IDSA News - October 2008
Vol. 18 No. 10
(Print All Articles)

SHEA, IDSA, and Partners Publish Strategies to Prevent Health Care-associated Infections

Diana Olson

For the first time, the Society for Healthcare Epidemiology of America (SHEA), IDSA, and three other leading health care organizations have come together to publish practical, evidence-based strategies to help hospitals prevent six of the most important health care-associated infections (HAIs). Hospitals should take note; otherwise their accreditation could be at risk.

For the first time, the Society for Healthcare Epidemiology of America (SHEA), IDSA, and three other leading health care organizations have come together to publish practical, evidence-based strategies to help hospitals prevent six of the most important health care-associated infections (HAIs). Hospitals should take note; otherwise their accreditation could be at risk.

The Compendium of Strategies to Prevent Health Care-Associated Infections in Acute Care Hospitals was produced by SHEA and IDSA in partnership with the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), and The Joint Commission, and is endorsed by an additional 29 health care organizations.

There are already more than 1200 recommendations on HAI prevention, said SHEA President P.J. Brennan, MD. What has been missing is clear, practical guidance on how to implement the best, evidence-based strategies. “Too often where we fail is not in knowledge, but in execution,” he said. The compendium attempts to address that shortfall.

“Not all HAIs are preventable, but it is imperative that we implement practices that we know are effective to prevent as many of these infections as possible,” said SHEA spokeswoman Deborah S. Yokoe, MD, lead author of the strategies.

“We looked at all existing HAI guidelines and literature to create recommendations that are understandable, easy-to-use, and stress accountability,” said David Classen, MD, IDSA spokesman and co-author of the strategies. Unlike other recommendations, the compendium outlines not only what hospitals should be doing but also what they should not do—because the science doesn’t support it.

The compendium follows an easy-to-use, outline format with checklists, advice on who should be responsible for what specific tasks, and details about the infrastructure that’s needed to accomplish the various strategies. Measures are included so that hospitals can chart their progress. “If you don’t measure it, you don’t improve,” said Dr. Classen.

The Joint Commission has incorporated the compendium’s recommendations into its 2009 National Patient Safety Goals. Starting this year, all hospitals will have to review their current practices and risks, and decide which of the compendium strategies they need to implement. In 2010, the recommendations will be added to The Joint Commission’s accreditation standards.

“As of today, the nation’s infection control team has a common playbook,” said Rich Umbdenstock, president and CEO of AHA at a press conference announcing the compendium.

 Recommendations are prioritized into two categories:

  1. Minimum basic practices that should be adopted by all acute care hospitals—such as removing catheters as soon as they are no longer necessary
  2. Special approaches for use in locations or populations within hospitals when infections are not controlled using basic practices. The evidence for using these approaches isn’t as strong as it is for the basic practices, or the benefit is seen mostly in outbreak settings—such as chlorhexidine baths or universal MRSA screening.

Two sections focus on preventing spread of specific organisms:

Four sections focus on device-and procedure-associated HAIs:

The compendium will be published as a supplement to SHEA’s journal Infection Control and Healthcare Epidemiology.

Accompanying the compendium are user-friendly patient guides that were authored by SHEA and endorsed by the Centers for Disease Control and Prevention, IDSA, and the other partners. The compendium, patient guides, and related materials are available online at www.shea-online.org/compendium.cfm.

ID Specialists Have New Negotiating Tool

Diana Olson

As emphasis on quality of care grows and reimbursement for hospital-associated infections declines, infectious diseases specialists have a growing opportunity to demonstrate their value as practitioners of infection control.  A new tool can help you justify your value and make your case effectively in negotiations with your hospital administration.

As emphasis on quality of care grows and reimbursement for hospital-associated infections declines, infectious diseases specialists have a growing opportunity to demonstrate their value as practitioners of infection control.  A new tool can help you justify your value and make your case effectively in negotiations with your hospital administration.

In “The Value of Infectious Diseases Specialists: Non-Patient Care Activities,” published in the October 15 issue of Clinical Infectious Diseases, Daniel P. McQuillen, MD, and colleagues from IDSA’s Clinical Affairs Committee have compiled the data supporting the importance of ID specialists in critical areas such as antimicrobial stewardship, infection control, and preventing and managing outbreaks among health care workers. The manuscript aims to help ID specialist successfully articulate their role in the quality-of-care and risk-management arenas.

