IDSA News - August 1, 2007
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CDC Recommends Influenza Vaccine for

Federal officials are urging influenza vaccination for all health care workers (HCWs) as part of a strategy to boost immunization rates for influenza.

Estimated coverage rates are less than 50 percent among critical groups for whom annual influenza vaccination is recommended, including HCWs, young children, adults with risk factors for influenza complications, and pregnant women.

A new report from the Centers for Disease Control and Prevention (CDC) recommends implementing or expanding strategies such as reminder/recall systems and standing orders programs. Among other considerations, CDC states that health care facilities should consider the level of vaccination coverage among HCWs to be one measure of patient safety and quality. In a move previously supported by IDSA, CDC suggests obtaining signed statements from HCWs who decline influenza vaccination.

The report makes no changes concerning the groups for whom vaccination is recommended or the antiviral medications used for chemoprophylaxis or treatment (oseltamivir or zanamivir).

 Click here for the full report. For more information, see www.cdc.gov/flu.

Key Studies Proposed to Answer Basic Questions

What is the optimal duration of therapy for cellulitis? Are two drugs better than one for community acquired pneumonia (CAP)? Are antibiotics really necessary when treating otitis media?

The evidence supporting the standard of care for these and other common infections is surprisingly weak. Inappropriate use of antibiotics is a major factor driving the growing epidemic of antibiotic-resistant infections. With a movement on the rise to penalize institutions for health care-associated infections, infectious diseases experts are looking for solid answers.

“Despite using antibiotics for decades, we still don’t know how to use them optimally,” said Louis B. Rice, MD, chair of IDSA’s Research on Resistance Work Group. For years, IDSA has been urging the National Institute of Allergy and Infectious Diseases (NIAID) to study these issues. This summer, the Society proposed three multi-center, controlled clinical trials using generic antibiotics to answer key questions about cellulitis, CAP, and otitis media in children, and to lay the groundwork to answer more.

  • Three days vs. seven to 10 days of antibiotic therapy for uncomplicated, community acquired cellulitis. The optimal duration of therapy for cellulitis, an extremely common infection for which large quantities of broad-spectrum antibiotics are prescribed, has not been defined. Shorter courses may work just as well as longer courses, while reducing exposure to antibiotics and the growth of resistant bacteria.
  • A three-armed study of community acquired pneumonia comparing seven days of aß-lactam, seven days ofß-lactam plus azithromycin, and three days ofß-lactam alone. Current guidelines recommend an agent against atypical pathogens, but there is evidence suggesting this does not improve outcomes. Also, some studies suggest shorter therapy with a ß-lactam may be just as effective as the current seven-day standard. Definitive answers are needed.
  • Amoxicillin or azithromycin plus analgesics vs. placebo plus analgesics for children older than 6 months with middle ear infections. More prescriptions for antibiotics are written for children with acute otitis media than anything else, but the evidence that antibiotics improve the time to resolution of symptoms is weak.

These issues have gone unresolved for so long because antibiotics have long been considered relatively benign medications with little risk to the patient, Dr. Rice said. The prevailing wisdom has been that the risk to the patient of an infection recurring is greater than the risk of taking more antibiotics than necessary. “But now we have MRSA, we have resistant Klebsiella and Pseudomonas, we have Acinetobacter, and we have C. difficile,” Dr. Rice said. “We have to weigh the risks and benefits differently.” 

IDSA drew up this proposal at the request of NIAID and has been in close communication with the institute. IDSA’S ultimate aim is to persuade NIAID develop the infrastructure to carry out more trials on antimicrobial usage.

This summer, NIAID has awarded two contracts to address the cellulitis question. These multisite, phase II/III clinical trials will use generic antibiotics to find optimal ways to treat uncomplicated skin and soft tissue infections caused by community acquired MRSA. The goal is to preserve the efficacy of vancomycin, linezolid, and other final-option drugs.

Click here to read details of IDSA’s proposal for the three clinical trials.

NIAID’s news release on the CA-MRSA trials can be found here.

Welcome to the New IDSA News!

Based on feedback from our recent member survey, we've made changes to IDSA News. In a new monthly, electronic-only publication, IDSA News aims to provide you with more of the information you want in a timely, easy-to-read format. Some of the changes you may notice include:

New sections let you zero in on what you want to know.
Shorter articles give you the facts quickly, with links to more information if you need it.
Policy and advocacy news focus more on what it means for you.

