IDSA News - March 1, 2008
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ACIP Makes New Recommendations on Flu, MMRV Vaccines
The federal Advisory Committee on Immunization Practices (ACIP) made
new recommendations on key vaccines at its February meeting in Atlanta,
according to IDSA’s ACIP liaison, Samuel Katz, MD, FIDSA.
Expand Influenza Vaccine: ACIP voted to extend
routine influenza virus vaccination to all healthy children ages 6
months to 18 years. (The previous recommendation was for vaccination of
children from 6 months to 59 months, children with certain chronic
conditions, and household contacts of children under 6 months.) The
expanded recommendation could be implemented by the 2009-2010 flu
season, but can be initiated in 2008-2009 when desired and feasible.
The new recommendation would increase the number of children
recommended for influenza vaccination by about 30 million.
Reports from the vaccine producers indicate that supply will not be
a problem. The recommendation represents another step forward by those
who seek universal flu vaccination for the entire population, said Dr.
Katz. There was discussion of the problems this year with mismatch of
vaccine strains versus the circulating ones. The 2008-2009 flu vaccine
for the United States will include three new strains: an
A/Brisbane/10/2007 (H3N2)-like virus, A/Brisbane/59/2007 (H1N1)-like
virus strain, and a B/Florida/4/2006-like virus.
MMRV No Longer Vaccine of Choice: ACIP voted to
withdraw the preferential recommendation for the measles, mumps,
rubella, and varicella vaccine (MMRV, marketed by Merck & Co., Inc.
as ProQuad) as the vaccine of choice for initial vaccination of
infants. Preliminary findings suggest that about one additional febrile
seizure would be expected to occur in the 7-10 day postvaccination
period for every 2,000 children aged 12-23 months who receive MMRV
vaccine, compared with MMR vaccine and varicella vaccine at the same
visit. Officials continue to evaluate the preliminary findings. The
updated recommendations have been published in Morbidity and Mortality Weekly Report (MMWR), http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5710a3.htm.
No Change on MCV4: A proposal to extend the
recommendation for meningococcal conjugate vaccine (MCV4) to include
healthy 2-10 year olds was voted down. The recommendation remains to
administer the vaccine only to high-risk children in that age group
(e.g., those with terminal complement deficiency, sickle cell disease,
or other splenic dysfunctions), all children 11-18 years old, and
adults at high risk who are 19-55 years old. For people age 2-55 years,
MCV4 is preferred; the meningococcal polysaccharide vaccination (MPSV)
is an acceptable alternative if MCV4 is not available. Adults age 56
and older at high risk should receive MPSV.
ACIP recommendations become official once approved by the Centers for Disease Control and Prevention and published in MMWR. For more information, see: http://www.cdc.gov/vaccines/recs/acip/.
CID Supplement Provides New Insight on Clostridium difficile Infection
The latest on key issues in the diagnosis and treatment of Clostridium difficile infection (CDI) and the risk of CDI associated with antimicrobial agents has been published in a supplement to the January 15 issue of Clinical Infectious Diseases, available online.
“C. difficile epidemiology is changing, and an epidemic strain is circulating in North American hospitals and causing increasingly severe disease with high mortality among elderly patients,” said Dale Gerding, MD, a guest editor of the supplement and an IDSA Board member.
The supplement includes up-to-date articles by leaders in various areas of CDI. Articles include:
The supplement contains new algorithms for the treatment of CDI and a summary of the methods used to prevent and control infection. Also included are the risks for CDI associated with the use of various antibiotics, and how the use of an antimicrobial can bring on CDI in a patient.
CME/CE credit is available for infectious diseases physicians, hospitalists, clinical pharmacists, and primary care clinicians.
EIN Reports Cases of Hyperviscous Klebsiella pneumoniae with Liver Abscesses
Note: The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of the EIN, the Infectious Diseases Society of America (EIN's sponsor), or the Centers for Disease Control and Prevention, which funds the EIN. The reader assumes all risks in using information posted on this electronic mail conference.
An EIN member in Oregon wrote: “We just discharged a 42-year-old Filipino male after 21 days of hospitalization and 10 drainage procedures for multiple liver abscesses due to a hyperviscous strain of Klebsiella pneumoniae. The illness is consistent with that described in several reports from Southeast Asia and one from North America (Clin Infect Dis. 2007;45:e25-28). The organism had a positive "string test" (figure 1) [described in the CID reference].
Figure 1. Laboratory test results for Klebsiella pneumoniae. A, Results of the string test.