In one study of a 174-bed community hospital, for example, a concurrent review program initiated by an ID specialist achieved $250,000 in annual cost savings while simultaneously reducing the prevalence of nosocomial infection due to Clostridium difficile and drug-resistant Enterobacteriaceae. Other studies have shown that ID consultations can improve care, outcomes, and costs for patients with Staphylococcus aureus bacteremia and other infections. These studies are cited in helpful, easy-to-use charts in the McQuillen manuscript.

The manuscript also includes sections on how to put the data to use in your negotiations and how to use words and phrases that are helpful in making your case. The authors point out that phrases such as, “I’m sure we are both concerned with the rising costs of antibiotic use for conditions such as ventilator-associated pneumonia and central line-related sepsis” are more likely to invite agreement and discussion, compared to a negative statement such as, “You must have been aware of this need for years.”

IDSA Journal Club, September 2008

This month: influenza symptoms in hospitalized patients; oseltamivir resistance rising; antiviral treatment and hepatitis C cirrhosis; Bartonella and chronic neurological symptoms; HPV in men; and new data on HAART and cardiovascualr risk. 

In this feature, a panel of IDSA members identifies and critiques important new studies that have a significant impact on the practice of infectious diseases medicine.

For more from Clinical Infectious Diseases and The Journal of Infectious Diseases, see the "In the IDSA Journals" section of IDSA News.

 


Influenza Definition Misses Many Hospitalized Patients
Sara Cosgrove, MD, MS

The traditional definition of influenza-like illness (ILI)—presence of fever plus cough or sore throat—does not accurately predict infection with influenza in hospitalized patients, particularly those with asthma, according to a study in the October issue of Infection Control and Hospital Epidemiology

The authors hypothesized that influenza may present differently in hospitalized patients compared to ambulatory patients due to underlying conditions, especially pulmonary conditions. Over three influenza seasons (2001-2004), investigators compared 123 general medicine patients found to have laboratory-confirmed influenza infection with 246 control patients who tested influenza-free.

 Although cough, fever, myalgia, and sore throat were more common in patients with influenza than controls, only 43 percent of case patients (53 of 123) met the definition of ILI.  The ILI definition was only 43 percent sensitive and 86 percent specific. The sensitivity increased to 91 percent if cough alone was used to predict influenza.  In patients with asthma, the sensitivity of using the ILI definition was 21 percent. 

This study further confirms the difficulty in predicting which hospitalized patients have influenza and identifies adult patients with asthma as a group where the diagnosis is particularly likely to be missed.  In addition to ensuring that patients are offered and encouraged to receive annual influenza vaccination, providers should strongly consider ruling out influenza in any adult patient with asthma or a new cough being admitted to the hospital during influenza season.  (Babcock et al., Infect Control Hosp Epidemiol 2008;29:921-926.)

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Oseltamivir Resistance Rising
Sara Cosgrove, MD, MS

In another report, published in the September issue of Antimicrobial Agents and Chemotherapy, 8.6 percent of A(H1N1) influenza viruses in the United States during the 2007-2008 influenza season were found to be resistant to oseltamivir, the most commonly used neuraminidase inhibitor.  This represents a significant increase from previous seasons and emphasizes the importance of judicious use of neuraminidase inhibitors in the management of patients with suspected influenza. (Sheu et al., Antimicrob Agents Chemother. 2008;52:3284-92.)

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Hepatitis C Therapy Can be Effective in Cirrhotic Patients
Khalil Ghanem, MD

A study published in the September 16 issue of the Annals of Internal Medicine found that the treatment of hepatitis C in cirrhotic patients can lead to regression of cirrhosis and improved clinical outcomes.

Some clinicians question the value of antiviral therapy for hepatitis C patients with cirrhosis. To address this issue, the authors retrospectively evaluated 96 cirrhotic patients infected with hepatitis C who were treated between 1988 and 2001 with various interferon-based regimens, with or without ribavirin, and who had pre- and post-treatment liver biopsies available. Eighteen of these patients experienced regression of cirrhosis following therapy.