As we launch this new project, we rely on your feedback to let us know what's working and what isn't. Take a second to rate the articles using the radio buttons at the bottom of the page. Adding comments in the box below the buttons will help us tailor content to what is most useful. If you have additional comments or suggestions, feel free to e-mail the editor, Steve Baragona, at sbaragona@idsociety.org.

We look forward to your input on this new edition of IDSA News.

Help Win Medicare Coverage for Antimicrobial

A bill in Congress would guarantee Medicare beneficiaries’ access to home infusion of antibiotics and other drugs by requiring Medicare to cover the related services. The bill, the Medicare Home Infusion Therapy Coverage Act of 2007 (H.R. 2567), introduced by Rep. Eliot Engel (D-NY), supports one of IDSA’s long-standing legislative priorities.

In 2003, Congress passed the Medicare Modernization Act (MMA), which directed the Centers for Medicare and Medicaid Services (CMS) to cover home infusion drugs under the new prescription drug benefit. Unfortunately, the legislation did not require CMS to cover the services related to the provision of infusions at home, including pharmacy services, physician services, supplies, and equipment.  This decision means that most Medicare beneficiaries still do not have access to infusion drugs, including antimicrobials, in the home setting.

IDSA needs your help to educate Congress about why home infusion services should be covered. Please visit IDSA’s online home infusions therapy resources at http://www.idsociety.org/homeinfusions.htm for more information about H.R. 2567 and to contact your members of Congress.

Also, if you treat Medicare patients who would like to share their experiences of how Medicare’s lack of coverage for home infusion therapy services has limited their treatment options and otherwise disadvantaged them, please have them contact Jason Scull of IDSA’s Clinical Affairs staff at jscull@idsociety.org or (703) 299-5146.

IDSA On Your Behalf

IDSA works on the state and federal levels to ensure that public health policies are based on a sound scientific foundation. Here is a sample of IDSA’s recent policy activities:

  • IDSA Endorses Access to Medicare Data Act  07/16/07
    The bill would advance medical research into antimicrobial resistance and other areas by providing federal health officials and other health researchers with controlled access to data on physician and prescription drug claims processed on behalf of Medicare beneficiaries.
  • IDSA, Others Oppose Thimerosal Amendment  07/18/07
    IDSA joined several organizations opposing an amendment that would prohibit the use of federal funds to administer an influenza vaccine containing the preservative thimerosal to children less than 3 years of age. Science has not found thimerosal to be detrimental. 
  • IDSA Urges Changes for Rhode Island Lyme Disease Bill 06/19/2007
    IDSA urged the Rhode Island State Senate to amend a bill that establishes a special commission to study Lyme disease, so that the commission would include board-certified ID physicians who represent a more balanced perspective. The Society also has weighed in on bills in Massachusetts and Pennsylvania.

Visit the Policy & Advocacy section of the IDSA website to learn more about IDSA’s policy activities and how you can get involved.

Physicians Could See 10 Percent Pay Cut

In what has become an annual ritual, physicians once again are facing a cut in Medicare reimbursement, but Congress once again is expected to block it and pass a small increase instead.

This year’s proposed cut is nearly 10 percent, according to the formula known as the sustainable growth rate (SGR). While physician payments were cut in 2002, Congress has intervened to prevent the cuts for the past five years. Congress has not yet dealt with the fundamental flaws in the SGR, however. The Congressional Budget Office estimates that replacing the SGR with a formula that allows payment rates to increase by the rate of medical inflation would cost $218 billion over 10 years.

Congress is considering changes to the SGR as part of a multi-pronged bill, known as the Children's Health and Medicare Protection (CHAMP) Act.  The CHAMP Act includes a .5 percent increase in Medicare physician payments, and also breaks the SGR up into six separate formulas that group similar physician services together.  These changes would cost significantly less than a full scale repeal of the SGR.

IDSA supports the bill, with a few reservations. IDSA’s letter to key Congress members on the issue is online, and go to IDSA’s Advocacy Center to urge your legislators to support the CHAMP Act.a

IDSA E-mail Alerts Keep You in the Loop on Outbreaks, Drug Recalls

IDSA offers opt-in e-mail news services that will keep you in the loop on breaking news and announcements from the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) about infectious diseases outbreaks, drug recalls, and other events affecting your work.

ID News Clips

ID News Clips is a daily news clipping service provided to keep IDSA and HIVMA members and leaders apprised of information about infectious diseases that is available on the Internet. 