“Has anyone encountered such patients—especially in patients of Asian descent or Hispanics? Our patient responded slowly, if at all, to various antibiotics, or combinations, of antibiotics. To my knowledge, no one has identified a genetic predisposition. We received one suggestion to look for occult chronic granulomatous disease and appropriate tests are in process.”
Here is a sampling of responses:
California: We have had three cases with in the past two months. Two patients are of Asian descent and one is Hispanic. All three had endogenous endophthalmitis and liver abscesses. They seem to have a similar resistance pattern (resistant to ampicillin only). I have not found any genetic predisposition noted in the literature.
Pennsylvania: This invasive syndrome of bacteremic Klebsiella pneumoniae with liver abscess and, occasionally, endophthalmitis is now in the United States! While it is appropriate to search for chronic granulomatous disease, these patients typically have no underlying diseases except for diabetes mellitus, which may become manifest during the infection. The patients are usually Asians who are recent arrivals. We have now seen two cases in non-Asians who have not been to Asia.
The typical presentation in the United States is the finding of K. pneumoniae bacteremia in a patient with liver abscess. The U.S. cases have generally responded poorly because intravenous antibiotics are accepted as the first line of therapy for liver abscess. The Taiwanese ID specialists have learned that expeditious drainage of the abscesses is advantageous.
The key clue will come from the clinical microbiology lab. The Klebsiella has a strikingly large sticky mucoid capsule. A color photo demonstrating the "string test" can be seen on p. 987 of Emerging Infectious Diseases 2007;13:986-993.
Singapore: Screen for undiagnosed diabetes, and look for abscesses in other locations.
I had one chap three years ago, a 46-year-old, previously healthy computer programmer, drinking lots of Coke to meet project deadlines, present with high fevers, leukocytosis, a right arm abscess (13 cm), and two leg abscesses. These were drained by the orthopedists. Blood cultures were positive for Klebsiella, but fevers persisted despite appropriate antibiotics.
Further scanning showed liver and prostatic abscesses, and the stubborn fevers resolved after all collections of pus were found and drained. His HbA1c was 15, and he had five or six separate abscess locations.
Connecticut: I had seen one patient in early 2007 with a similar problem. He was of Asian descent and had a liver abscess—a presumed 'hyperviscous' strain of Klebsiella pneumoniae was obtained from the abscess. The string test was positive. I treated him with ertapenem because we were concerned about other gut flora involved.
In my reading at that time, this phenomenon had been noted in people of Asian descent but the predisposition has not been studied. We did not look for other occult processes. He responded very well to therapy with improvement in the abscesses. I cannot comment about complete resolution because he moved to another city and changed providers.
California (2): I recently had a 50-year-old Caucasian female with extensive colon cancer stage 4 with multiple metastases to her liver who developed biliary obstruction; a stent was placed by interventional radiology. She had Klebsiella (resistant to ampicillin) sepsis, and multiple abscesses after the stent was obstructed due to metastases; it was drained but she still had several abscesses. Due to extensive metastases, no further drainage was done. She died a week ago from sepsis and extensive cancer.
Oregon (original poster): Looks like we have a problem. When you look under the rock…
EIN is interested in any additional reports of cases of this pathogen. Please e-mail email@example.com with any information.
IDSA E-mail Alerts: Ricin, Influenza, HIV/AIDS, Other ID Topics
IDSA offers two e-mail services to help members stay informed of updates from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). Recent alerts have included:
IDSA frequently sends subscribers messages from the CDC regarding urgent public health issues, as well as ID-related messages from CDC and FDA on label changes, adverse events, newly approved drugs, and other safety information on FDA-approved drugs and biologics.
To sign up for these services, IDSA members can visit http://www.idsociety.org/Content.aspx?id=4250.
Fluoroquinolone-resistant Meningococcus Reported
The first cases of ciprofloxacin-resistant Neisseria meningitidis in North America have been reported along the border of North Dakota and Minnesota.
Three cases of ciprofloxacin-resistant serogroup B N. meningitidis infection including one fatality occurred this January, according to the Centers for Disease Control and Prevention (CDC). All three were indistinguishable by several assays including pulsed-field electrophoresis and multilocus sequence typing, and all had identical gyrA gene sequences conferring resistance. The first case was epidemiologically linked to an August 2006 fatality. Isolates from the 2006 patient were sensitive to ciprofloxacin, however.
CDC is advising practitioners in the region not to use ciprofloxacin for prophylaxis of close contacts. Ceftriaxone, rifampin, and azithromycin are recommended instead.