The authors then compared those who experienced histological regression of cirrhosis to those who did not. The outcome measures of interest were a combined liver end-point (ascites, hepatic encephalopathy, bleeding, bacterial peritonitis, liver cancer, and liver transplantation) and death.

After a median of 118 months of follow-up, none of the patients who demonstrated regression of cirrhosis experienced any of the liver-related complications described above, compared to 27 patients in the group that did not. Similarly, no patient with regression of cirrhosis experienced liver-related death or transplantation compared to 22 of those without regression.

Although the study was retrospective and many patients were treated with interferon regimens that are currently not considered standard of care, this study clearly demonstrates that regression of cirrhosis is possible and that antiviral treatment of patients with hepatitis C and liver cirrhosis is justified. (Mallet et al., Ann Intern Med. 2008:149;399-403.)

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Bartonella Bacteremia and Neurological Symptoms
Khalil Ghanem, MD

A case series published in the September issue of the Journal of Clinical Microbiology suggests an association between chronic neurological symptoms and Bartonella species bacteremia in patients with documented animal or arthropod exposures.

The authors report six cases of immunocompetent patients who presented with a myriad of subacute to chronic neurological symptoms (including seizures, paralysis, headaches, fatigue, memory loss, and visual disturbances) and who were found to have bacteremia with Bartonella henslea and/or Bartonella vinsonii subspecies berkhoffii. All six patients reported clear exposures to cats (mostly scratches or bites), arthropods, farms, or farm animals. The duration of neurological symptoms lasted from one month to five years. In most of these cases, treatment of the infection led to subjective improvement of the neurological symptoms.

In addition to serological testing, the investigators used broth enrichment methods coupled with molecular diagnostics to document infection. These methods are not routinely available in clinical laboratories.

The association noted in this paper is interesting but far from definitive. Given that infectious diseases clinicians are often asked to evaluate patients with neurological symptoms of unclear etiology, the possibility of Bartonella infection can be entertained when evaluating patients with clear animal or arthropod exposures.  (Breitschwerdt et al., J Clin Microb. 2008:46; 2856-2861.)

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HPV Infection: Common in Men, But a Little Bit Different.
Jason Weinberg, MD

Human papillomavirus (HPV) infection is common in men, but its epidemiology is somewhat different than in women, according to a study in the September 15 edition of The Journal of Infectious Diseases.

HPV infection is associated with cancers both in women and men, and sexual transmission of HPV from men affects disease in women.  HPV vaccine trials are underway in men, but very little is known about the natural history of HPV infection in men.  In this prospective cohort study, samples were obtained from 290 adult male subjects every 6 months. Subjects were followed for a median of 15.5 months.

HPV prevalence and incidence in men in this study were similar to those previously reported for women: 52.8 percent of men were infected with HPV over the course of this study, compared to 53.8 percent of women in the authors’ previous work; and both studies found an incidence rate of 29.4 per 1000 person-months.  However, while studies have shown women are more likely to acquire HPV at a younger age, men did not show as clear an age trend in this study. Men cleared both oncogenic and nononcogenic HPV infections within six months on average, while oncogenic infections have appeared to linger longer in women.

Although not the focus of the study, the behavioral data highlight the fact that many men become sexually active at an early age, have multiple sexual partners, and do not consistently use condoms, which emphasize the potential for HPV infection in men to directly affect women's health.

While the study provides valuable information about the natural history of HPV infection in men, it has a relatively small sample size and limited duration of follow-up.   I would also note that uncircumcised men, who some studies suggest may be at increased risk for HPV infection, were underrepresented in the patient population. (Giuliano et al. J Infect Dis. 2008;198:827-35.)

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New Data on HAART Risk for Heart Disease in Adults and Children
Sabrina Kendrick, MD

Abacavir—but not didanosine—was associated with an increased risk of cardiovascular disease (CVD) in a study in the September 12 issue of AIDS. Also, a separate pediatric study found protease inhibitor therapy was a significant contributor to increased risk of CVD in HIV-infected children.

Both abacavir and didanosine have been associated with CVD in previous studies. In the AIDS study, from the Strategies for Management of Anti-Retroviral Therapy (SMART) and the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Groups, patients receiving abacavir were compared to those receiving didanosine and to those receiving other nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs).

