The CDC recommends that everyone six months of age and older receive an influenza vaccine (commonly known as a flu shot). Flu shots not only prevent infection—they also decrease the risk of severe disease or death and the need for hospitalization. ACIP recommends that people who are 65 years and older preferentially receive one of the three higher dose or adjuvanted influenza vaccines. Most people need one dose of influenza vaccine each season, and the recommended timing of influenza vaccination is September and October. Pregnant people who are in their third trimester can get a flu vaccine to protect their babies from flu after birth, when the child is too young to get vaccinated.

For the first time, people with egg allergies can be vaccinated without special additional safety measures needed. They can receive any influenza vaccine (egg-based or non-egg-based) that is otherwise appropriate for their age.

This year’s flu vaccines are available at drugstores, hospitals, doctor’s offices, occupational health clinics, and elsewhere.

COVID-19

Yes, COVID-19 is still around, and cases have been increasing in frequency over the last few months. Many people in the United States have now gone more than a year without a booster, and immunity has waned. Fortunately, most recent cases have been minor, and severe COVID-19 has been rare in people under age 50, especially if they have received a vaccine shot or had the virus before. Nearly all U.S. residents fall into one or both categories. Nonetheless, COVID-19 is still a dangerous disease with an unpredictable outcome, and the risk of “long COVID” is present in each case of the disease.

First, all law enforcement personnel should be aware that the infections are still in the community and are now coming in larger numbers in congregate care facilities and senior sites. Many police departments are renewing their PPE practices for entering those facilities and for managing any community members who have respiratory symptoms. Emergency responders should use protection that is N-95 and higher, and surgical masks should be used by the patient and family. Personnel who get ill with COVID-19 are subject to the isolation procedures that were used in 2022. Now is the time to review those practices and recommendations.

Free COVID-19 tests are once again available at the website www.COVIDTests.gov. Public safety agencies should check the COVID tests that are still in inventory to see if they have expired. The current strains of COVID are still detected by the test kits that have been available for years.

Those law enforcement personnel who are traveling may want to incorporate the use of PPE in their travel plans, especially in congested travel modes. And, as always, this is not the time for officers to come to work sick.

For members who do get COVID-19 infections, talk to a doctor about taking Paxlovid or a different anti-viral treatment. These medications can make a big difference in reducing severe infection and hospitalization and in reducing the potential for long COVID.

The best defense against COVID-19 is still vaccination, which is especially important for highly vulnerable people like the elderly and the immunocompromised.

The important news is that updated COVID-19 booster vaccines arrived in late September 2023. They will target the XBB.1.5 strain of the Omicron variant, which has circulated through the United States for much of 2023. The CDC and ACIP have updated guidance, and the new COVID vaccines will be recommended for those who are pregnant, for anyone with moderate or severe immunocompromising conditions, for all adults 65 and older, and for adults of any age with chronic medical conditions that make the risk of severe COVID more likely.

Patients who have had a recent COVID-19 infection should wait at least three months before getting a booster COVID-19 vaccine. The same goes for patients who received a dose of the previous bivalent vaccines any time since July 2023.

Individuals not in the higher risk groups may consider vaccination in late October or early November. That will maximize protection for those planning to spend the winter holidays traveling or with extended families in large indoor gatherings.

Timing Recommendations

Although the landscape around fall vaccines is more complex this year, the overarching message from the CDC is that immunizations are very important to staying healthy during winter respiratory virus season. A good strategy for healthy persons, like many law enforcement personnel, may be to get their COVID-19 booster and flu shot at the same time, in October or early November.

Patients can receive an influenza vaccine simultaneously with either the RSV vaccine or the updated COVID-19 booster. When multiple vaccines are given at the same time, the injection sites should be spaced apart appropriately from one another or in opposite arms.

At this point there are no data around the co-administration of the RSV vaccines and COVID-19 boosters, but most experts recommend a two-week period between receiving an RSV vaccine and the updated COVID-19 vaccine.

The Bottom Line

For law enforcement personnel, this is another time to focus on the importance of keeping members healthy through the respiratory season and to adopt practices that reduce the risks to personnel, their family members, and the community members they encounter from flu, RSV, and COVID-19. 🛡

Please cite as

James Augustine, “Autumn Wellness for Officers and Community,” Police Chief Online, October 4, 2023.