IDSA News - November 1, 2007
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ACIP Recommends Meningococcal Vaccine for High-Risk Two-Year-Olds

The Advisory Committee on Immunization Practices (ACIP) has recommended extending meningococcal vaccination to children 2 to 10 years of age at high risk of meningococcal disease, according to IDSA’s ACIP liaison, Samuel Katz, MD, FIDSA. That includes children with asplenia, terminal complement deficiencies, or HIV infection, or those who are encountering a meningococcal disease outbreak. Current recommendations from the Centers for Disease Control and Prevention (CDC) advise vaccinating all persons 11 to 55 years of age.

At its meeting Oct. 24 and 25, Dr. Katz said, ACIP also endorsed the decision by the Food and Drug Administration (FDA) to extend the age limit on FluMist live attenuated nasal influenza vaccine down to 2 years of age. Those with history of asthma or significant wheezing within the past year should be excluded. Both the influenza and meningococcal vaccines were recommended for inclusion in the federal Vaccines for Children program.

ACIP members also emphasized that those receiving vaccine should remain in the physician’s office for 15 minutes following injection, according to Dr. Katz. A significant number of syncopal episodes following vaccination have been reported, a few of them resulting in serious injury. Most have followed vaccination with Merck’s human papillomavirus (HPV) vaccine, Gardasil. 

HPV Vaccine Preference?

Next year FDA is expected to approve another HPV vaccine, GlaxoSmithKline’s Cervarix. Cervarix protects against two HPV strains linked to cervical cancer, while Gardasil, a quadrivalent vaccine, protects against two carcinogenic strains as well as two linked to genital warts. This could justify a preferential recommendation for Guardasil, but Dr. Katz, pointed out, “there is no precedent for such a differentiation in ACIP recommendations because no vaccines for the same infection have been so different in the past.” He said there likely will be considerable debate over this topic in future ACIP meetings. Stay tuned for details.

The next ACIP meeting is Feb. 27-28, 2008.

For more from ACIP, see http://www.cdc.gov/vaccines/recs/acip/.

EIN Reports Cases of Severe Neonatal Enteroviral Disease

In mid-October, a member of the Emerging Infections Network (EIN) reported a recent increase in severe enteroviral infections, identified as Coxsackie B viruses, in newborn infants in the Los Angeles metropolitan area.

The member wrote, “All presented in the first week of life. Meningitis, myocarditis, disseminated intravascular coagulation (DIC), and hepatitis were seen alone or in combination. There were two deaths from myocarditis. Three infants with myocarditis still have poor cardiac function.” The member asked if others were seeing similar cases.

Two EIN members in California, two in New Jersey, one in Alaska, and one in Illinois reported similar cases of neonatal enterovirus infection. Cases presented with meningitis, hepatitis, myocarditis, DIC, or a combination. Two cases were fatal; a few had persistent heart complications. Several cases were not severe and the infants made full recoveries. A member in Michigan reported a mild enterovirus season overall.

Enterovirus was identified from cultures of stool, urine, cerebrospinal fluid (CSF), or nasopharynx; or by PCR of CSF. In some patients virus was identified in one sample and not another. Two cases were classified as Coxsackie B1 virus; the others were not classified.

Some members mentioned the unavailability of pleconaril, a novel antiviral against enteroviruses and rhinoviruses that has had a rocky history in clinical trials. One asked about the status of this drug.

A member in Alabama responded, “The NIAID Collaborative Antiviral Study Group (CASG) has an ongoing controlled trial of pleconaril in babies with neonatal enteroviral sepsis syndrome. It is a Phase II study with virologic endpoints, and to our knowledge is the only way to gain access to systemic pleconaril. Due to the time required to establish all regulatory and contractual arrangements with new sites, it can be challenging to bring new sites online after an enterovirus baby is identified. Arrangements can sometimes be made to transport a patient to a study site, though, and in addition consideration can be given to adding new sites prior to the time an enterovirus patient is identified. Further information on the study can be found at http://www.casg.uab.edu/.”

