Higher levels of the omega-3 fatty acid eicosapentaenoic acid (EPA) found in the blood appear to explain why icosapent ethyl drives down the risk of a cardiovascular (CV) event.

REDUCE-IT: Serum EPA Levels Key to Vascepa's CV Benefits

We interview experts on investigational treatments such as liso-cel, and ask how to bring them to community practice.

Spotlight on CAR T-Cell Therapy

The American Journal of Accountable Care® features research and commentary on new payment models.

New Members for AJAC Board

AMCP 2021, held virtually April 12-16, 2021, will bring together pharmacists, providers, payers, biopharmaceutical and life science industry leaders, digital health innovators, and policy makers.

Coverage of AMCP 2021 Is Coming

The 2021 Virtual Spring Managed Care Forum will be held virtually April 21-23, 2021. Topics include the future of health care beyond COVID-19, virtual health in the era of COVID-19, type 2 diabetes, multiple sclerosis, chronic cough, oncology, and more.

Coverage of the NAMCP Spring Forum Is Coming

 since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey. 

A significantly higher percentage of women presented to the emergency department (ED) for 

 during the preovulatory interval of their menstrual cycle—when estrogen levels are on the rise and headaches are typically less frequent and severe—compared with other intervals of the cycle, according to an 

 presented at the American Academy of Neurology’s 73rd Annual Meeting, being held virtually April 17-22, 2021.

Findings may represent a delay in seeking care for perimenstrual attacks or could indicate other factors aside from hormone levels contributing to when women present for headache, authors wrote.

As females exhibit higher prevalence of migraine worldwide (18% vs 6% in males), and because the condition has been historically associated with menstruation, 

 have aimed to analyze estrogen’s role in migraine pathogenesis.

“Hormone levels can impact the severity and frequency of migraine and tension headaches,” authors wrote. They continued, “perimenstrual attacks, thought to be precipitated by falling estrogen levels, are more severe and refractory to treatment. Given this, we hypothesized that there is an increase in ED presentations for headache during the perimenstrual interval.”

 attacks are considered menstrual migraines if they occur within the 5-day window of the 2 days prior to menstruation and the first 3 days of menstruation.

To better understand the relationship between presentation to the ED for headache and intervals of the menstrual cycle in reproductive age women, researchers assessed all first time ED visits for the primary complaint of headache at a single health network.

All women between ages 18 and 42 with data regarding their last menstrual period (LMP) who presented to the Montefiore Health System network between January 2017 and December 2019 were included in the study.

Menstrual cycle phase was based on a 28-day cycle by calculating the time from the start of each woman’s LMP to ED visit, authors explained. “Using day 1 as the start of menstruation, menstrual intervals were defined as preovulatory (days 5-11), periovulatory (days 12-18), postovulatory (days 19-25), and perimenstrual (days 26-4),” they said.

A total of 4996 women with a mean (SD) age of 29.4 (7.1) and who presented to the Montefiore ED for the primary complaint of headache were included in the analysis. Approximately 7% of women were taking hormonal contraceptives at the time of presentation.

1154 (23.1 %) were within the perimenstrual interval

Overall “significantly more women presented during the preovulatory period compared to the perimenstrual (z=2.797, P=.005) and all other intervals,” researchers concluded.

Jicha C and Pavlovic J. Relationship between intervals of the menstrual cycle and presentation to the emergency department for headache. Presented at: American Academy of Neurology 73rd Annual Meeting; April 17-22, 2021; Virtual. Accessed April 19, 2021. https://index.mirasmart.com/AAN2021/PDFfiles/AAN2021-002935.html

Articles

Data from a single health system show women who present to the emergency department for headache tend to do so during the preovulatory interval of their menstrual cycle.

When in Menstrual Cycle Does Headache Lead to Emergency Department Visit?

Note: This timeline will update throughout the year as new developments take place

March 11 represents the one-year anniversary since the World Health Organization declared COVID-19 a global pandemic, and shortly after, former President Donald Trump had declared a national emergency, with states beginning to issue stay-at-home orders, mask mandates, and capacity limits at businesses like restaurants and bars. For a full look at how the pandemic evolved throughout 2020, 

If 2020 was dominated by the news of how COVID-19 spread across the globe, putting normal life on hold for most people and overwhelming health care providers, then 2021 has so far been focused on ending the pandemic through vaccine distribution.

With research into hundreds of vaccine candidates, there are now 3 vaccines approved by the FDA. As of March 10, 

 that more than 93.6 million vaccine doses had been administered. Alaska, New Mexico, North Dakota, South Dakota, and Connecticut have administered the most doses per 100,000 of the total population. And with close to 10% of the US population fully vaccinated, updated guidance is starting to roll out.