Compared to other NRTIs in the multivariate analysis, abacavir use was associated with a more than four-fold increased risk of clinical myocardial infarction and nearly double the risk of other major CVD events including stroke, coronary artery disease, and death. In a subset of patients at study entry, the inflammation biomarkers C-reactive protein and interleukin-6 were each significantly higher for patients receiving abacavir compared to those receiving other NRTIs. The authors propose that abacavir may precipitate a CVD event through subclinical atherosclerosis manifested clinically by vascular inflammation. Didanosine was not associated with abnormal biomarker levels nor altered CVD risk.

There are several limitations, the main being the observational design and the inability to assign causal effect of potential underlying biological mechanisms. Also, the numbers associated with the CVD outcomes were small and limited the power of the analysis. It’s compelling that two observational studies come to the same result (co-authors of this study reported similar findings in Lancet 2008;371:1417-1426), but I don’t believe it is enough evidence to change patterns of abacavir use. (SMART/INSIGHT and D:A:D Study Groups, AIDS. 2008;22:F17-F24.)

The second study, a small prospective longitudinal analysis to determine risk factors for CVD in HIV-infected children, appears in the October issue of The Journal of Pediatrics. Forty-two perinatally infected children were compared with controls from National Health and Nutrition Examination Survey (NHANES) data. The significant findings suggest protease inhibitor therapy—but not nonnucleoside reverse-transcriptase inhibitor therapy—is associated with adverse lipid profiles, increasing risk for premature CVD. (Miller et al., J Pediatr 2008;153:491-7.)

Both studies underscore the increasing problem of cardiac morbidity and mortality as adult and pediatric HIV-infected populations live longer. Larger, randomized control trials are needed to elucidate the problems.

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CDC Expands Testing Recommendations for Hepatitis B

Stephanie Cox

The Centers for Disease Control and Prevention (CDC) has published new recommendations to increase routine testing in the United States for chronic hepatitis B, a major cause of liver disease and liver cancer.

CDC now recommends routine testing for individuals born in Asia, Africa, and other geographic regions with a 2 percent or higher prevalence of chronic hepatitis B virus infection. Expanded testing is essential because the rate of liver cancer deaths and chronic hepatitis B in the United States remains high among these groups.

The expanded recommendations also include testing of injection drug users and men who have sexual contact with other men, CDC continues to recommend testing all pregnant women, infants born to infected mothers, household contacts and sex partners of infected individuals, and people with HIV.

These new recommendations are critical to identifying people who are living with the disease without the benefits of medical attention. According to CDC, chronic hepatitis B virus infection affects the lives of as many as 1.4 million Americans.  However, because many chronic hepatitis B virus infections are either asymptomatic or never reported, the actual number of people with infections is estimated to be higher.

The report also advises that persons with chronic hepatitis B virus infections be referred to specialists for ongoing monitoring and medical care. Several new therapies are available, which can delay or reverse the effects of liver disease. In addition, the recommendations urge health care professionals to educate their patients about hepatitis B, begin lifelong monitoring for progression of liver disease, and ensure protection of close contacts of infected persons.

The recommendations are published in the September 19 issue of CDC’s Morbidity and Mortality Weekly Report Recommendations & Reports. Visit CDC’s website for more information for health care workers on chronic hepatitis B infection.

EIN: Rates of a Rare Disease Rising?

Steve Baragona

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 EIN, IDSA (EIN's sponsor), or the Centers for Disease Control and Prevention, which funds the EIN. The reader assumes all risks in using this information.

Cases of Lemierre’s disease may be increasing in some areas, according to anecdotal reports from members of the Emerging Infections Network (EIN), and some cases have been caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA).

A rare but life-threatening illness, Lemierre’s is characterized by septic internal jugular vein thrombophlebitis. Typical cases of Lemierre’s occur following a sore throat, when invasive Fusobacterium species take up residence in an abscess in the mouth, pharynx, neck, or head created by the sore-throat pathogen and then travel to the jugular vein. Septic emboli may move to the lungs, causing shortness of breath, chest pain, and pneumonia. A handful of cases are reported each year nationwide, usually among young, previously healthy patients.

Although several members—from New York to Minnesota to California—reported no change in the number of Lemierre’s cases, others from around the country said they have experienced increases. Several reported having seen their first cases in years, sometimes decades. For example, a member in Ohio described having seen two adolescent cases in the last four years and none in the previous 20 years.