Hib Vaccine Shortage Likely

Merck & Co., Inc. is reporting manufacturing problems that will likely result in a shortage of its Haemophilus influenzae type B (Hib) vaccine, PedvaxHIB (PRP-OMP), according to the Centers for Disease Control and Prevention (CDC). 

CDC says it will dip into its vaccine stockpile to make up limited amounts of the vaccine, and Sanofi Pasteur says it is working to provide additional supplies of its ActHib (PRP-T) vaccine. CDC estimates providers will need to use ActHib for about half of their Hib vaccine needs. 

The CDC announcement has instructions for providers whose patients have already started a vaccine series with Merck’s PRP-OMP vaccine and must complete it with Sanofi Pasteur’s PRP-T vaccine.

Merck expects PedvaxHIB to be available sometime in the first quarter of 2008, depending on when its manufacturing issue is resolved.

For more information on vaccine shortages, see http://www.cdc.gov/vaccines/vac-gen/shortages.

Hot Topics in Infectious Diseases 2007

Here’s this year’s list of the must-read papers as chosen by leaders in the fields of infectious diseases and HIV and presented at IDSA 2007 during the always popular “What’s Hot” session. Each presenter also describes why the articles made his list.

Bennet Lorber, MD, FIDSA, Temple University Health Sciences Center:

Pronovost et al. “An intervention to decrease catheter-related bloodstream infections in the ICU.” N Engl J Med 2006;355:2725-32.

Each year almost 50,000 patients in the United States develop catheter-related blood stream infections resulting in at least 17,000 attributable deaths. In this study, a few simple infection control interventions were instituted, namely a) handwashing, b) full-barrier precautions during catheter insertion, c) using chlorhexidine to clean skin, d) avoiding the femoral site, and e) removing unnecessary catheters. These simple, low-tech, low-cost interventions reduced the rate of catheter-related bloodstream infections by 66 percent, and the impact was sustained over a long period.

Johnson et al. “Sharing of virulent Escherichia coli clones among household members of a woman with acute cystitis.” Clin Infect Dis 2006;43:e101-8.

A longitudinal study in the household of woman with cystitis showed extensive sharing of E. coli clones among family members and a pet dog. Patterns of sharing suggest host-to-host transmission and are not consistent with sexual transmission or a food source.  It is suggested that household members could serve as reservoirs for later recolonization and explain observation of widely separated same-strain recurrent urinary tract infections in women without evidence of sustained colonization with the causative strain.  

Scott et al. “An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq.” Clin Infect Dis 2007;44:1577-84.

This study reports on an epidemic of highly resistant Acinetobacter infections in U.S. military personnel in Iraq who were critically ill following severe trauma.  The infection source appears to be nosocomial and related to the field hospital environment. Infection control in field hospitals is tough; new approaches are needed.

Högenauer et al. “Klebsiella oxytoca as a causative organism of antibiotic-associated hemorrhagic colitis.” N Engl J Med 2006;355:2418-26.

K. oxytoca can cause antibiotic-associated hemorrhagic colitis.  Look for it (culture for K. oxytoca) in younger patients with right-sided or transverse colon hemorrhagic colitis.  While looking, stop antibiotics and NSAIDs.

Dr. Lorber’s other hot articles:

Wilson et al. “Prevention of infective endocarditis. Guidelines from the American Heart Association.” Circulation 2007;116:1736-54.

Gupta et al. “Statin use and hospitalization for sepsis in patients with chronic kidney disease.” JAMA 2007;297:1455-64.

Barry M. “The tail end of guinea worm: global eradication without a drug or a vaccine.” N Engl J Med 2007;356:2561-64.

John G. Bartlett, MD, FIDSA, Johns Hopkins University School of Medicine, past president of IDSA:

Lindenauer et al. “Public reporting and pay for performance in hospital quality improvement.” N Engl J Med 2007;356:486-96.