CDC Health Alert Network Service 

This service forwards Health Alert Network (HAN) messages from CDC to subscribers. It is intended for members who do not receive these messages from other sources. Recent messages included a notice about hepatitis A infections linked to children adopted from Ethiopia and a notice about the outbreak of botulism in July that was associated with canned chili. 

FDA Message-forwarding Service

This new service forwards ID-related messages from FDA on label changes, adverse events, newly approved drugs, and other safety information on FDA-approved drugs and biologics. Recent messages included notices about label changes for Rocephin, an Invanz recall, and the botulism outbreak.

Click here to for information on how to subscribe to these services.

Be Sure To Take Advantage of These JID and CID Resources

Are you taking advantage of all the resources available to you as an IDSA member? Readers of The Journal of Infectious Diseases (JID) and Clinical Infectious Diseases (CID) have several free, easy, and automatic ways to stay informed:

  • E-TOC alerts deliver journal tables of contents directly to a user’s e-mail inbox. Individuals can register online at the University of Chicago Press (UCP) website, select the journals for which they would like to receive alerts, and receive an e-mail notification each time a new issue is published. The e-mail contains the new journal issue’s table of contents and links directly to the issue online.
  • RSS (which stands for “Really Simple Syndication”) disseminates summary information about new journal articles and new tables of contents as they go online. Individuals can subscribe to the journals’ RSS feeds by going to the journal website, copying the URL for the RSS feed to their clipboard, and pasting it into an RSS reader. The RSS reader regularly checks all subscribed feeds for new content and downloads any updates it finds.
  • UpToDate is a comprehensive, evidence-based clinical information resource available to clinicians on the Web, desktop, and PDA. UpToDate is designed to give clinicians the concise, practical answers they need when they need them the most—at the point of care. Many articles in the online versions of CID and JID have accompanying links to similar topics at the UpToDate website.
  • News/In the Literature: Each issue of CID includes an “In this Issue” column, which briefly summarizes key CID articles; “In the Literature,” which summarizes key infectious diseases studies that have been published in other leading journals, and a “News” column, which includes infectious diseases coverage by Reuters with expert commentary by a CID editor. These columns are available online and in print.

Visit JID at http://www.journals.uchicago.edu/JID/home.html and CID at http://www.journals.uchicago.edu/CID/home.html to take advantage of these resources.

New Online Course Features Modules on Avian Flu

The Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE) have released an online training course on human health issues during an avian influenza investigation.  The free materials include presentations, case studies, and tabletop exercises. Users can adapt the materials to meet the needs of different groups.

The six modules cover:

  • surveillance
  • case management
  • personal protective equipment
  • poultry farm investigation
  • management and public health action
  • laboratory

"CDC/CSTE Rapid Response Training: The Role of Public Health in a Multi-Agency Response to Avian Influenza in the United States" is available at http://www.cste.org/influenza/avian.asp.

In Memoriam: Ward Bullock, Jr., MD

by Peter D. Walzer, MD, MSc, and George Deepe, MD

It is with the deepest sorrow that we announce the death of Ward E. Bullock, Jr., MD, emeritus professor of medicine and former director of the division of infectious diseases at the University of Cincinnati College of Medicine.  Dr. Bullock passed away on April 17 at the age of 75.  

Ward received his MD degree from Temple University. He performed his internal medicine residency at the University of Minnesota and completed his training in infectious diseases and immunology at Yale University. He first came to prominence in the 1960s for his studies of leprosy performed at the U.S. Naval Medical Research Unit in Taiwan. A groundbreaking article in the New England Journal of Medicine revealed the impairments of cellular immunity associated with leprosy.  This paper and others reawakened international interest in leprosy research.

Ward continued his productive leprosy work at the University of Cincinnati, where he served as associate chair for research in internal medicine and senior associate dean, and also turned his attention to Histoplasma capsulatum. Using his experience with leprosy, he pioneered the study of the host response to this fungus in both animal models and humans. Ward’s steady output of insightful publications on the immunopathogenesis of histoplasmosis had a major national impact on stimulating interest in medical mycology. 

Ward’s academic accomplishments were recognized in many ways: consistent NIH funding, membership in prestigious societies, and service on advisory panels and editorial boards.  The characteristics we appreciated most were his vision, leadership, concern for the common good, and tireless support of the efforts of his faculty and fellows to achieve excellence in their activities. 

