Thursday Shorts: RSV vaccine, doxypep, rural surgery, and exchange subsidies
March 6, 2025
A) RSV vaccine protects adults for two seasons
Respiratory Syncytial Virus (RSV) vaccine is now recommended for pregnant women expecting during the fall and winter, adults over age 75, and adults ages 59-74 at higher risk from RSV. The U.S. Preventive Services Task Force briefly recommended vaccinating all adults at age 60, although the recommended age for vaccination was changed because of a small but statistically significant risk of Guillain Barre syndrome (GBS), which can cause temporary paralysis. GBS is a potential complication of multiple viral infections and is a rare side effect of some vaccinations.
A study of U.S. veterans showed that the vaccine is effective in the second RSV season after vaccination. Those who received the vaccine were 78% less likely to get an RSV infection, 79% less likely to visit an emergency department for RSV, and 80% less likely to be hospitalized with RSV. Babies of women who got RSV vaccination late in their pregnancy were 82% less likely to need medical care for RSV than babies of women who were not vaccinated.
B) DoxyPEP reduces sexually transmitted infections by over 90%
A study of medical records of 2,083 mostly gay male patients in Los Angeles showed that those who were prescribed doxycycline post-exposure prophylaxis were 86% less likely to be diagnosed with syphilis, 90% less likely to be diagnosed with chlamydia, and 55% less likely to be diagnosed with gonorrhea. Two other studies (in San Francisco and Seattle) reported similar results in January. This provides powerful evidence that offering high risk people access to doxycycline for treatment after unprotected sexual intercourse can dramatically reduce sexually transmitted infections.
C) Surgical travel times up in rural communities
Source: Mullens, et al JAMA February 12, 2025
Researchers in JAMA correlated member zip code and hospital location to calculate what portion of rural Medicare beneficiaries had to travel more than 60 minutes for surgical care. This increased between 2010 and 2020, likely because of closure of many rural facilities. Delays due to transport are most worrisome for emergency procedures like repair of an abdominal aortic aneurysm (AAA). People often die without immediate surgery. Average travel times for rural patients with AAAs increased from 63 minutes in 2010 to 71 minutes in 2020.
Rural residents continue to be at higher risk due to lack of local access to care. This is a large problem in maternity care, too, although the researchers could not evaluate that with the Medicare database.
D) Discontinuing enhanced exchange subsidies would push many off insurance and some into employer-sponsored insurance
Source: Richards, et al Commonwealth Fund, February, 2025. Dark bars reflect individual premiums if the enhanced subsidies are not renewed.
FPL=federal poverty level, about $16,000 income for an individual and $32,000 annual income for a family of four
The American Rescue Plan increased subsidies for individuals purchasing health insurance on the exchange marketplaces, and the Inflation Reduction Act extended these subsidies through 2025. Without new Congressional action, the enhanced subsidies will stop at the end of this year.
The Commonwealth Fund calculated what would happen to premiums in exchange (Obamacare) marketplaces if the enhanced premium credits enacted during the Biden Administration expire as currently scheduled at the end of this calendar year. The researchers estimate that almost 4 million people would become uninsured in 2026, and over 7 million would drop insurance by 2030. Those who are younger and healthier would be most likely to stop their insurance, which would make the pool of participants in the exchange plans much sicker.
This could thwart the intentions of employers hoping to convert their health insurance into Individual Coverage Health Reimbursement Arrangements (ICHRAs). ICHRAs allow employees to use employer funds to purchase individual insurance but will likely require a stable ACA marketplace to succeed. Proposed cuts in Medicaid along with discontinuation of enhanced exchange subsidies could also increase the number of uninsured, which could contribute to financial instability in many hospital systems.