Metersky et al. “Antibiotic timing and diagnostic uncertainty in Medicare patients with pneumonia.” Chest 2006;130:16-21.

Polgreen et al. “An outbreak of severe Clostridium difficile-associated disease possibly related to inappropriate antimicrobial therapy for community-acquired pneumonia.” Infect Control Hosp Epidemiol 2007;28:212-14.

Lindenauer et al. show that a Medicare trial run of “pay-for-performance” achieved a 12 percent increase in compliance with the “4 hour” rule for administering antibiotics for community-acquired pneumonia (CAP).  But Metersky et al. and Polgreen et al. wrote about the downside: abuse of antibiotics, including some deaths due to Clostridium difficile in patients treated for CAP but in retrospect did not have it.  The Centers for Medicare and Medicaid Services has decided to drop the “4 hour rule” for “pay-for-performance” due to unintended consequences.

Zar et al. “A comparison of vancomycin and metroniazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity.” Clin Infect Dis 2007;45:302-7.

These authors report a prospective study of 150 patients with C. difficile infection who were randomized to oral vancomycin or metronidazole.  Vancomycin proved superior but only in those classified as having serious disease, with cure rates of 97 percent for vancomycin vs. 76 percent for metronidazole.

Wang et al. “Increased vancomycin MICs for Staphylococcus aureus clinical isolates from a university hospital during a 5-year period.” J Clin Microbiol 2006;44:3883-6.

Hidayat et al. “High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections.” Arch Intern Med 2006;166:2138-44.

Tenover and Moellering. “The rationale for revising the Clinical And Laboratory Standards Institute vancomycin minimal inhibitory concentration interpretive criteria for Staphylococcus aureus.” Clin Infect Dis 2007;44:1208-15.

These studies provide the rationale for the Clinical And Laboratory Standards Institute (CLSI) recommendation to reduce the minimal inhibitory concentration (MIC) threshold for S. aureus sensitivity to vancomycin from 4 mcg/mL to 2 mcg/mL.  The concern was based on a number of associated observations including 16 anecdotal cases of patients with S. aureus isolates with MICs of 4 mcg/mL who had persistent bacteremia for more than a week despite standard doses of vancomycin.  There were many concerns, including MIC creep, heteroresistance, and nephrotoxicity of vancomycin with increased doses. In addition, there was the calculation that an MIC of 4 requires a dose of 8 gm/day to achieve the desired AUC/MIC ratio!

Labandeira-Rey et al. “Staphylococcus aureus Panton-Valentine leukocidin causes necrotizing pneumonia.” Science 315:1130-3.

Voyich et al. “Is Panton-Valentine Leukocidin the major virulence determinant in community-associated methicillin-resistant Staphylococcus aureus disease?” J Infect Dis 2006;194:1761-70.

Labandeira-Rey et al. examine the virulence of USA 300 strains of MRSA and show that Panton-Valentine leukocidin (PVL) causes lung necrosis and death with nasal challenge in mice.  BUT Voyich et al. tested the same hypothesis using intramuscular and intravenous challenge, and concluded that PVL is nothing more than a marker for the USA 300 strain.  The truth may be someplace in the middle.

Gandhi et al. “Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa.” Lancet 2006;368:1575-80.

Extensively drug-resistant tuberculosis (XDR TB) is a new term used for multidrug-resistant TB that is also resistant to fluoroquinolones and at least one injectable drug.  This paper reviews 53 cases in rural South Africa.  There appeared to be a strain that was commonly hospital-acquired; all 44 patients tested for HIV were positive and 52 (98 percent) died, with a median survival time of 16 days.  The author emphasized the need for surveillance, hospital infection control, and better microbiology.

Escombe et al. “Natural ventilation for the prevention of airborne contagion.” PLoS Med 2007;4:e68.

The authors examine airflow as an indicator of TB control in hospitalized patients in Lima, Peru.  The best (safest) airflow was in old hospitals with high ceilings and big open windows.  The worst airflow was in rooms constructed with (expensive) mechanical ventilation to assure negative pressure.