The cases are reported in the Feb. 22 issue of Morbidity and Mortality Weekly Report, which lists the counties where ciprofloxacin prophylaxis is not recommended.
North Dakota and Minnesota public health officials and CDC are conducting a survey to determine how common fluoroquinolone-resistant meningococcus is among area residents. CDC is also testing existing isolates for resistance and conducting surveillance for additional cases.
CDC is encouraging laboratories to check isolates for fluoroquinolone resistance, particularly among serotype B isolates. Resistant isolates, as well as cases of meningococcal disease that fail ciprofloxacin treatment, should be reported to local health officials, and to CDC’S Meningitis and Vaccine Preventable Diseases Branch at (404) 639-3158.
In the IDSA Journals
Vaccine-derived Poliovirus Is As Virulent as Wild Virus
An unusual twin outbreak of wild-type poliovirus (WPV) and circulating vaccine-derived poliovirus (cVDPV) in Indonesia in 2005 demonstrated that cVDPV is as potent as WPV. Previous cVDPV outbreaks had caused relatively few paralytic cases, leading some to propose that cVDPV might have a lower virulence and attack rate than WPV. The 2005 outbreak on the Indonesian island of Madura was the largest on record, with at least 45 cases. It demonstrated the risks posed by low immunization rates among subpopulations, and the need for vigilant surveillance. (Estívariz et al., J Infect Dis. 2008;197:347-354; commentary by Wright and Modlin, J Infect Dis. 2008;197:335-336.)
Trichomonas Infection Is Associated with Increased HIV Risk
Trichomonas vaginalis is the most common nonviral sexually transmitted disease worldwide. The odds ratio of HIV acquisition among women infected with T. vaginalis was 2.74 in this nested case-control study of a general-population cohort, after controlling for hormonal contraception, other STIs, and behavioral and demographic factors. (Van Der Pol et al., J Infect Dis. 2008;197:548-554; commentary by McClelland, J Infect Dis. 2008;197:487-489.)
Vitamin D and Tuberculosis
Studies have shown a relationship between vitamin D deficiency and rates of Mycobacterium tuberculosis infection in immigrants from areas of endemicity. The authors examined the association between moderate-to-severe 25(OH) vitamin D deficiency and M. tuberculosis infection, particularly latent tuberculosis infection, among 375 African immigrants to Australia. They found an inverse relationship between vitamin D levels and both the likelihood of any M. tuberculosis infection and the likelihood of having or having had active tuberculosis. This study adds to the evidence that vitamin D has a role in cell-mediated immunity. (Gibney et al., Clin Infect Dis. 2008;46:443-446.)
Clostridium difficile-attributable Cost
The care of patients who develop infection due to C. difficile can be costly. In this study, performed at a Missouri hospital, the authors calculated the cost of the initial hospitalization with C. difficile–associated disease (CDAD) and the costs of subsequent hospitalizations for CDAD within six months after the initial hospitalization. They used two methods: linear regression and propensity score matched-pair analysis. By linear regression, the cost-of-care per episode was $2,454, and the inpatient cost over a six-month period was $5,042. By propensity score, the per-episode cost was $3,240, and the six-month inpatient cost was $7,179. (Dubberke et al., Clin Infect Dis. 2008;46:497-504.)
Tigecycline and Drug-resistant Gram-negative Bacilli
Tigecycline is active against many multidrug-resistant gram-negative bacilli, but drug resistance is not uncommon and may emerge during treatment. A retrospective review in one center showed that five of nine Acinetobacter baumannii isolates demonstrated intermediate resistance to tigecycline before treatment and that another isolate developed full resistance during treatment. Given this evolution of drug resistance and the availability of other therapies, the authors question the routine use of tigecycline for infections due to multidrug-resistant organisms. (Anthony et al., Clin Infect Dis. 2008;46:567-570.)
In Wake of Unusual Case, Immunization Experts Seek to Reassure Public about Vaccine Safety
Following an unusual vaccine injury case in the U.S. Court of Federal Claims, immunization experts are seeking to address the public’s concerns about vaccine safety.
The case involved a previously healthy 19-month-old child who received five shots in a single day because she was behind on the immunization schedule. She subsequently developed symptoms of autism. A muscle biopsy and genetic testing revealed that she had a preexisting mitochondrial dysfunction disorder. The court agreed to pay the family from the National Vaccine Injury Compensation Program, which compensates people who likely have been injured by vaccines.