One member referenced an abstract presented at the Pediatric Academic Societies’ Annual Meeting showing that of the 13 cases identified in a Utah health care system from 2002 to 2007, eight were in the last two years.  They concluded that Lemierre’s and Lemierre’s-like syndrome  is identified with increasing frequency and the “range of pathogens is expanding, and includes multidrug-resistant Fusobacterium sp. and MRSA.”

In addition, several others reported cases of Lemierre’s-like disease caused by MRSA. A member in Georgia said, “We have seen a presumptive septic jugular thrombophlebitis with septic pulmonary emboli related to MRSA. The increased incidence of the community-acquired MRSA strain across the country may contribute to the increased cases, but obviously these are not related to Fusobacterium.”

Clinicians are advised to have a high index of suspicion for Lemierre’s. Another abstract showing increasing rates of Lemierre’s disease is scheduled to be presented at the 48th ICAAC/IDSA 46th Annual Meeting this month in Washington, DC.


E-mail the Emerging Infections Network. 

The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public-health community detect trends in emerging infectious diseases.

A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) and supported by funding from the Centers for Disease Control and Prevention, EIN tracks emerging infectious diseases and keeps the public-health community up to date with issues that are currently affecting or may soon affect members’ clinical practices.The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. The EIN listserve allows members to discuss new disease trends and difficult cases. Click here for more information or to join EIN.

Drug Approvals, Recalls, Adverse Events Update

Rebecca Dotson
Teaser here

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:

FDA Alert

CDC Alert

IDSA members can sign up for this service online. (You must be logged in to have access to this link.)

In the IDSA Journals

Steve Baragona

Intradermal Shot Improves Influenza Vaccine Response in Older Adults

Adults over age 65 have the highest annual mortality from influenza and have decreased immune response to influenza vaccine, which is normally delivered intramuscularly. Researchers used a simple, reliable microinjection system to deliver trivalent influenza vaccine intradermally to more than 700 subjects with an average age of 70. Immune responses, as measured by antibody titers, seroprotection rates, and seroconversion rates, were superior in these individuals when compared to control subjects who received vaccine intramuscularly. The overall frequency of systemic adverse events was equivalent between intradermal and intramuscular immunization. Local reactions, e.g., erythema, swelling, induration, and pruritus, were more common in the intradermal group, but were mild. (Holland et al., J Infect Dis. 2008;198:650-658. Editorial commentary by McElhaney and Dutz, J Infect Dis. 2008;198:632-634.)

H5N1 Vaccines: Good News on Priming, Cross-reactivity, Dose Sparing

Two studies provide good news on influenza A H5N1 vaccines. In the first, 37 subjects previously vaccinated against a clade 0 strain of the virus (A/Hong Kong/156/1997) in studies conducted in 1997-1998 were given one dose of vaccine derived from a newer, clade 1 strain (A/Vietnam/1203/2004). Sixty-eight percent of these subjects had positive immune responses (4-fold increase in antibody level to a titer of 1:40 or greater), compared to 43 percent of 103 H5N1-naïve subjects given two doses of the clade 1 vaccine. (Goji et al., J Infect Dis. 2008;198:635-641). In the second study, an oil-in-water adjuvanted vaccine was safe and immunogenic at 1.9 µg of antigen, the lowest effective dose yet studied. This clade 1 vaccine also demonstrated cross-reactivity against clade 2 virus.  These studies advance our knowledge regarding potentially useful H5N1 vaccines and point to new strategies for pandemic influenza preparedness. (Levie et al., J Infect Dis. 2008;198:642-649. Editorial commentary discussing both studies by Poland and Sambhara, J Infect Dis. 2008;198:629-631.)

Increasing Legionellosis in the United States  

The authors analyzed all cases of legionellosis reported to the Centers for Disease Control and Prevention from 1990 through 2005. From 2002 through 2003, the number of reported cases increased by 70 percent, and the incidence of legionellosis has remained at 2003 levels since that time. Cases were concentrated on the East coast. The increases have been greatest among younger persons. (Neil and Berkelman, Clin Infect Dis. 2008;47:591-599.)