Dr. Bartlett’s other hot articles:

“Severe methicillin-resistant Staphylococcus aureus community acquired pneumonia associated with influenza—Louisiana and Georgia, December 2006-January 2007.” MMWR 2007;56:325-329.

Yang et al. “Immunization by avian H5 influenza hemagglutinin mutants with altered receptor binding specificity.” Science 2007;317:825-8.

IDSA Publishes Updated Guidelines on Sporotrichosis

New IDSA practice guidelines on the management of sporotrichosis have been published in the November 15 issue of Clinical Infectious Diseasesnow available online.

The new guidelines replace previous guidelines that were published in 2000 and include recommendations for lymphocutaneous, cutaneous, osteoarticular, pulmonary, disseminated disease, and meningitis. Additionally, the new guidelines include recommendations for treatment of pregnant women and children.

As with the previous guidelines, itraconazole is still the treatment of choice for patients with lymphocutaneus, cutaneous, or osteoarticular sporotrichosis. If using itraconazole, serum levels should be taken to determine that the patient has adequate absorption of the drug.

New published data show that terbinafine is effective in high doses and thus is now recommended as a second-line therapy. In contrast to the earlier guidelines, the panel preferred lipid formulations of amphotericin B over amphotericin B deoxycholate for treatment of meningeal, disseminated, and severe pulmonary sporotrichosis.

“Most people with sporotrichosis do fine and can be treated by a primary care physician,” said lead author Carol A. Kauffman, MD, FIDSA, of the University of Michigan Medical School and the Ann Arbor Veterans Affairs Healthcare System. “However, patients whose infections have reached the bones, joints, lungs, or central nervous system are exceedingly difficult to treat and probably should be seen by an infectious diseases consultant.”

Sporotrichosis is a fungal infection caused by the fungus Sporothrix schenckii, which is found throughout the world in decaying vegetation, sphagnum moss, and soil. The disease is fairly common in Brazil and Peru, particularly in places where people come in regular close contact with soil. In the U.S., it is often seen among landscapers, forestry workers, and people who have had motor vehicle accidents—particularly with dirt bikes—that exposed their wounds to soil. Symptoms include the development of  painless or mildly painful nodules resembling insect bites that appear where the fungus enters through a break in the skin. Eventually, the lesions ulcerate and are very slow to heal. Although the infection will not resolve by itself, it usually responds well to treatment, but can cause more serious problems for patients with compromised immune systems.

See: Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America, CID 2007:45 1255-1265.

In the IDSA Journals

C. difficile Found on Asymptomatic Patients

This study offers reasons why efforts to control Clostridium difficile infection haven't been more successful: the bacteria may be thriving on asymptomatic patients and items in their immediate vicinity such as call buttons, bed rails, bedside tables, and telephones. The researchers found that spores were easily transferred from the patient's skin to investigators' hands. (Riggs et al., Clin Infect Dis. 2007;45:992-998.)

 

 

 

 

Pill Box Organizers Improve HIV Patients’ Viral Suppression

Inexpensive pill box organizers are an easy, successful, and cost-effective tool to help patients take their medications as prescribed, according to a new study of low-income urban residents living with HIV infection. Pill box organizers were associated with a 4 percent improvement in adherence, 0.12 log reduction in HIV viral load, and an estimated 11 percent reduction in the risk of progression to clinical AIDS. At only $5 per pill box, this intervention was highly cost-effective. (Petersen et al., Clin Infect Dis. 2007;45:908-915.)

Herpes simplex encephalitis in Sweden  

A Swedish study conducted over a 12-year period involving patients with herpes simplex encephalitis found an incidence of 1 case per 2,200,000 population. The one-year mortality rate was 14 percent. Of the survivors, 87 percent were readmitted to the hospital, and an epileptic seizure was the reason for readmission in 24 percent. This corresponds to a 60- to 90-fold increase in risk, compared with that in the general population. (Hjalmarsson et al., Clin Infect Dis. 2007;45:875-880.)