Here is a look at how vaccine development, approval, and rollout has progressed so far in 2021.

Operation Warp Speed Initiates Talks With Moderna on Half-Dose Vaccines

Operation Warp Speed official Moncef Slaoui, MD, begins discussions with Moderna and the FDA regarding the possibility of 

 so as to double the number of people vaccinated against COVID-19. The announcement comes after data show that two 50-mcg doses of Moderna’s vaccine in individuals aged 18 to 55 years resulted in identical immune responses compared with the standard two 100-mcg doses.

UK Begins Distributing AstraZeneca/Oxford Vaccine

The United Kingdom begins to inoculate its population with the COVID-19 vaccine manufactured by 

, which can be stored at refrigerator temperatures between 2° and 8° Celsius, potentially enabling easier distribution. As a result of a highly transmissible variant of COVID-19 spreading throughout the United Kingdom, Prime Minister Boris Johnson hints at upcoming tighter restrictions.

FDA Advises Against Altering Vaccine Schedules

FDA issues a statement cautioning health care workers against making 

 to authorized dosing schedules for approved COVID-19 vaccines. The agency notes that potential changes would be premature and there is not enough evidence of their efficacy compared with approved 2-dose vaccine schedules.

Moderna to Produce 600 Million Vaccine Doses

 it will increase production from 500 million doses to 600 million doses for 2021 and plans to allocate resources to produce 1 billion doses in total this year. At this point, the company has supplied the US government with 18 million doses and projects to make nearly 100 million doses available to Americans by the end of the first quarter of 2021.

HHS to Provide $22 Billion to Fund Testing, Vaccine Distribution

HHS announces that the CDC plans to provide more than 

 in funding for states and territories to support the nation’s COVID-19 response, as a result of the Coronavirus Response and Relief Supplemental Appropriations Act. More than $3 billion of the sum will be made available through the CDC Immunization and Vaccines for Children cooperative agreement.

CDC: COVID-19 Vaccine Benefits Outweigh Allergic Reaction Risk

 to either the Pfizer/BioNTech or Moderna vaccine among nearly 2 million vaccinated Americans prompt the CDC to announce the incidences should not dissuade individuals from getting vaccinated. Of those who reported incidents, 20 fully recovered while most had a history of such reactions. The statement comes as the CDC anticipates the imminent spread of a highly contagious coronavirus variant, first reported in the United Kingdom, throughout the United States.

Study Shows Patients With Heart Failure Should Be Prioritized for Vaccines

Results of an investigation published in 

 find the risk of death from COVID-19 is reportedly twice as high in patients with acute 

The single-center study indicates these patients should be extra cautious to avoid contracting COVID-19 and ought to be considered a high-priority population as vaccine distribution begins.

American Hospital Association Pushes for Faster Vaccine Rollout

) sends a letter to HHS Secretary Alex Azar stressing that there should have been a universal COVID-19 vaccine rollout. The letter highlights 64 disparate plans being implemented, lack of standardized tasks needed to accomplish delivery, and a failure to provide progress reports compared with plan goals. According to the AHA, to achieve herd immunity 1.8 million individuals need to be vaccinated every day from January 15 through May 31.

Health officials begin to enlist regional and supermarket pharmacies ahead of schedule to address delays in vaccine rollouts, 

. Federal and state officials ask Rite Aid Corp., Kroger Co., Stop & Shop Supermarket LLC, and other retailers to administer vaccines to frontline workers and eligible vulnerable populations weeks before previously planned to troubleshoot protocols.

Biden Plans to Rapidly Release Most COVID-19 Doses

Then–President-Elect Joe Biden announces he will quickly release most available vaccine doses to inoculate more people, reversing Trump’s previous policies, according to the 

. Biden’s plan does not involve cutting 2-dose vaccines in half but accelerating shipments of first doses instead of holding second doses in reserve.

States and local health departments struggle to implement mass vaccination programs while facing a surge in COVID-19 cases and record-breaking hospitalizations, 

 reports. Staff shortages and shrinking budgets complicate efforts to receive, store, distribute, track, and administer vaccines, as well as monitor individuals for adverse events.

Biden’s goal remains 100 million vaccinations in 100 days, and he pledges to release all available doses, 

 Trump’s decision to hold back doses to ensure that second shots were available for those who had already received their first Pfizer/BioNTech or Moderna dose—at this point, the only approved COVID-19 vaccines. Rollout has been chaotic, as the CDC relegated responsibility to states to determine vaccination priority and extra doses built up in freezers or were trashed due to regulation confusion.