Single-day Famciclovir for Genital Herpes 

In this double-blind study, nearly 1200 adults with histories of recurrent genital herpes were randomized to receive either single-day famciclovir (1000 mg twice daily) or 3-day valacyclovir (500 mg twice daily). Patients initiated treatment within 6 hours after a recurrence of symptoms. The groups had similar treatment outcomes, with approximately one-third of patients in each group having aborted episodes, and minimal differences in time to healing of lesions. The overall incidence of adverse events was similar for both groups. (Abudalu et al., Clin Infect Dis. 2008;47:651-658.)

Internet-based Antimicrobial Stewardship  

The implementation of an internet-based antimicrobial stewardship program at Johns Hopkins Children's Medical and Surgical Center led to an almost 12 percent decrease in dispensed doses. The online system enhanced communication between prescribers, pharmacists, and pediatric infectious disease fellows and yielded a significant reduction in the number of missed and delayed doses. (Agwu et al., Clin Infect Dis. 2008;47:747-753.)

More from the literature: the IDSA Journal Club

Don’t miss this feature to help you stay up to date on the infectious diseases literature. Each month, the IDSA Journal Club features brief summaries of key infectious diseases studies in the previous month’s major journals chosen by the new IDSA Literature Review Panel.

In addition, the “In This Issue” section of each issue of Clinical Infectious Diseases (CID) highlights several important studies from that journal. (Click for October 1 or October 15.) For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, in each issue of CID:

October 1      

  • Avian H7 Influenza Viruses with Adaptation to Human Airway Epithelial Cell Receptors
  • Spinal Facet Joint Infection
  • The Downs and Ups of Infection with Group B Streptococci (GBS)
  • Maybe Femoral Venous Catheterization Isn't So Bad after All
  • Multidrug-Resistant Staphylococcus aureus (MRSA) Infection among Men Who Have Sex with Men

October 15  

  • Ventilator-Associated Tracheobronchitis (VAT)
  • Bladder Catheters and Infection: We Can Do Better
  • Mumps is Back!

HIV Travel and Immigration Ban Lifted—Sort Of

Steve Baragona

The federal government recently took actions intended to make it easier for people with HIV to travel and immigrate to the United States. But the ban on HIV-positive immigrants remains on the books while the lengthy rulemaking process goes on, and the new rule for HIV-positive travelers still puts up substantial barriers.

When Congress renewed the President’s Emergency Plan for AIDS Relief (PEPFAR) this summer, it revoked the 1987 law that put HIV on the list of diseases that bar a person from entering the United States. The HIV Medicine Association (HIVMA) has long advocated for lifting the ban because there is no public health rationale for excluding people with HIV.

But revoking the law that put HIV on the list was only the first step. The Department of Health and Human Services (HHS) still must rewrite the rules to take HIV off the list. In a letter to HHS Secretary Michael Leavitt, HIVMA urged HHS to act swiftly to end the ban. Centers for Disease Control and Prevention Director Julie Gerberding, MD, MPH, wrote a letter to the editor of the Washington Post saying HHS intends to do so and has begun the rulemaking process, but she cautioned that the process takes time.

Meanwhile, the Department of Homeland Security has released a new rule that is intended to streamline the process of entry for HIV-positive visitors. Currently, short-term visitors can apply for a waiver under an intrusive and cumbersome process.  The new visa rule allows people with HIV to travel to the United States for no more than 30 days without a waiver.

The decision to grant a visa rests with the consular officer, however, who is unlikely to have much useful knowledge about HIV disease and must determine that applicants have no symptoms of active infection, have been counseled on how HIV is transmitted, and have sufficient medications for the duration of their stay. Furthermore, applicants must have the resources or insurance to pay for their health care while they are in the United States. Those admitted to the United States under this visa may not apply to become residents or even extend their stay.

HIVMA opposed these provisions during the rulemaking process and continues to do so.

IDSA Advocacy Update: New Legislation Gives Incentives for Development of “Old” Antibiotics

Rebecca Dotson

Newly enacted, IDSA-backed legislation aims to help “old” antibiotics gain new approvals from the Food and Drug Administration.

