Health Advisory: COVID-19 Updates for Providers & Opioid Cluster

| June 9, 2021
doctor writing on chart

Contact: Melissa Sixberry, Director of Disease Control                                                                              509-249-6509

**Clinical leadership is expected to schedule time to review guidelines with staff**

June 9, 2021

 Requested actions

  • Be aware of local and national reports of myocarditis and pericarditis among people who received COVID-19 mRNA vaccine within the last 2 weeks.
  • Promptly report cases to the U.S. Vaccine Adverse Events Reporting System (VAERS) at https://vaers.hhs.gov/reportevent.html.
  • Report cases to Communicable Disease Information & Reporting Line: (509) 249-6541. Include vaccine manufacturer, vaccination date, dose number and history of prior SARS-CoV-2 infection.
  • Be aware patients may call to request vaccine records due to Washington State Vaccination Incentives
    • Refer patients to MyIR Mobile
    • Vaccinate everyone 12 years or older against COVID-19.
      • Review all patients’ vaccination records and help them get up to date with vaccines. You can administer COVID-19 vaccine simultaneous with, or within any number of days of, other vaccines.
  • Build trust in COVID-19 vaccines.
  • Emergency department data collected by RHINO detected a statistically significant opioid cluster in the Yakima Area
  • Vaccination numbers as of June 5th

Background

Myocarditis and pericarditis following COVID-19 vaccination

On May 17, the Centers for Disease Control and Prevention (CDC) Vaccine Safety Technical Subgroup reported a few cases of myocarditis and pericarditis among people who received COVID-19 mRNA vaccine. No similar reporting pattern is observed after receiving Janssen (Johnson & Johnson) COVID-19 vaccine. Cases are predominantly male adolescents and young adults. Disease onset occurs more often following dose 2 than dose 1, and typically within several days after vaccination. Most cases appear to be mild, and follow-up is ongoing. It is not currently clear if there is a causal association with COVID-19 vaccination. CDC continues to recommend COVID-19 vaccination for people 12 years or older.

CDC is monitoring myocarditis and pericarditis in multiple safety systems, including VAERS and the Vaccine Safety Datalink (VSD). To date, a safety signal has not been identified in VAERS or VSD.

CDC posted Clinical Considerations: Myocarditis and Pericarditis after Receipt of mRNA COVID-19 Vaccines Among Adolescents and Young Adults, as well as related resources for the public. To support ongoing monitoring for this potential adverse event, evaluate patients with chest pain for myocarditis or pericarditis and inquire about recent COVID-19 vaccination. Promptly report any such cases to VAERS and to the Health Department. Clinical features of myocarditis and pericarditis include:

  • Chest pain or pressure.
  • Shortness of breath.
  • Palpitations.
  • Electrocardiogram (EKG) changes.
  • Elevated cardiac biomarkers.

Elicit a detailed history, including vaccination status and potential exposures to COVID-19. Test patients for COVID-19 infection with a molecular (PCR) test. Initial evaluation should include ECG, troponin level, and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate. It is important to consider other potential causes.

New vaccination incentives

On June 3, Gov. Jay Inslee announced COVID-19 vaccination incentives. The state will draw winners from the Washington State Immunization Information System (WA IIS). Accurate and prompt vaccination records are crucial to properly incentivize vaccine recipients.

  • Enter all COVID-19 vaccination records into WA IIS as quickly as possible.
  • Make sure patient information is accurate and up to date.
  • Make sure you enter all submitted patient information. Many people are having trouble getting MyIR Mobile to recognize them because the provider did not enter their phone number or other crucial information.

Be prepared, patients may contact you to verify their vaccination status. If they do so, you may:

  • Send them to MyIR Mobile if they can read English and have internet access and skills.
  • Send them to the Washington State Department of Health (DOH) call center at (800) 525-0127 if they prefer a different language or don’t have internet access or skills. Operators can help callers access and verify their vaccination records in WA IIS and can help in many languages or connect with an interpreter.
  • Supply them with a WA IIS or electronic health record (EHR) printout if the above options don’t work for them.

Opioid Cluster in the Yakima Area 16 cases of overdoses reported by syndromic surveillance. Most cases referenced a blue pill with a M on it and referenced as Percocet. These were actually fentanyl. YHD continues to offer free Narcan at our syringe program weekly.   Vaccine Update Yakima County continues to receive additional doses of COVID-19 vaccines. As of June 5, 2021, of individuals 16 years and older, 54.83% have initiated vaccination and 46.97% have been fully vaccinated in Yakima County.

Additional resources