Pregnancy May Slow—Not Accelerate—Progression to AIDS

A new study may help put to rest fears that pregnancy accelerates progression to full-blown AIDS in HIV-infected women receiving antiretroviral therapy. The study revealed that pregnancy may, in fact, slow disease progression in these women. (Tai et al., J Infect Dis. 2007;196:1044-105.)

Some Good News on PCV Serotype Replacement

A study of people vaccinated with the 7-valent pneumococcal conjugate vaccine (PCV) shows the non-vaccine serotypes that replaced those targeted by the vaccine came from a diverse population of serotypes—not from a few especially virulent or drug-resistant “escape” strains. Capsule-switching was rare. The authors say the study is “cause for cautious optimism” that widespread use of the vaccine will not result in the rapid appearance of dangerous new strains. (Lipsitch et al., J Infect Dis. 2007;196:1221-1227.)

Genital HPV Infection Common in Males

A study of 240 sexually active heterosexual male university students found genital human papillomavirus (HPV) infection was more common than that reported in similar groups of women. HPV was found in multiple genital regions. The findings have implications for HPV prevention strategies targeting women. (Partridge et al., J Infect Dis 2007;196:1128-1136.)

Low Rates of Flu Vaccination Underscore Need for Vigilance

Influenza vaccination rates among certain key groups are low, according to three new reports published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR).

During the 2005-2006 flu season, only 31.9 percent of children age 6-23 months received at least one dose of flu vaccine and only 20.6 percent were fully vaccinated, according to CDC. A more recent report using 2006-2007 data from six sentinel sites shows that less than 30 percent of children in this age group and less than 20 percent of children age 24-59 months were fully vaccinated. The CDC’s Advisory Committee on Immunization Practices (ACIP) first recommended influenza vaccination for children age 6-23 months in 2004.

A third report, which tracked coverage by state, showed a decline in vaccination rates for adults. Among adults age 18-49 with high-risk conditions, the flu vaccine coverage rate nationwide was 30.5 percent in 2005-2006—a drop of 5 percentage points since 2003-2004. The report noted declines of 4 or more percentage points among all other adults as well. (See figure.)

The reports underscore the need to increase awareness among health care providers and the public regarding the flu vaccine and the value of vaccinating throughout the flu season.  Other public health implications include the need to monitor vaccine coverage rates, ensure stable supplies of vaccine, and strengthen financing for adult vaccines.

ACIP recommends annual influenza vaccination for children age 6-59 months. Two doses should be given, at least 4 weeks apart, to fully vaccinate children in this age group who are receiving influenza vaccination for the first time.

For adults, ACIP recommends annual influenza vaccination for persons age 18-49 years with high-risk conditions and all adults who want to reduce the risk for becoming ill with influenza or of transmitting flu to others. CDC’s Healthy People 2010 objectives include increasing vaccination levels to 90 percent for adults age 65 and older.

Sources:

Influenza Vaccination Coverage Among Children Aged 6-23 Months—United States, 2005-06 Influenza Season, MMWR, September 21, 2007 / 56(37);959-963.

Influenza Vaccination Coverage Among Children Aged 6-59 Months—Six Immunization Information System Sentinel Sites, United States, 2006-07 Influenza Season, MMWR, September 21, 2007 / 56(37);963-965.

State-Specific Influenza Vaccination Coverage Among Adults Aged >18 Years—United States, 2003-04 and 2005-06 Influenza Seasons, MMWR, September 21, 2007 / 56(37);953-959.

New CA-MRSA Evaluation and Treatment Flyer Available

A new chart is available to assist in evaluating and treating skin and soft tissue infections in the era of community-associated methicillin-resistant Staphylococcus aureus (MRSA).

A collaboration of IDSA, the Centers for Disease Control and Prevention, and the American Medical Association, this helpful resource is targeted at family practice clinicians. It includes considerations and precautions when using antimicrobial therapy options for outpatient management. IDSA encourages its members to make their family-practice colleagues aware of it.