Ward Bullock touched the lives of many people.  He will be sorely missed.  Ward is survived by his wife, a son and daughter, a brother, a sister, three step-daughters, and seven grandchildren.

Members on the Move

Anthony S. Fauci, MD, FIDSA, is one of eight distinguished individuals awarded the National Medal of Science by President Bush on July 27 at the White House.  Dr. Fauci was recognized for his pioneering research on the mechanisms regulating the human immune system and for his illuminating work on the pathogenesis of HIV, which forms the basis of the current treatment strategies for HIV disease.  Dr. Fauci is the director of the National Institute of Allergy and Infectious Diseases in Bethesda, Md.

IDSA 2007 Elections: Donít Forget to Vote!

IDSA members will elect new officers and Board members this summer. Ballots will be sent to all members in August and will be due in September. Your ballot will include biographical statements and personal sketches from each of the candidates. The slate is as follows:

Vice President:

Cynthia L. Sears, MD, FIDSA
Professor of Medicine, Johns Hopkins University School of Medicine; Attending Physician, Johns Hopkins Hospital
Baltimore, MD

Richard J. Whitley, MD, FIDSA
Director, Division of Pediatric Infectious Diseases; Vice-Chair, Department of Pediatrics; University of Alabama at Birmingham
Birmingham, AL                                                                    

Secretary:

Monica Farley, MD, FIDSA
Professor of Medicine and Associate Director, Division of Infectious Diseases, Emory University School of Medicine; Staff Physician, Atlanta VA Medical Center
Decatur, GA

William Schaffner, MD, FIDSA
Chair, Department of Preventive Medicine and Professor of Medicine (Infectious Diseases), Vanderbilt University School of Medicine; Consultant in Epidemiology, Tennessee Department of Health
Nashville, TN

Director #1:

Stephen Calderwood, MD, FIDSA
Morton N. Swartz MD Academy Professor of Medicine (Microbiology and Molecular Genetics), Harvard Medical School; Chief, Division of Infectious Diseases, Massachusetts General Hospital
Boston, MA

Arturo Casadevall, MD, FIDSA
Professor of Medicine, Division of Infectious Diseases; Leo and Julia Forchheimer Professor and Chair, Department of Microbiology and Immunology; Albert Einstein College of Medicine
Bronx, NY

Director #2:                    

Sandra A. Kemmerly, MD, FIDSA
Associate Chair of Infectious Diseases, Ochsner Medical Center; Medical Director, Ochsner Health System; Clinical Assistant Professor of Medicine, Louisiana State University School of Medicine
New Orleans, LA

Russell M. Petrak, MD
Managing Partner, Metro Infectious Disease Consultants; Assistant Professor, Rush Medical College; Medical Director, Infectious Disease, RML Specialty Hospital; President, The Metro Foundation; Infectious Diseases Consultant, multiple acute care hospitals
Hinsdale, IL   

HIVMA Representative to the IDSA Board:

Judith Aberg, MD, FIDSA
Associate Professor of Medicine and Principal Investigator of the AIDS Clinical Trials Unit; New York University School of Medicine; Director of Virology of the South Manhattan Healthcare Network
New York, NY

Daniel Kuritzkes, MD, FIDSA
Professor of Medicine, Harvard Medical School; Director of AIDS Research, Brigham and Women’s Hospital
Boston, MA

Welcome, New IDSA Members!

Members

Bookstaver, Paul, PharmD
Chen, Aaron, MD
Ecker, David, PhD
Foguena, Alain, MD 
Galindo-Fraga, Arturo, MD
Ho, Macy, PharmD
Ismailjee, Sameer, MD
Krishnan, Rakhi, MD
Lane, Jason, MD
Ledeboer, Nathan, MD
Marcolini, Julio, MD
Miller, Dennis, MD
Mimica, Marcelo, MD
Patel, Pragna, MD
Razeghi, Jasmine, MD
Steinhauer, Bruce, MD 

Associate Members

Algier, Patrick J, MS
Alves, Fabio, MD
Borchardt, Roy, PhD
Burns, Tia, PA-C
Chen, Wei-Ting, MD
Chong, Chia-Yin, MBBS, MRCP, MS
Dickey, Michelle, MS, NP
Fehrenbacher, Lynne, PharmD
Fleisher, Jorge, MD
Greene, Julie
Handy, Rupert, FRACP
Kadakia, Ankita, MD
Kale-Pradhan, Pramodini, PharmD
Kang-Birken, Lena, PharmD
Koski, Theresa, PharmD
Le, Jennifer, PharmD
Levy, Gweneth, MD
Ling, Brenda, PharmD
Martin, Jr., David
Mcniff, Todd
Nulens, Eric, MD
Purkas, Valerie, MD
Siddiqui, Abdul, MD
Simdon, Jason, PharmD
Williams, James