The legislation repeals components of a 1997 law that blocked antibiotics from receiving certain market exclusivity benefits that would have kept generic competitors off the market longer. That law was a blow to drugmakers’ incentive to develop these antibiotics. Under the new law, antibiotics approved before 1997 can get three years’ exclusivity if they are approved for a new indication. Antibiotics that had begun the approvals process but did not follow through once the 1997 law went into effect can get five years’ market exclusivity if the drug is approved.  This fix puts these antibiotics on the same playing field as all other drug categories.

Although the legislation will apply to only a handful of drugs, IDSA has been backing the provision for some time as a way to raise awareness of the need for new incentives to develop antibiotics. (See IDSA’s Dec. 2007 letter to Sen. Edward Kennedy, Chairman of the Committee on Health, Education, Labor, and Pensions.)

In other news, the president has signed legislation that bolsters funding for the Center for Disease Control and Prevention’s (CDC) National Program for the Elimination of Tuberculosis and authorizes much-needed new research on TB prevention and treatment at the National Institutes of Health and CDC. The Comprehensive Tuberculosis Act Elimination Act of 2008 was endorsed by IDSA, HIVMA, and several other organizations.

Other advocacy efforts include:

  • The House of Representatives passed a resolution supporting increased public and private commitment to prioritize prevention and public health for all people in the United States. IDSA and 157 other organizations signed a letter supporting the nonbinding resolution, H. Res. 1381.
  • A bill introduced in the House of Representatives would improve the nation’s surveillance and reporting for diseases and conditions and expand resources for several existing CDC programs. IDSA has endorsed the bill, the National Integrated Public Health Surveillance Systems and Reportable Conditions Act (H.R. 6905)
  • The House of Representatives approved a resolution highlighting the problems associated with methicillin-resistant Staphylococcus aureus (MRSA).  The intent of the resolution (H. Res. 988) is to raise greater awareness about resistant infections toward the goal of enacting the IDSA-backed Strategies To Address Antimicrobial Resistance (STAAR) Act next year.

Announcing the New IDSA/HIVMA Board Members

Steve Baragona

IDSA and HIVMA members have elected the following members to positions on the boards of directors:

IDSA

Vice President:

James Hughes, MD, FIDSA
Emory University
Atlanta, GA

Directors:

Thomas File, Jr, MD, MS, FIDSA
Northeastern Ohio Universities College of Medicine
Akron, OH

Carol Kauffman, MD, FIDSA
University of Michigan
Ann Arbor, MI

William Powderly, MD, FIDSA
University College Dublin
Dublin, Ireland

HIVMA

Vice Chair:

Kathleen E. Squires, MD
Thomas Jefferson University
Philadelphia, PA

Infectious Diseases seats:

Adaora A. Adimora, MD, MPH
University of North Carolina at Chapel Hill
Chapel Hill, NC

Joel E. Gallant, MD, MPH
Johns Hopkins University
Baltimore, MD

Stephen P. Raffanti, MD, MPH
Vanderbilt University
Nashville, TN

Family Medicine seat:

Sharon D. Lee, MD
University of Kansas
Kansas City, KS

Nurse Practitioner seat:

Mimi Rivard, APRN, MSN
St. Vincent’s Medical Center
Bridgeport, CT

The new members will take office following the conclusion of the 48th ICAAC/IDSA 46th Annual Meeting.

Congratulations to the 2008 Society Award Winners!

IDSA, the Education and Research Foundation, and the HIV Medicine Association offer awards to individuals to honor outstanding achievements in the field of infectious diseases and HIV/AIDS.  Award recipients are pioneers in the study of newly emerging diseases, inspiring and supportive teachers, those who paved the way for life-saving vaccines, and those who have made significant contributions to HIV knowledge and the provision of quality HIV care. 

Alexander Fleming Award
The Alexander Fleming Award is granted in recognition of a career that reflects major contributions to the acquisition and dissemination of knowledge about infectious diseases.

 

Robert C. Moellering, Jr., MD, FIDSA, is a prolific researcher who has carried out numerous studies of the mechanism of action and mechanisms of resistance of antimicrobial agents.


Oswald Avery Award
The Oswald Avery Award recognizes outstanding achievement in an area of infectious diseases by an individual member or fellow of IDSA who is 45 or younger.

 

Vance G. Fowler, Jr., MD, MHS, is recognized for his scholarly research of serious infections caused by Staphylococcus aureus.


