COVID-19 Incidence and Mortality Among Unvaccinated and Vaccinated Persons Aged ≥12 Years by Receipt of Bivalent Booster Doses and Time Since Vaccination - 24 U.S. Jurisdictions, October 3, 2021-December 24, 2022.

On September 1, 2022, CDC recommended an updated (bivalent) COVID-19 vaccine booster to help restore waning protection conferred by previous vaccination and broaden protection against emerging variants for persons aged ≥12 years (subsequently extended to persons aged ≥6 months).* To assess the impact of original (monovalent) COVID-19 vaccines and bivalent boosters, case and mortality rate ratios (RRs) were estimated comparing unvaccinated and vaccinated persons aged ≥12 years by overall receipt of and by time since booster vaccination (monovalent or bivalent) during Delta variant and Omicron sublineage (BA.1, BA.2, early BA.4/BA.5, and late BA.4/BA.5) predominance.† During the late BA.4/BA.5 period, unvaccinated persons had higher COVID-19 mortality and infection rates than persons receiving bivalent doses (mortality RR = 14.1 and infection RR = 2.8) and to a lesser extent persons vaccinated with only monovalent doses (mortality RR = 5.4 and infection RR = 2.5). Among older adults, mortality rates among unvaccinated persons were significantly higher than among those who had received a bivalent booster (65-79 years; RR = 23.7 and ≥80 years; 10.3) or a monovalent booster (65-79 years; 8.3 and ≥80 years; 4.2). In a second analysis stratified by time since booster vaccination, there was a progressive decline from the Delta period (RR = 50.7) to the early BA.4/BA.5 period (7.4) in relative COVID-19 mortality rates among unvaccinated persons compared with persons receiving who had received a monovalent booster within 2 weeks-2 months. During the early BA.4/BA.5 period, declines in relative mortality rates were observed at 6-8 (RR = 4.6), 9-11 (4.5), and ≥12 (2.5) months after receiving a monovalent booster. In contrast, bivalent boosters received during the preceding 2 weeks-2 months improved protection against death (RR = 15.2) during the late BA.4/BA.5 period. In both analyses, when compared with unvaccinated persons, persons who had received bivalent boosters were provided additional protection against death over monovalent doses or monovalent boosters. Restored protection was highest in older adults. All persons should stay up to date with COVID-19 vaccination, including receipt of a bivalent booster by eligible persons, to reduce the risk for severe COVID-19.

Effect of Paralytic Agents on Post-Intubation Sedation in the Emergency Department.

Purpose: This study aimed to evaluate the frequency at which postintubation sedation is administered following use of long-acting paralytic agents compared to short-acting paralytic agents during rapid sequence intubation performed in the emergency department. Methods: This retrospective, single-center study of intubated patients in the emergency department analyzed the difference in time to administration of additional sedation following use of a short-acting paralytic (succinylcholine) compared to use of a long-acting paralytic (rocuronium or vecuronium). A total of 387 patients were available for analysis. The primary outcome was additional sedation given within 15 minutes following administration of a paralytic agent. The secondary outcome sought to evaluate the incidence of hyperkalemia due to paralytic agents by comparing potassium level before and after paralytic administration. Results: 46.9% of patients who received a short-acting paralytic agent received additional sedation within 15 minutes, compared to 40.9% of patients who received a long-acting paralytic agent. The Chi-square analysis comparing the short and long-acting paralytic groups showed no statistically significant difference (χ² [1, N = 387] = 1.24, P = .266) in the frequency of additional sedation administered. Excluding patients who did not receive any additional sedation, the mean time from paralytic administration to additional sedation in all patients was 20.03 ± 18 minutes. No statistically significant difference was detected between groups regarding changes in potassium level. Conclusion: The use of long-acting paralytic agents was not associated with increased time to administration of sedation compared to shortacting paralytic agents. There is an opportunity to reduce the time to sedation administration for intubated patients receiving both short- and long-acting paralytic agents.