Members-In-Training

Agbebi, Abayoumi, MD
Aggrey, Gloria, MD
Ahmed, Mohammed, MD
Ake, Julie, MD
Akers, Kevin, MD
Aljifri, Alanoud, MD
Alroy-Preis, Sharon, MD
Amjadi, Amir Ali, MD
Asavametha, Krirk, MD
Ashame, Elias, MD
Athas, Deena, MD
Babila, Jennifer, MD, PhD
Baker, Stacey, MD
Barczak, Amy, MD
Barigala, Ravikiran, MD
Baril, Melanie, MD
Barry, Pennan, MD
Bassiri, Hamid, MD, PhD
Bhavan, Kavita, MD
Blanchard, Edward, MD
Bonham, Shalmith, MD
Borelli, Timothy, DO
Branstetter, Danny, MD
Bustinduy, Amaya, MD
Campo Osoria, Marcela, MD
Cerar, Dasa, MD
Chamie, Gabriel, MD
Chang, Man-Kuang, MD
Charbonneau, Alain, MD
Christensen, Joshua, MD
Colombo, Rhonda, MD
Comer, Robert, MD
Cooper, Mandelin, PharmD
Cope, Jennifer, MD
Cottreau, Jessica, PharmD
Coyne, Katherine, MD
Czarnogorski, Maggie, MD 
Dalal, Aman, MD
De Marco, Brendan, MD
Delair, Shirley, MD
Desruisseau, Andrew, MD
Dewan, Rajeev, MD
Doggett, Joseph, MD
Dombrowski, Julia, MD
Donaghy, Henry, MD
Downs, Jennifer, MD
Duke, Nathaniel, MD
Elsaghbine, Fady, MD
Escobedo, Antonio, MD
Falcone, Franco, MD
Febles, Taynet, MD
Fink, Doran, MD
Garcia, Maria-Isabel Rosas, MD
Genske, Christina, DO
Gohil, Shruti, MD
Goldstein, Deborah, MD
Green, Jaime, MD
Greenberg, Lior, MD
Guerra, Carlos, MD
Guinazu, Diana, MD
Gupta, Kaveri, MD
Hanmod, Santosh, MD
Hebbeler-Clark, Renee, MD
Honda, Hitoshi, MD
Hong, Steven, MD, MPH
Jacobson, Karen, MD
Jain, Vivek, MD
Janmeja, Milan, MD
Jin, Justin, MD
Johnson, Mark, MD
Jones, Makoto, MD
Joseph, Julie, MD
Kajioka, Eric, MD
Kakkar, Fatima, MD
Kaltsas, Anna, MD
Kelley, Colleen, MD
Kempker, Russell, MD
Khodadadi, Arbi, MD
Kim, James, MD
Klinkenberg, Lee, MD
Koethe, John, MD
Koo, Sophia, MD
Kopack, Angela, MD
Koster, Michael, MD
Ktaich, Nessrine, MD
Kunz, Anjali, MD
Le, Thuy, MD
Leahy, Timothy Ronan, MB, BCh, MRCP
Levison, Julie, MD
Li, Jonathan, MD
Lidnakis, Michail, MD
Liu, Anne, MD
Lubin, Andrew, MD
Mannepalli, Supriya, MD
Marschall, Jonas, MD
McDermott, Brian, DO
McGrath, Eric, MD
McMahon, James, MD
Mehta, Sapna, MD
Mendoza, Daniel, MD
Miceli, Marisa, MD
Millan, Ximena, MD
Mishra, Shrimant, MD
Murthy, Madhu, MBBS
Muskardin, Danny Thomas, MD, PharmD
Nausheen, Sara, MD
Nieves, Delma, MD
Nnedu, Obinna, MD
Oluwatade, Olatunji, MD, MPH
Onen, Nur, MD
Ouyang, Jeannette, MD
Padilla, Guillermo Orlando, MD
Pahud, Barbara, MD
Pang, Xin, MD
Parkar, Tabassum, MD
Parks, Amanda, MD
Parvez, Najma, MD
Paschke, Amanda, MD
Pastagia, Mina, MD
Patel, Gopi, MD
Patel, Devang, MD
Patel, Swetal, MD
Perez, Kialing, MD
Perez, Mario, DO
Petht, April, MD
Pokkila-Worle, Read, MD
Powers, James, MD
Ramers, Christian, MD
Rangaraj, Gopikishan, MD
Reyes, Katherine, MD
Reznicek, Julie, MD
Ritter, Michele, MD
Rizk, Nesrine, MD
Roan, Florence, MD
Robinson, Qwintin, MD
Rodriguez, Gilhen, MD
Rosenzweig, Jaclyn, MD
Ross, Allison, MD
Sahni, Nishani, MD
Salmon, Joanne, MD
Sandkovsky, Uriel, MD
Sankuratri, Madhuri, MD
Santos, Carlos, MD
Sarda, Vanessa, MD
Sell, Bevin, MD
Sengupta, Devi, MD
Shafi, Humaira, MD
Shahid, Zaninab, MD
Sharma, Luna, MD
Sharma, Monica, DO
She, Rosemary, MD
Shenoi, Sheela, MD
Shiga, Takuya, MD
Shimukowa, Makondo, MD
Siddiqui, Uzma, MD
Siegel, Marc, MD
Simmons, Rachel, MD
Singh, Devika, MD
Singh, Sunita, MD
Skarbinski, Jacek, MD
Solis, Edward, MD
Sonnenberg, Edith, MD
Sonyay, Alexandra, MD
Swami, Sanjeev, MD
Tallent, Sandra, PhD
Taormina, Mia, MD
Thompson, Debra, MD
Troy, Stephanie, MD
Tucker, Joseph, MD
Uchenna, Ezike, MD
Umoren, Inemesit, MD
Van Schooneveld, Trevor, MD
Viola, George, MD
Vogenthaler, Nicholas, MD
Vu, David, MD
Yalamanchili, Rajeev, MD
Yang, Eric, MD
Yung, Sunny, MD, PhD
Zawada, Gregory, MD