Although some media reports have been confusing, the decision to provide compensation to the family was not made on the basis of thimerosal exposure in vaccines, said Neal A. Halsey, MD, of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health. Dr. Halsey chairs IDSA’s Immunization Work Group. “Neither the Department of Justice nor the U.S. Public Health Service has decided that vaccines cause autism, as alleged in statements made by some individuals to the press,” he said.
In fact, officials from the Centers for Disease Control and Prevention have stressed that the child represents one special case and does not change the immunization recommendations for children.
The child’s case has been described in an article published in the medical literature. (See abstract at Developmental Regression and Mitochondrial Dysfunction in a Child with Autism, J Child Neurol 2006; 21; 170.)
“This child unfortunately has an underlying disorder of mitochondrial dysfunction that affects the body’s ability to deal with stress and respond to infections or other immunological stimuli,” said Dr. Halsey. “Children with mitochondrial dysfunction often develop neurological problems, including developmental regression, as was reported in this child. Infections and other stresses can trigger neurologic complications in these children. The vaccines she received protect against several diseases which could have caused her similar problems.”
According to Dr. Halsey, the decision to provide compensation appears to be based on the underlying condition and the presumption that the administration of vaccines may have resulted in oxidative stress similar to what can occur with infections. The vaccine court can make decisions based on less strong evidence than would be accepted in other forums.
Various experts have pointed out that there is no established link between vaccines, mitochondrial disorders, or autism. It is not known whether the underlying disease would have progressed in the same way if the child had not been vaccinated.
More information about the case is expected to be released in May.
For more information, see:
Information on the Vaccine Injury Case
Information about the National Vaccine Injury Compensation Program
Information on Thimerosal
Information on Vaccines, Autism, Mitochondrial Disease
Infection Prevention Brochure Updated
The Joint Commission recently revised its Five Things You Can Do to Prevent Infection brochure.
IDSA and other organizations contributed their expertise to the revision. The brochure encourages people to clean their hands, make sure health care workers clean their hands or wear gloves, cover their mouths and noses when they sneeze or cough, avoid close contact with others when sick, and stay up to date on immunizations.
The brochure is part of a patient safety initiative, “Speak Up,” launched in 2002 in collaboration with the Centers for Medicare and Medicaid Services to help prevent medical errors by equipping patients to become active, informed participants in their own health care.
The “Speak Up” program has developed other brochures, posters, and buttons on a variety of related topics. For more information visit http://www.jointcommission.org/GeneralPublic/Speak+Up/.
New Toolkit Helps Community Leaders Prepare for Pandemic Influenza
The Department of Health and Human Services (HHS) has released a toolkit to help community leaders educate their constituents about steps they can take to prepare for an influenza pandemic. The 21-item toolkit, called, "Take the Lead: Working Together to Prepare Now," is aimed at leaders in the health care, business, faith-based, and civic communities. It is designed to help them spread the word about the critical need for individual pandemic influenza preparedness. It includes:
- information about pandemic influenza
- ready-to-use and ready-to-tailor resources prepared by HHS and the Centers for Disease Control and Prevention (CDC) including fact sheets, posters, and sample e-mails and newsletter articles
- incentive ideas and materials to encourage organizations to prepare and to encourage other leaders to get involved
HHS developed the kit with CDC and input from community leaders. The complete kit is available for download at the pandemicflu.gov website. Visit http://pandemicflu.gov/takethelead/full_toolkit.pdf.
Hib Vaccination Increasing in Low-income Countries
The percentage of the world’s children who have been fully immunized against Haemophilus influenzae has increased substantially in the last several years, according to the Centers for Disease Control and Prevention (CDC).
In 1999, only 8 percent of the birth cohort received all three doses of the Hib vaccine. In 2006, that figure grew to 22 percent of the birth cohort. Those figures are expected to grow further as 23 additional countries are expected to introduce the vaccine in 2008.
The increase is an outgrowth of recent efforts by the public-private partnership the Global Alliance for Vaccines and Immunizations (GAVI). GAVI helps supply vaccines in countries with gross national incomes under $1,000 per capita.
GAVI started an initiative 2005 to accelerate adoption of Hib vaccine in GAVI-eligible countries. In 2004, 13 eligible countries were using the vaccine. By 2007 the figure had increased to 47. At least eight more applications are expected this year.
Success with the Hib vaccine suggests similar strategies may be effective to speed up introduction of new vaccines such as the rotavirus and pneumococcal vaccines.
The results appear in the Feb. 15 issue of Morbidity and Mortality Weekly Report.