CDC, HHS Update Vaccine Allocation Guidance

 that forthcoming COVID-19 vaccine supplies will be based on to-this-point administration rates and each state’s total population of residents who are 65 years and older—but states have only 2 weeks to prepare. Vaccine rollout continues to be bumpy, and this update aims to address some of the issues hindering access to higher-risk individuals—health care and frontline workers, and those with comorbidities—with states possibly receiving fewer doses from lack of data reporting. All available vaccine doses are released, and distribution expands to pharmacies and community health centers.

Elderly Los Angeles County Residents Report Confusion, Delays

Conflicting messages from California Governor Gavin Newsom and local health officials lead to floods of phone calls and 

 inundated with appointment requests. While the governor said that Los Angeles County residents 65 and older were eligible to receive a COVID-19 vaccine, health officials reiterated that the group still has to wait. At this point, the city is in phase 1A of rollout (health care workers, skilled nursing and long-term care facility residents), and phase 1B eligibility (which includes people over age 65) is not slated to open until early February.

Limited pharmacy access, or living in a “pharmacy desert,” is predicted to affect access to available vaccines, with 

—the national average is just 1.83 pharmacies per 10,000 people—translating to more competition for fewer appointments and rural and urban areas alike being affected. At the time of this report, the authors predict that 423 counties had capacity to vaccinate only up to 10% of their combined populations and 177 had zero capacity because they didn’t have any pharmacies. Officials continue to sound the call for more mass vaccination sites and supportive infrastructure.

Ethnic and racial minorities continue to be disproportionately affected by the pandemic, with 

 showing Black Americans being vaccinated at rates 2 to 3 times below White Americans. COVID-19–related mortality, meanwhile, remains 3 times greater in Black, Hispanic, and Native American populations. Top reasons for these disparities, including among health care workers, are lack of access (ie, to technology and vaccines) and mistrust of the vaccine.

California COVID-19 Variant May Be Vaccine Resistant

Following genetic sequencing, researchers report that current vaccines may not be strong enough against 

, first identified in Denmark in March 2020 before surfacing in California in May. Prevalence of this variant is growing, with 1 comparison showing a jump from 3.8% of samples tested in late November to early December 2020 to 25.2% of samples tested in late December 2020 to early January 2021.

Pfizer, Moderna, AstraZeneca to Test Vaccines in Adolescents

With current vaccines still prioritized for older Americans and those with underlying heath conditions, as well as health care workers, 

 reveal their testing plans for younger Americans. Moderna is testing doses among 12- to 18-year-olds, Pfizer is said to have recruited 12- to 15-year-olds, and AstraZeneca and Oxford University report wanting to compare outcomes among 6- to 11-year-olds and 12- to 18-year-olds.

Incoming CDC Director Walensky to Prioritize Vaccine Rollout

Rochelle Walensky, MD, MPH, the soon-to-be 19th director of the CDC, 

 science-based communication in an effort to address vaccine hesitancy and antivaccination sentiment. Vaccine rollout continues to vary widely among states, and Walensky pledges to increase both vaccination sites and those administering doses to overcome these disparities, especially in harder-to-reach areas.

 in Novovax’s COVID-19 vaccine trial to see if they were administered a placebo and are eligible to receive the already-approved Pfizer/BioNTech or Moderna vaccine. Novovax’s phase 3 trial, which had a goal of 30,000 participants, has already been delayed by manufacturing lags despite a $1.6 billion infusion from Operation Warp Speed in July 2020. Accelerated expanded eligibility is also hindering recruitment of new trial enrollees.

California Reports Allergic Reactions to Moderna Vaccine

After vaccinations were paused on January 19 at a San Diego vaccination center due to 

 possibly related to lot 041L20A of Moderna’s COVID-19 vaccine, they are allowed to resume by the California Department of Public Health. The move follows discussions among allergy and immunology specialists, the CDC, the FDA, Moderna, and the County of San Diego Department of Public Health. This batch contained more than 1 million doses that were distributed to almost 1700 vaccination sites in 37 states, and California received 330,000-plus of these doses for 287 providers.

Pfizer Vaccine Effective Against United Kingdom’s B117 Variant

 from Pfizer and BioNTech indicates that the companies’ COVID-19 vaccine works just as well against a highly transmissible coronavirus variant, B.1.1.7, first discovered in the United Kingdom. Effectiveness against COVID-19 variants originating from South Africa and Brazil continue to be investigated, with experts noting that updated immunizations may be explored if the virus picks up enough significant mutations impacting the vaccines’ efficacy.