In the IDSA Journals

Avian Influenza Virus Infection in Veterinarians

In this case-control study, the health of patients with botulism was evaluated >6 months after illness. Those who had previously had botulism were substantially more likely than control subjects to report fatigue, generalized weakness, dizziness, dry mouth, difficulty lifting things, and difficulty breathing with moderate exertion.(Myers et al., Clin Infect Dis. 2007;45:4-9.)

Ionization, Fungi, and Health Care Water Supplies

In a study ofthe hot and coldpotable water supplies ofSpanish health care centers,the prevalence of fungiwas significantly lower insystems using copper- orsilver-ionized water than insystems using nonionized water. (Pedro-Botet et al.,Clin Infect Dis. 2007;45:84-86.) 

Long-term Outcomes of Botulism 

In this case-control study,the health of patientswith botulism was evaluated>6 months after illness.Those who had previouslyhad botulism were substantiallymore likely than controlsubjects to report fatigue,generalized weakness, dizziness, drymouth, difficulty lifting things,and difficulty breathing withmoderate exertion. (Gottlieb et al., Clin Infect Dis. 2007;45:174-180.)

 

Genetic Factors Linked to Fever Following Smallpox Vaccination

New evidence supports the link between genetic factors and certain adverse events related to smallpox vaccination.  The study may have implications for predicting adverse events from other live vaccines. Researchers studied 346 individuals who had participated in previous smallpox vaccination trials, 94 of whom developed fevers after vaccination.  The authors identified a total of eight haplotypes in four different genes that were associated with altered susceptibility to fever after vaccination. (Stanley et al., J Infect Dis.2007;196:212-219.)

New Data on Transmission, Malignancy of Human Herpesvirus 8 (HHV-8)

In a study examining 13,894 adults in the National Health andNutrition Examination Survey III, researchers found transmission of HHV-8 (also known as Kaposi sarcoma-associated herpesvirus) in men linked to sexual activity, especially male-to-male sexual activity, but not linked to heterosexual transmission to women. (Engles et al., J Infect Dis. 2007;196:199-207.) A second study found HHV-8 was not a major cause of prostate cancer, disputing the conclusions of a previous study that had found elevated levels of HHV-8 antibodies in men with prostate cancer. (Jenkins et al., J Infect Dis 2007;196:208-211.)