The information provided is based on the CDC report,"Reasonable Strategies for Clinical Management of MRSA in the Community, with a Focus on Skin and Soft Tissue Infections." The document, which describes strategies based on the input from MRSA experts and a review of available data, is available for download.

CDC Creates Database of State Immunization Laws

The Centers for Disease Control and Prevention (CDC) has recently created an online database of state immunization laws for health care workers and patients in health care settings. The database includes information on laws that require assessment of vaccination status as well as requirements to provide or administer vaccines. It includes the 50 states and Washington, DC, and is current through September 2007. The State Vaccination Laws database is intended for immunization program managers, health care providers, advocacy groups, legal and public health researchers and policymakers, and the general public.

New Compilation of Latest HIV Research Available

More than 30 of the most significant articles in HIV research published in the IDSA journals in the last year are now available in the 2007 Clinical Issues in HIV Medicine, produced by HIVMA.

Edited by Kenneth H. Mayer, MD, FIDSA, and Daniel R. Kuritzkes, MD, FIDSA, this year’s HIV compendium includes state-of-the-art articles from both Clinical Infectious Diseases and The Journal of Infectious Diseases. Some of the hot topics covered include:

  • adherence
  • metabolic complications of HIV infection and treatment
  • screening for acute infection
  • HIV and sexually transmitted infections 

Several articles focus on special issues in the developing world, including measuring virologic suppression and resistance testing in resource-limited settings.

Copies of the compendium are available as a booklet or CD-ROM by contacting Caroline Page at cpage@idsociety.org or (703) 299-1215.

Stay Informed about Daily ID News

The 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.  To sign up for this service please visit:
http://www.idsociety.org/Content.aspx?id=4250.

Updated IDSA/SHEA Infection Control Fellows Course Available

Three new sessions have been added to the online IDSA/SHEA Infection Control Fellows Course. The new sessions, taped in 2006 at Johns Hopkins Hospital, include, “Antimicrobial Stewardship,” “The Role of the Hospital Epidemiologist,” and “Hand Hygiene/Isolation and Disinfection.”

The course gives infectious diseases fellows and others basic training and background in infection control. The updated course consists of a 21-question pre-test, 14 lectures (approximately 12.5 hours) and a 32-question post-test. Other features include:

  • synchronized audio and searchable slides
  • printable slides
  • a searchable transcript for each lecture
  • self-pacing and "bookmarking" capabilities  

A preview of the course is available online. To register, visit www.iccourse.org and follow the instructions in the green “Registration” box on the right side of the page. The first version of the course is still available for previous registrants at http://version1.iccourse.org.

Call for Public Comment: HIV/AIDS Performance Measures

The National Committee for Quality Assurance (NCQA) is soliciting comments on a set of quality measures that focus on HIV/AIDS, for use at the individual provider and system level. The proposed measures will be considered for endorsement by the National Quality Forum (NQF) and for use in various care settings including the CMS Physician Quality Reporting Initiative (PQRI). 

Please review and comment on the measures on the NCQA Website. Public comment will close on Dec. 14. 

The draft measures were developed by the Infectious Diseases Society of America/HIV Medicine Association, the American Medical Association-convened Physician Consortium for Performance Improvement (PCPI), and the Health Resources and Services Administration (HRSA). HIVMA members Judy Aberg, MD, and Michael Horberg, MD, co-chaired the panel that developed the measures.

All comments submitted will be reviewed by NCQA, the PCPI, HRSA, and HIVMA/IDSA prior to measure finalization.

Contact a member of the HIV/AIDS Performance Measures Project Team at MDSpecmeasures@ncqa.org with any questions.

Support Builds for STAAR Act

Support is building among medical societies, public health organizations, and members of Congress for an IDSA-backed bill that would lay a strong foundation for tackling the growing crisis of antimicrobial resistance.