Amazon Offers to Help Distribute Vaccines

To assist Biden’s goal of vaccinating 100 million Americans against COVID-19 in his first 100 days in office, Amazon sent a letter to the president offering to help by leveraging the company’s operations, information technology, and communications capabilities. Since then, Biden updated his goal to 

New Data Shows Moderna Vaccine Can Induce Rare Anaphylactic Reactions

According to data by the CDC, Moderna’s COVID-19 vaccine induces rare anaphylactic reactions in a small number of people, similar to that found in recipients of the Pfizer/BioNTech vaccine. Reported by 

, the CDC estimated a prevalence of 2.1 cases of anaphylaxis per million doses of the Moderna vaccine and 6.2 cases per million doses of the Pfizer vaccine.

Fauci: Vaccine Neutralizing Antibodies Lessened by Variants, but Still Likely Effective

The nation’s top infectious disease expert, Anthony Fauci, MD, 

 that current COVID-19 vaccines may be less effective against more contagious variants first identified in South Africa, the United Kingdom, and Brazil, although they will still likely provide enough protection.

Health Officials Nationwide Report Limited Vaccine Supply

If 2020 was dominated by the news of how COVID-19 spread across the globe, then 2021 has so far been focused on ending the pandemic through vaccine distribution.

A Timeline of COVID-19 Vaccine Developments in 2021

A new study from a team of investigators at the NYU Langone Multiple Sclerosis Center and the University of Alabama School of Public Health shows that higher risk of COVID-19 among individuals with 

 (MS) cannot be predicted by disease-modifying therapy (DMT) alone. Their findings indicate that being on public insurance, younger age, and Hispanic ethnicity are better predictors of COVID-19 and related hospitalization for persons with MS.

 showing these results is being presented at this year’s American Academy of Neurology 73rd Annual Meeting, held virtually April 17-22, 2021.

“We wanted to determine whether the frequency and severity of COVID-19 in patients with MS differ by DMT,” the authors stated. “To more accurately estimate whether the risk of COVID-19 varies by DMT, one need to know both the number of COVID-19 cases (numerator) and the number of patients on the given DMT (denominator). Studies thus far compared the frequency of DMTs among COVID-19 cases using numerator data only.”

Their study, which took place between March 2020 and February 2021 encompassed 1635 patients from NYU’s MS Care Center who were on any of these DMTs: rituximab, ocrelizumab, dimethyl fumarate, siponimod, or natalizumab. Either the CDC’s case definition or lab testing (polymerase chain reaction or immunoglobulin G) determined positive/negative COVID-19 status.

There were 203 cases of COVID-19 among the 66% of patients for whom lab-confirmed results were available. By DMT, most of these patients (mean [SD] age, 41.6 [12.6] years; 72% female; 84.7%, relapsing-remitting MS) were on ocrelizumab (n = 69), followed by dimethyl fumarate (n = 41), natalizumab (n = 34), siponimod (n = 30), and rituximab (n = 29). There were 3 deaths and 19 hospitalizations. Fifty-nine percent also had at least 1 comorbidity, with the most common being current or former smoker (31%). A majority were White and fully ambulatory.

However, when considering all of the patients with MS included in this study, COVID-19 was shown to happen most often among those on rituximab (18.2%) or dimethyl fumarate (15.2%), followed by natalizumab (13.2%), ocrelizumab (10.5%), and siponimod (10.2%). In addition, more of those on rituximab or dimethyl fumarate were hospitalized because of COVID-19 (17.2% and 14.6%, respectively) vs patients on ocrelizumab, siponimod, or natalizumab (7.2%, 6.7%, and 2.9%, respectively). A majority of hospitalizations were seen among Hispanic (14.3%) and Black (13.0%) patients.

Broken down by age, most COVID-19 cases were seen among patients younger than 29 years, aged 50 to 64 years, and aged 65 years and older on dimethyl fumarate and patients aged 30 to 49 years on rituximab.

When just looking at COVID-19 infection, being on public insurance (odds ratio [OR], 6.1; 95% CI, 4.29-8.78), having a younger age (OR, 4.7; 95% CI, 1.73-12.76), and being Hispanic (OR, 1.7; 95% CI, 1.03-2.71) were the most significant predictors

When looking at just COVID-19–related hospitalization, being Hispanic (OR, 4.8; 95% CI, 1.08-21.45) was the most significant predictor

The authors attributed their findings to certain socioeconomic conditions.

“Younger patients may be more likely to travel, and there are more crowded living conditions and higher COVID-19 prevalence in neighborhoods of patients on public insurance and Hispanics,” they concluded. “DMT did not predict either infection or hospitalization.”