Altered Gene Expression in Postinfective Fatigue Syndrome (PIFS)

In a unique, prospective, population-based study that may open doors to better understanding of chronic fatigue syndrome, the authors examined changes in gene expression in patients who developed PIFS following Epstein-Barr virus infection. They identified 35 gene expression changes that correlated with the course of PIFS. These genes had not previously been linked to PIFS and included genes involved insignal transduction pathways, metalion binding, and ionchannel activity. (Cameron et al., J Infect Dis.2007;196:56-66.)

ACIP Issues New Immunization Recommendations

Samuel Katz, MD, IDSA liaison to ACIP

The Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention, made the following recommendations at its June meeting:

  • Meningococcal Conjugate Vaccine for Teens: Meningococcal conjugate vaccine (MCV4) is back in abundant supply, so vaccination of 11-12 year olds has been resumed. ACIP now recommends giving the vaccine to all persons aged 11-18 years. So far, 7.5 million doses have been distributed. An estimated 1,400 to 2,800 cases of meningococcal disease occur in the U.S. annually, with high rates of morbidity and mortality.
  •  
  • Hepatitis A Vaccine for Post-Exposure Prophylaxis: A change in the recommendation for post-exposure prophylaxis for hepatitis A virus (HAV) calls for use of HAV vaccine up to 14 days after exposure, rather than immune globulin (IG), for healthy individuals 1 to 40 years of age. For others IG is still preferred, including infants under 12 months of age, adults over age 40, immunocompromised individuals, and those with chronic liver disease.
  •  
  • Adult Immunization Schedule: A new adult immunization schedule for 2007-2008 reflects current recommendations for use of licensed vaccines in people 19 and older. Changes include the addition of zoster vaccine.

Slide presentations and the full ACIP report will be available at www.cdc.gov/vaccines/recs/acip/default.htm

West Nile Virus Epidemic Continues

A 14 percent increase in reported cases of West Nile Virus neuroinvasive disease (WNND) last year suggests that the West Nile Virus (WNV) epidemic is here to stay. The number of WNND cases reported to the Centers for Disease Control and Prevention (CDC) rose to 1,491 last year – the highest number reported since 2003. The west-central states and Idaho hosted the majority of human WNV disease cases and Washington reported its first human cases. This increase in WNV activity across the United States emphasizes the need for continued surveillance, research, and mosquito control. Click here for the CDC’s 2006 West Nile Virus activity report.

 

Malaria Rates Increase in 2005 

The Centers for Disease Control and Prevention (CDC) saw an increase of about 15 percent in reported malaria cases in 2005. Most of the increase resulted from cases from the Americas and Asia. It is unclear, however, whether this is due to better reporting or an increase in travel to these areas. Among travelers, those returning from West Africa had the highest case rates.

Only 18 percent of those who acquired malaria while traveling had followed a CDC-recommended chemoprophylaxis regimen. See http://www.cdc.gov/travel.

Click here for the CDC’s 2005 malaria surveillance summary.

New JID Supplement Tackles HIV-TB Co-infection

The latest on key issues in the diagnosis and treatment of tuberculosis (TB) in HIV-infected patients is presented in a supplement to the August 1 issue of The Journal of Infectious Diseases.

The supplement includes up-to-date articles by leaders in many areas of this complex dual pandemic. Topics include:

  • Treatment strategies for HIV-TB co-infection
  • Drug interactions, additive toxicities, and immune reconstruction syndrome
  • Research on new drugs, new diagnostics
  • TB prevention in the context of HIV infection
  • Models for integrating TB and HIV programs

The supplement grew out of two major meetings in the summer of 2005 on the current state of the science in HIV-TB co-infection—one in Boston, Massachusetts, and one in Rio de Janeiro, Brazil. Following those two meetings, authors were asked to summarize current knowledge and areas of needed research in the areas of diagnostics and therapeutics.

The focus of the supplement is on treatment in resource-constrained settings, particularly sub-Saharan Africa. The authors expect there will be other supplements summarizing key issues in different geographic regions and highlighting different aspects of both pandemics, such as vaccine development or the impact of injection drug use.

Click here to view the supplement online.

Practice Management Resources Available

IDSA’s website offers resources to help physicians and their practice managers with the business aspects of infectious diseases private practice. The Practice Management section of our website features resources for billing and coding, Medicare, health information technology, and more, as well as recent articles from IDSA News about practice management and updates on federal policy affecting your practice. You also will find a link to sign up for our popular list serve for practice managers.