The federal Strategies to Address Antimicrobial Resistance (STAAR) Act (S. 2313/H.R. 3697) would foster innovative approaches to surveillance, prevention, control, and research. The bill calls for development of a strategic research plan, creation of an office within the Department of Health and Human Services (HHS) to coordinate efforts within HHS and with other U.S. departments, and strengthening national sentinel surveillance and clinical research.

The STAAR Act now has 14 co-sponsors in the House of Representatives, and a Senate companion bill, initially introduced by Sens. Sherrod Brown (D-OH) and Orrin Hatch (R-UT), now includes Sens. Charles Schumer (N-NY) and Richard Durbin (D-IL) as co-sponsors. In addition, the American Public Health Association, the Association for Professionals in Infection Control and Epidemiology, the National Foundation for Infectious Diseases, the Pediatric Infectious Diseases Society, and the Society for Healthcare Epidemiology of America (SHEA) have endorsed it.

“Infectious diseases physicians are challenged literally every day by drug-resistant infections. We can’t solve this problem in isolation. We need federal policymakers to step up to the plate,” said IDSA President Don Poretz, MD, FIDSA. “The ultimate goal should be an effective, interlocking federal, state, and local framework to respond to drug-resistant and other serious infections. IDSA believes the strategies in the STAAR Act provide a good starting point.”

IDSA is calling for additional measures beyond the STAAR Act, such as:

  • significantly increasing funding for National Institutes of Health-sponsored research on antimicrobial resistance and health care-associated infections

  • strengthening funding streams for the Centers for Disease Control and Prevention (CDC), public health agencies and laboratories, and hospitals and other health care facilities engaged in surveillance, research, prevention, and control

  • spurring the development of new antibiotics, vaccines, and diagnostics to treat, prevent, and detect serious and life-threatening infections

  • restricting antimicrobial drugs from being used for growth promotion in food-producing animals, and reducing use of antimicrobials in agriculture and the environment in general

In a move applauded by IDSA, Sen. Schumer also has introduced legislation (S. 2351) that provides a 50 percent tax credit for research and development of new antibiotics, antivirals, vaccines, biological products, and diagnostics for use against drug-resistant and other serious and life-threatening infections for which the product pipeline is slim. The bill specifically mentions methicillin-resistant Staphylococcus aureus, Escherichia coli, Klebsiella species, Acinetobacter, and extensively drug-resistant tuberculosis. Sen. Schumer is an influential member of the Senate Finance Committee, which makes him well placed to move the tax credits. See IDSA's letter of support.

In other news, IDSA and SHEA have worked with Sen. Durbin, a member of the Senate leadership, to strengthen a bill he has introduced (S. 2278) that aims to reduce community-acquired and hospital-associated infections. “While we support the spirit of this bill, we want to work with Congress to make sure any strategies that are adopted are based on science and actually work at the local hospital and community level,” said Dr. Poretz.

The Durbin bill would establish best-practice guidelines for infection control plans, require hospital reporting of HAIs through the CDC’s National Healthcare Safety Network, require feasibility studies of pay-for-performance standards linked to the reduction of community and hospital infections, fund and prioritize research in this area, and establish an interagency working group. Durbin's bill already has five additional co-sponsors, including presidential candidates Sens. Hillary Clinton (D-NY) and Barack Obama (D-IL).

Other bills that IDSA supports include:

  • The Preservation of Antibiotics for Medical Treatment Act (S. 549/H.R. 963), which would phase out the use of antimicrobials for growth promotion in food animals. See IDSA's letter of support.

  • The Access to Medicare Data Act (S. 1507), which would provide researchers with controlled access to Medicare prescription drug data. Such data could enhance the study of how and why resistance emerges. See IDSA's letter of support.

Find out more about the STAAR Act. http://www.idsociety.org/staaract.htm

Keep Up with Drug Approvals, Recalls, Adverse Events

IDSA offers a new members-only service that e-mails ID-related messages from the Food and Drug Administration on label changes, adverse events, newly approved drugs, and other safety information on FDA-approved drugs and biologics.  Recent alerts have included:

To sign up for this service, IDSA members can visit http://www.idsociety.org/Content.aspx?id=4250.