Indonesia Sends WHO First H5N1 Samples in Months
For the first time in at least six months, Indonesia has submitted H5N1 influenza virus samples to the World Health Organization (WHO) for analysis.
The two samples are from patients whose cases WHO confirmed in February. Both were from the suburbs of Jakarta. One died of the infection; the other was hospitalized after her mother died of H5N1 influenza.
Indonesia stopped sending samples because of concerns that any vaccine produced from them by Western pharmaceutical companies would be too expensive for low-income countries like Indonesia to afford. Meetings between officials from WHO and Indonesia on virus-sharing policy have not yet produced an agreement.
Indonesia’s health minister says the samples are for evaluation only and may not be used for vaccine production without Indonesia’s permission.
It is unclear whether Indonesia will continue sending influenza virus samples for analysis.
President Announces Initiative to Fight Neglected Tropical Diseases
President Bush recently announced a new initiative designed to considerably decrease the impact of neglected tropical diseases in developing countries. The President’s New Global Initiative to Combat Neglected Tropical Diseases, announced on Feb. 20, will increase the U.S. commitment in this area from $15 million to $350 million by 2013.
These funds will provide integrated treatment to more than 30 million people to treat such diseases as lymphatic filariasis (elephantiasis); schistosomiasis (snail fever); trachoma; onchocerciasis (river blindness); and three soil-transmitted helminths–hookworm, roundworm, and whipworm.
Peter Hotez, MD, PhD, president of the Sabin Vaccine Institute and executive director of the Global Network for Neglected Tropical Diseases, is pleased with the announcement. “Many of the afflicted are the world’s poorest citizens who have nowhere else to turn for treatment,” he said. “With this announcement, President Bush has sent a strong signal that the United States cares deeply about those who are so often forgotten. The Initiative says that these diseases should be neglected no more.”
A fact sheet about the initiative is available from the White House website.
How to Code for Extra-long Subsequent Hospital Visits
Let’s say your partner saw a patient in the hospital and billed using one of the current procedural terminology (CPT) codes for an initial consultation, 99251 through 99255. A few days later you see the same patient, who has developed significant complications and requires more than 30 minutes of additional bedside time. How do you account for the work of your extra-long follow-up visit? Must you use subsequent hospital care CPT codes (99231 through 99233) or can you use another consultation code? What about the prolonged services add-on CPT codes (99356-99357)?
According to Larry Martinelli, MD, FIDSA, chair of IDSA’s Clinical Affairs Committee, even though the patient has developed new and significant complications, your work is considered subsequent hospital care and is most likely covered under the subsequent hospital care CPT codes (99231 through 99233). Dr. Martinelli said only under rare circumstances might billing for a new consult be allowed. “If the request is for a new problem and some time has passed since anyone from the group has seen the patient and a new consult request is written for the new problem, then maybe it is okay to bill a new consult,” he said.
However, you can bill prolonged-service CPT codes (99356 through 99357) in conjunction with subsequent hospital care CPT codes (99231 through 99233) if you are engaged in an additional 30 minutes of direct (face-to-face) contact with a patient. Use CPT code 99356 to report prolonged services of 30 to 74 minutes. Use CPT code 99357 to report each additional 30 minutes of prolonged service time. Since prolonged services are add-on codes, modifiers are not needed.
For more information about billing and coding or other practice management issues, IDSA members and their practice managers are invited to join the Practice Management listserve at http://www.idsociety.org/practicemanagement.
IDSA Advocacy Update
Protecting Infectious Diseases Program Funding, Supporting Pandemic Planning
As Congress debates funding levels for federal infectious diseases programs, IDSA is working to protect infectious diseases programs at the National Institutes of Health and Centers for Disease Control and Prevention as well as to support additional funding in key areas. IDSA’s efforts are in response to significant funding cuts in President Bush’s proposed budget for fiscal year (FY) 2009.
IDSA’s recent letter to Congress focuses on protecting and strengthening antimicrobial resistance, immunization, HIV/AIDS, pandemic influenza and other key program funding.
IDSA and the Trust for America’s Health also have urged Congress to significantly increase funding in FY 2009 for the Biomedical Advanced Research and Development Authority (BARDA). BARDA’s mission is to support research and development of critically needed medical countermeasures against biological, chemical, nuclear, and radiological attacks as well as naturally occurring threats such as pandemic influenza.
The Society also signed on to a letter developed by the Working Group on Pandemic Influenza urging Congress to adequately fund pandemic influenza activities in FY 2009.