Limitations on their results include the 34% of patients for whom lab-confirmed COVID-19 results were not available, loss of follow-up, selection bias, and limited sample size

Smith TE, Madhavan M, Gratch D, et al. Does frequency of COVID-19 differ by disease modifying therapy in MS patients? Presented at: Presented at: American Academy of Neurology 73rd Annual Meeting; April 17-22, 2021; Virtual. Accessed April 18, 2021. https://cattendee.abstractsonline.com/meeting/10429/Presentation/9014

Compared with disease-modifying therapy (DMT), age, insurance status, and Hispanic ethnicity were shown to more accurately predict likelihood of COVID-19 and hospitalization from it among individuals with multiple sclerosis (MS).

DMT Alone Not a Good Predictor of COVID-19 Among Patients With MS

Among the infants gestationally exposed to SARS-CoV-2, the virus that causes COVID-19, and who tested positive after birth, none had 

 abnormalities, according to an uncontrolled case series. Additionally, few ocular irregularities were observed among exposed newborns who tested negative.

, likely rules out a moderate to high increased risk of ocular effects in newborns of mothers who experienced SARS-CoV-2 infection, regardless of what point during gestation the exposure occurred.

“Additional controlled and larger-sized studies with standardized imaging (fundus images and optical coherence tomography imaging) and standardization of ophthalmologists would be needed to rule out a low increased risk,” wrote the investigators.

Viruses that cause diseases similar to COVID-19 are known to cause ocular complications in newborns. A previous study evaluating 38 pregnant women with COVID-19 found no association with increased mortality, morbidity, or maternal transmission in newborns. However, no studies have analyzed the ophthalmological impacts of infection with SARS-CoV-2 during pregnancy.

From April to November 2020, the investigators enrolled newborns of mother with COVID-19 admitted to 3 maternity hospitals in São Paulo, Brazil. All the infants underwent an external ocular examination and binocular indirect ophthalmoscopy.

The study enrolled 165 newborns with maternal COVID-19 infection. The age of the newborns at the time of examination ranged from 1 to 18 days. The mean (SD) weight of the newborns was 2931 (702) g, 74.5% (n = 123) were born full term, and 25.4% (n = 42) were born preterm. Twenty-nine (17.6%) infants were born weighing less than 1500 g and 2 were classified as having an extremely low birth weight, or weighing less than 1000 g. The mean (SD) length of the infants was 47.3 (3.9) cm.

Diagnosis of COVID-19 in the mothers was reported between the first and 40th gestational weeks, and 6 newborns tested positive for SARS-CoV-2 via polymerase chain reaction. One infant tested positive within its first 18 days, suggesting horizontal viral transmission, and the remaining 5 tested positive on their first day of life, suggesting vertical viral transmission. No infants testing positive had ocular abnormalities.

“Although more data are needed, vertical transmission of SARS-CoV-2 seems to be possible and should be a concern, especially in a condition that could be asymptomatic, that is so wide- spread in the population, and that could bring a substantial burden to patients and to the health care system even at low rates of congenital infection,” wrote the investigators.

Of the 5 infants who tested positive on the first day of life, 4 were infected during the third trimester and 1 during the first trimester.

Despite all positive infants presenting with no ocular abnormalities, some who tested negative showed fundus abnormalities that may or may not be associated with COVID-19 exposure during gestation.

“Considering the noninvasive nature of fundus examination, retinal changes should be further investigated in prospective studies to understand their possible applications in the diagnosis and management of COVID-19,” the investigators suggested.

Additionally, 1 infant testing negative presented with retinal vascular tortuosity and venous engorgement, 7 infants presented with retinal hemorrhages, and 2 had retinopathy of prematurity. One COVID-19–negative infant also had to be treated with antivascular endothelial growth factor injection for an aggressive posterior form.

The investigators noted the lack of control group and standardized imaging as study limitations.

Kiappe OP, Santos da Cruz NF, Rose PAC, Arrais L, Bueno de Moraes NS. Ocular assessments of a series of newborns gestationally exposed to maternal COVID-19 infection. Published online April 7, 2021. Accessed on April 14, 2021. doi: 10.1001/jamaophthalmol.2021.1088

A study of newborns exposed to SARS-CoV-2, the virus that causes COVID-19, during gestation found few instances of ocular abnormalities, with none detected in exposed infants who testing positive.

Low Rate of Ocular Abnormalities Seen Among Newborns Exposed to SARS-CoV-2 In Utero

Half of All US Adults Have Received 1 COVID-19 Dose

, the United States reached a milestone Sunday as 50% of all US adults have now received at least 1 COVID-19 shot. Following news of the global coronavirus death toll topping 

, nearly 130 million people 18 and older have received a vaccine dose nationwide, with the US vaccination rate currently at 61.6 doses per 100 people. Notably, states with the highest vaccination rates have a history of voting Democratic and supporting President Joe Biden in the 2020 election, compared with Republican supporting states such as Alabama and Tennessee who have the lowest rates across the country.