Vaccine-derived Polio Outbreak in Nigeria

By D.A. Henderson, MD, MPH, FIDSA
Center for Biosecurity, University of Pittsburgh Medical Center

The largest outbreak to date of poliomyelitis caused by vaccine-derived polioviruses (cVDPV) has struck Nigeria. Ninety-three cases have been reported from October 2005 to August 2007, with two additional related cases in neighboring Niger. Current Centers for Disease Control and Prevention (CDC) reports show no further cases since August.

The isolates derived from mutated type 2 oral vaccine strains that had combined with indigenous Coxsackie-type enteroviruses resulting in recombinant virus forms.  Of the 95 isolates, 71 showed a typical divergence from the genome sequence of the vaccine strain; the 24 others exhibited a less marked divergence but were clearly derived from the type 2 vaccine. 

cVDPV is known to evolve, in rare cases, from any of the three live, attenuated viruses used in oral polio vaccine.  During the 20-month period in this most recent report, CDC identified only six other VDPV recombinant isolates–two of type 3 from Cambodia and four from Myanmar.

In 2003, false rumors that the vaccine was unsafe had shut down vaccination campaigns in northern Nigeria, which likely contributed to the outbreak of cVDVP. However, the campaigns have been able to be restarted and have been intensified using monovalent strains. As of September 30, Nigeria had reported 220 cases of non-VDVP polio cases in 2007, all cases being either type 1 or type 3.  This is substantially fewer cases than the 921 cases reported during this period last year.

For more information, see the Sept. 28 Morbidity and Mortality Weekly Report.

Also see www.polioeradication.org.

Welcome, New IDSA Members!

Members

Barez, Marie Yvette, MD
Beauchamps, Laura, MD
Bu, Efrain, MD
Collins, Jaime A., MD
El Dakdouki, Ghenwa, MD
Fernandez, Lenora, MD
Franchi, Diane, MD
Hernandez, Elfleda, MD
Klemow, Steven, MD
Kuter, Barbara, MPH
Mahon, Barbara, MD, MPH
Montalban, Cecilia, MD
Panaligan, Mario, MD
Pelz, Robert, MD, PhD
Rosenthal, Jonathan, MD
Salvador, Annabelle, MD
Schwartz, David, MD
Sciberras, Andrea, DO
Song Taek, Heo, MD
Stephens, Jeffrey, MD
Tiu, Dionisio, MD
Torres-Nieves, Armando, MD
Vial, Dablo, MD
Webb, Terence, MD
Wigelsworth, Darron, PhD

Associate Members

Arias, Veronica
Barber, Breur, MD
Beutler, Steven, MD
Chin, Judy, PharmD
Cunha, Clovis Arns Da
Dasaraju, Purushothama
Foster, Dru
Giannitsioti, Efthynia
Hoey, Christopher, PharmD
Meislich, Debrah, MD
Murphy, Erin, PA
Omrani, Ali, MD, MBBS, MSc, MRCP
Porter, Chris, MSN
Ruane, Peter
Stephanopoulos, Efthinios
Vreden, Stephen, MD

Members-In-Training

Achilles, Jennifer, MD
Beneri, Christy, MD
Chung, Heath, MD
Etienne, Joseph, MD
Flores, Jose, MD
Gahunia, Mona, MD
Glikman, Danny, MD
Gonzalez-Morales, Padro, MD
Gregg, Kevin, MD
Hinestrosa, Federico, MD
Kalu, Stella, MD, MBBS
Kuo, Melissa, MD
Naseer, Bilal, MD
Osawa, Ryosuke, MD
Patel, Vallari, MD
Perry, Paul, MD
Quan, Clifford, MD
Sam-Agudu, Nadia, MD
Thiel, Derrick, DO
Tilghman, Myres, MD