Other advocacy efforts include:
NIAID Resistance Research Agenda, Shortcomings Highlighted in JID
The National Institute of Allergy and Infectious Diseases (NIAID) has outlined its priorities for research into antimicrobial resistance and antimicrobial research in an article in the April 15 issue of The Journal of Infectious Diseases (JID). An accompanying commentary questions whether NIAID’s agenda is focused on the right pathogens or the right questions.
NIAID currently spends $800 million per year in antimicrobial research, according to the article, co-authored by NIAID Director Anthony S. Fauci, MD, FIDSA. That includes $200 million annually in research to better understand the causes, consequences, and treatments of drug resistance.
The article says NIAID has taken a multi-faceted approach to addressing resistance by funding research, partnering with public and private agencies, and creating a flexible infrastructure to respond to emerging needs. NIAID funding currently supports several key areas, including:
- Developing rapid, more sensitive and specific diagnostic tests for invasive bacterial infections
- Determining doses that balance the effectiveness of a drug with its toxicity
- Studying the structure and physiology of bacterial biofilms to prevent or disrupt their formation
NIAID wrote the article in part to respond to IDSA inquiries about the institute’s resistance research agenda. Antimicrobial resistance is one of IDSA’s key issues and is the subject of the Society’s ongoing “Bad Bugs, No Drugs” campaign.
As part of that campaign, IDSA has identified several resistant pathogens for which antimicrobial research is gravely lacking. In the editorial commentary accompanying the NIAID article, Louis B. Rice, MD, chief of medical service at Louis Stokes Cleveland VA Medical Center and chair of IDSA’s Research on Resistance Work Group, picked up on that theme. He named six antibiotic-resistant bacteria that have become dominant pathogens in health care settings around the world, which he called “the ESKAPE bugs”:
- Enterococcus faecium
- Staphylococcus aureus
- Klebsiella pneumoniae
- Acinetobacter baumanni
- Pseudomonas aeruginosa
- Enterobacter species
Dr. Rice said research into these pathogens is especially important because lessons learned studying them “could be applied to virtually any species that attempts to take their place.”
But it is difficult to tell how much of NIAID’s $800 million budget for antimicrobial research is dedicated to these key pathogens because the funding is spread out across antivirals (including HIV), antibiotics (including tuberculosis), antiparasitics (including malaria), and antifungals, and also includes prevention and vaccine research.
Dr. Rice noted that even after nearly eight decades of use, some of the most basic research questions about antibacterial therapy remain. “For most bacterial infections, minimal lengths of treatment have never been defined,” he said. “The benefit of antimicrobial therapy over placebo for many common infections (such as otitis media or sinusitis) remains murky. The use of combinations of antibiotics is widespread, without conclusive evidence of benefit in most circumstances.” Much more needs to be learned about basic infection-control measures, he added, as well as the best ways to effectively disseminate them.
Following discussions with IDSA leaders, an NIAID advisory council has endorsed in concept clinical trials to answer some of these questions. Furthermore, the IDSA-endorsed Strategies to Address Antimicrobial Resistance (STAAR) Act, a bill currently under consideration in Congress, would strengthen federal coordination of surveillance, prevention, and control, and research activities. IDSA also is advocating for an increase of $100 million in 2009 for clinical research into antimicrobial resistance research at NIAID.
IDSA has mobilized more than a dozen key medical, public health and healthcare organizations to endorse the STAAR Act. See the coalition’s recent letter to Congress.
Stay tuned for updates on these and other important developments in antimicrobial resistance research.
Welcome, New IDSA Members!
Beil, Robert, MD
Boutlis, Craig, MD, PhD
Gough, Kevin, MD
Houston, Stan, MD
Lievano, Fabio, MD
Monteforte, Melinda, PharmD
Oliver-Commey, Joseph, MD
Orwig, Kara, PharmD
Roberts, Fred, MD, FRCPC
Rosenthal, Victor, MD
Theodoros, Kelesidis, MD
Winn, Robert, MD
Kaech, Susan, PhD
Abaaba, Abiedu, MD
El Khoury, Marc, MD
Gjino, Alma, MD
Grein, Jonathan, MD
Guffey, Michael, MD
Husarsky, Eliot, MD
Kapoor, Rama, MD
Kilgore, April, MD
Maron, Gabriela, MD
Mir, Fatima, MBBS
Murphy, Michael, MRCP
Naseer, Shabnam, DO
Naz, Farah, MBBS, DCH
Nguewou, Annick, MD
Shaikh, Zahirabanu, MD
Shust, Gail, MD
Vidwan, Navjyot, MD