Study Identifies Factor Causing AZ Vaccine-Related Blood Clots

A study published this past Friday in the 

 unveiled the cause behind abnormal, rare clotting events 

 with the COVID-19 vaccine manufactured by AstraZeneca and the University of Oxford, finding that antibodies for clot-promoting platelet factor 4 (PF4) on enzyme-linked immunosorbent assay (ELISA) were present in 5 of the 7 patients who developed blood clots. Reported by 

, researchers recommended that people presenting with PF4 antibodies should not undergo platelet transfusions due to the risk of worsening the blood clotting, with use of a nonheparin anticoagulant agent and intravenous immunoglobulin instead recommended for treatment of the first blood clot occurrence.


Fauci Expects Decision on J&J Vaccine Pause by Friday

’ Face the Nation, the nation’s top infectious disease expert and chief medical adviser to President Biden, Anthony Fauci, MD, said that he believes a decision on whether to end the 

 of the COVID-19 vaccine manufactured by Johnson & Johnson will come by Friday, when the CDC's 

Advisory Committee on Immunization Practices

 meets. Stressing that these clotting events were significantly rare, Fauci and other federal officials still recommend those who have received the J&J shot to be alert for symptoms such as severe headaches, movement difficulty, chest discomfort, and difficulty breathing.

Half of US adults have been administered 1 COVID-19 vaccine dose; researchers identify cause of clotting events associated with AstraZeneca vaccine; Anthony Fauci, MD, the chief medical advisor to the president, says he believes a decision on whether to resume the J&J vaccine will come by Friday.

What We're Reading: Half of US Adults Given 1 Vaccine Dose; Cause of AZ Clots Identified; ACIP to Meet on J&J Pause

Rajiv Nijhawan, MD, is associate professor of dermatology and Mohs surgeon at UT Southwestern (UTSW) Medical Center and director of the UTSW High Risk Skin Cancer Transplant Clinic, in Dallas, Texas. He is one of several clinicians who will be presenting “Pearls for Surveillance and Management of High-Risk Skin Cancer Patients” at this year's American Academy of Dermatology Virtual Meeting Experience (AAD VMX). The session will focus on the greater skin cancer risk that organ transplant recipients face, as well as discuss results Nijhawan and colleagues have seen at their clinic dedicated to these patients.

What developments are you especially looking forward to hearing about at AAD VMX?

Because my subspecialty is surgery, a skin cancer oncology focus, those are all the talks that I always look forward to hearing about just because they're most related to my daily practice. There's some great surgical talks, some great oncology-related talks. Those are the sessions I'm most looking forward to.

Can you tell us about your presentation at this year’s meeting?

What we try to do in this talk is break it down into like what's been the most helpful as we implement [our transplant] clinic, in terms of how can we improve our patient outcomes as much as possible. It's really just high-yield pearls that we're hoping other practitioners [and] other physicians across the country can use in the information we present and apply it to their daily practice.

It's very much a clinically high-yield type of talk, where we review simple things like which medications are at higher risk. One, for example, is azathioprine. Azathioprine historically was used a lot in transplant patient populations. But we know that, unfortunately, it's one of the drugs that has an even higher risk compared to other immunosuppressant medications. Not every immunosuppressive medication is built the same. Some actually predispose [patients] to higher rates of skin cancer compared to others.

So one pearl, for example, is looking at medications closely, having a conversation with the transplant teams or the transplant doctor, [saying], “Hey, can we switch this medication to this alternative?” Sometimes something as simple as that can really make a difference in terms of decreasing rates of skin cancer. Sometimes a patient’s on a medication at 50 mg once a day, so can we see if they can tolerate 25 mg a day without rejecting their organ?

On the transplant side of things, they're so focused on, “Let's not change what's not broken.” From their perspective, their organ’s working well, they don't have signs of rejection, they can breathe better. But there are obviously downstream side effects with these medications. So sometimes we just kind of make the transplant teams reflect on that, asking, “Hey, this patient's developed 6 skin cancers in 6 months. What wiggle room do we have for decreasing this dose maybe or changing this dose?” They're very receptive to that. And I think it was early on seeing the impact we had and seeing the positive change we're having for our patients who were a lot more open to having those conversations.

Another pearl is, there's medication called voriconazole. Initially, our lung transplant patients were on that prophylactically to prevent fungal infections, just without any end in sight. But the problem with that medication was it’s phototoxic. Meaning if you're on the medication, you go out in the sun, you just can get a sunburn almost immediately—and that obviously puts them at a higher risk for skin cancer development. And while, yes, the prophylaxis, meaning preventing fungal infections, is important, it's kind of a balance: Is that that important to have every day for the rest of your life vs now they're developing dozens of skin cancers a year?

So having those conversations allowed us to say which patients surely need that medication, whereas which patients may forego that medication, or now that there's newer alternatives, should we consider an alternative medication to that early on? For so many years, it was kind of the only great option. But now that we've had more recently, in the last 4 or 5 years, alternatives, [we can ask], “Hey, can we consider this incentive there?

So that's really the focus of our talk: What can you take home to your patients when you're telling them what to look for? And it's just simple pearls, and then we kind of review some cases. At the end of our talk, my colleague, Dr. Srivastava [Divya Srivastava, MD], really highlights some of our own personal patients and the simple changes we made that we hope will benefit them long term.

Videos

Rajiv Nijhawan, MD, is associate professor of dermatology and Mohs surgeon at UT Southwestern (UTSW) Medical Center and director of the UTSW High Risk Skin Cancer Transplant Clinic, both in Dallas, Texas. 

Dr Rajiv Nijhawan Previews Talk on Skin Cancer Risk Among Organ Transplant Recipients

Christine Ko, MD, professor of dermatology and pathology at Yale University and a presenter of “What's New in Dermatopathology,” speaks on COVID-19 skin-related vaccine reactions and clinical-pathologic discussions to come at this year’s American Academy of Dermatology Virtual Meeting Experience.

With the cancellation of last year's meeting, what are you looking forward to hearing about this year?

I always love the AAD meeting, and it was a disappointment, I think for everyone, as the pandemic has sort of chugged along that we can’t go to the meetings that we love. So even though it's virtual again, this year, I'm excited to hear some of the types of sessions and the speakers that I love to listen to. A lot of what I love is clinical-pathologic correlation, so I'm excited to hear Dr. Callen’s session [Jeffrey P. Callen, MS, FACP, FAAD, MACR, University of Louisville School of Medicine]. And there's some other clinical-pathologic correlation sessions, for example, led by Dr. Samimi [Sara S. Samimi, MD, Penn Medicine].

Can you preview for us your presentation, “What’s New in Dermatopathology?”

We're going to try to have a somewhat interactive, visually rich presentation of dermoscopy. So, how to look at the clinical, look with that magnifier, the dermatoscope, and then also correlate it to what you would see under the microscope. I think that'll be really exciting and very visually interesting. That's going to be by Dr. Michelle Tarbox [Michelle Tarbox, MD, Texas Tech University Health Sciences Center], who's from Texas. And then one of my awesome colleagues, Dr. Bill Damsky [William Damsky, MD, PhD, Yale School of Medicine] is going to address COVID arm, which is, I think, a very timely thing as the vaccine continues to roll out across the nation and the world. And Dr. Nooshin Brinster [Nooshin K. Brinster, MD, NYU Langone] from NYU and Dr. Tarbox and myself, we'll have a little fun discussion with Dr. Damsky about vaccine reactions, what we've seen as pertains to the skin, and what other interesting things about the skin and COVID that people might want to talk about. So there'll be some Q&A from the audience if they want.

Christine Ko, MD, is professor of dermatology and pathology at Yale University and a presenter of “What's New in Dermatopathology” at this year’s American Academy of Dermatology Virtual Meeting Experience (AAD VMX). 

Dr Christine Ko Addresses Dermatopathology, COVID Arm Ahead of AAD VMX

In guiding employers on their education efforts regarding COVID-19 vaccines, a communication strategy characterized by fact checking, employee empowerment, and prevention is warranted, said Christine Brophy, vice president of behavior change for Vitality.

 Hello, I'm Matthew Gavidia. Today on the 

 is pleased to welcome Christine Brophy, vice president of behavior change for Vitality, who will speak on a recent 

 by her organization on affiliated members’ perception toward the COVID-19 vaccine, as well as a 

global toolkit on COVID-19 vaccine education

 for employers and the broader community.

Great to have you on, Christine, can you just introduce yourself and tell us a little bit about your work?

 Sure, thank you, Matthew. So, yes, my name is Christine Brophy and I've been with Vitality now for just under 22 years. What I do here is really work on campaigns and health initiatives to help our members engage in healthy behaviors. So, I do a lot with engagement campaigns, and just help with our global development of the product.

 In the survey, it was found that approximately 30% of respondents have not decided or don’t plan to get a COVID-19 vaccine. How can the vaccine toolkit help engage workers, particularly those waiting to see how the vaccine fares nationwide?

 Sure, using surveys is really a technique that we've used for a very long time to help us better serve our population, it's a pretty common starting point for us. So, especially like a year ago, when the pandemic started, it was how we set out to engage with our members to understand their situation, and then to rapidly address their needs.

So, it was a natural starting point as we were following the rollout of vaccines and we knew that if we could identify our members’ intentions, that we could really help them navigate what we expected to be a potentially complex rollout. After we closed the survey down, we actually had about just under 70,000 members who did let us know what their intentions were, and those insights that we gained really helped us confirm what we suspected, but then also prioritize our approach to building out this toolkit.

I'll just say that, in addition to serving our members, we also reached out to some of our clients to hear about lessons that they were learning if they were involved in phase 1 of the rollout, along with what was happening with the EEOC [Equal Employment Opportunity Commission] and their guidance.

 and our members wanted some guidance, so we did prioritize this toolkit and it really helped us figure out which tools to grab out of the behavioral science toolbox to get busy addressing those needs.

 Delving into the Vaccine Toolkit designed to help guide employers in their education efforts on the COVID-19 vaccine, can you discuss the design of the toolkit and what materials and information are provided?

 Sure. So, we know our employers are juggling a lot of logistics during these times, and just like our members, they needed timely insights that could be easily actioned. As we created this blueprint, we focused on how to address the hesitancy using the principles, and it really started with helping to empower them with a solid communication strategy, knowing how important that is to motivate people.

So, the strategies that we put together were really in a simple consumable format, just to guide them to really focus on increasing information accuracy, and letting them know the important role that they can play in reducing barriers and establishing incentives, in creating social norms, just in terms of how they made information available about how they were approaching the vaccine and so on.

In this toolkit, we created engagement checklists, like really visual, “do this and don't do that” sorts of examples, how to offer incentives or communicate the offering of incentives, and how to encourage vaccines. We know to be effective, it's not about trying to change a person's belief system, it's really just important to be sensitive to that and consider that as you provide important education and information about the behaviors that can help stop the spread of the virus.

So, everything was about shaping behavior with sensitive and timely communication and reducing their work by showing up with the communication tools, assets, examples. We've hosted webinars; we've given them instructions on how to create video testimonies of inspiring stories of people getting vaccinated.

We've actually been able to create a few of our own because of the answers we've gotten in surveys. There’s a really emotional moment there to capitalize on when people want to share that they've been vaccinated, and really for some how life-changing it is to be on the other side of the risk of the virus.

Building on something you just said, how can the toolkit guide employers on accommodating workers who may opt out of receiving a vaccine due to distrust or religious reasons?

 Given the phased rollout of the vaccine, we knew we had quite a bit of runway that we could use to reach our members and get them to learn more about how the vaccine was developed, its safety, and so on and so forth.

So, it was really important to use that runway and not stop having important conversations with people about virus prevention just because they had decided they didn't want to get vaccinated. And there's been a lot of people who are in this sort of wait and see mode, and we wanted to make sure that we could fill that space while they were waiting.

So, the same behavioral insights that informed our toolkit were used to form what we're calling our 

, and applying a lot of the same approaches that resonated with our members when we launched We’re in This Together a year ago.

The Stay Safe Together campaign is a series of 3 interactive goals that focus on know the facts, recommit to your role in the space of prevention and what it means to you and why you choose to stay committed, and then stay safe, which is a goal around tracking all the different behaviors tied to preventing the spread of the virus to really help them focus on these 3 distinct areas to better understand that prevention is power in a world that really now includes the coronavirus.

We took a look at where we are today vs a year ago, and we think we're all suffering from information overload and COVID-19 fatigue. So, we wanted to create a sense of community, and to make it interactive and more fun.

We wanted to offer a different way for members to engage, and we're offering things like bingo cards and games, crossword puzzles, so it's not just about, here's some more information for you to think about, but really kind of turning that around into some activities and engaging ways to show what you know. Then once a member completes all of these 3 goals, we give them a virtual badge that just officially invites them into our Stay Safe Together community.

 To learn more, visit our website at ajmc.com. I’m Matthew Gavidia, thanks for joining us!

In guiding employers on their education efforts regarding COVID-19 vaccines, a communication strategy characterized by fact checking, employee empowerment, and prevention is warranted.

Shaping COVID-19 Vaccine Education in the Workplace Through Communication, Prevention

's parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.

An educational nursing program can positively impact medication compliance in patients receiving oral pulmonary arterial hypertension (PAH) therapies.