Mentor Award
The Mentor Award was created to recognize individuals who have served as exemplary mentors and is presented to an IDSA member or fellow who has been exceptional in guiding professional growth of infectious diseases professionals.

Gerald Medoff, MD, FIDSA, has trained scores of infectious diseases medical students, residents, fellows, and faculty in the 38 years he has been at Washington University.

 

Carol J. Baker, MD, FIDSA, has personally supervised the academic and research development of some 64 postdoctoral fellows.


Society Citation
The Society Citation is a discretionary award given in recognition of exemplary contribution to IDSA, an outstanding discovery in the field of infectious diseases, or a lifetime of outstanding achievement in a given area—either in research, clinical investigation, or clinical practice.

Russell Petrak, MD, is receiving the Society Citation for his dedicated service and contributions to the Society, particularly as chair of the Clinical Affairs Committee and a member of the Outpatient Parenteral Antimicrobial Therapy (OPAT) Task Force.


Clinical Teacher Award

The Clinical Teacher Award honors a career involved in teaching clinical infectious diseases to fellows, residents, or medical students and recognizes excellence as a clinician and motivation to teach the next generation.

 

Larry M. Baddour, MD, FIDSA, well regarded for his magnetic personality, outstanding clinical excellence, superb teaching skills, an infectious enthusiasm, is the recipient of IDSA’s 2008 Clinical Teacher Award.


Watanakunakorn Award
Named to honor the memory of Dr. Chatrchai Watanakunakorn, this award is given annually by the IDSA Education and Research Foundation to an IDSA member or fellow in recognition of outstanding achievement in the clinical practice of infectious diseases.

 

Michael L. Butera, MD, is sought out by his colleagues and regarded as a compassionate and dedicated clinician who has given selflessly to his patients and his community, and has served his community on the important issues of our time.

The awards will be presented during ceremonies at the 48th Annual ICAAC/IDSA 46th Annual Meeting in Washington, DC, October 25-28, 2008. More information about this year's Society Award winners is available online.  

IDSA Congratulates the 2008 Joint Research Award Winners

The IDSA Education and Research Foundation (ERF) and the National Foundation for Infectious Diseases (NFID) have joined forces to offer the IDSA ERF/NFID Joint Research Awards.  Our goal is to support needed research by promising young researchers who may not otherwise find funding as federal and other institutional research support becomes more difficult to obtain.

Merle A. Sande/Pfizer Fellowship Award in International Infectious Diseases

 

Ulrike Buchwald, MD, FIDSA, will research neonatal immunization with pneumococcal conjugate vaccine (PCV) in infants in Gambia. 

 
Astellas Young Investigator Awards

 

 

Adrianus W. M. van der Velden, PhD, will study the response of CD8+ T cells to Salmonella proteins.

Rebecca Pellett Madan, MD, will evaluate differences in mucosal immunity between HIV-infected and HIV-uninfected adolescent women. 


ASP Young Investigator Award in Geriatrics 

 

Amie L. Meditz, MD, is examining the impact of aging and exogenous sex hormones on susceptibility to HIV-1 infection.   


Wyeth Young Investigator Award in Vaccine Development

 

Elizabeth Miller, MD, will study a vaccine candidate that uses dendritic cells that are stimulated with inactivated HIV. 

More information about the 2008 Joint Research Award Winners is available online.

Congratulations to This Year's HIVMA Leadership Award Winners!

Teaser here

The HIV Medicine Association offers awards to individuals to honor outstanding achievements in the field of HIV/AIDS.  Award recipients have made significant contributions to HIV knowledge and the provision of quality HIV care. 

 Emerging Leader in HIV Research Award

 

Rochelle Walensky, MD, is a prolific researcher best known for her work on the impact and cost effectiveness of routine, voluntary testing for HIV infection.

 
HIV Clinical Education Award

 

Jeffrey L. Lennox, MD, is an extraordinarily gifted teacher and clinician who has made important efforts to improve the management of HIV infection.

The awards will be presented during ceremonies at the 48th Annual ICAAC/IDSA 46th Annual Meeting in Washington, DC, October 25-28, 2008. Read more about the 2008 HIVMA Leadership Award Winners online.

Members on the Move

Jeanna Ray

Wafaa El-Sadr, MD, FIDSA, is the recipient of the prestigious 2008 MacArthur Fellowship.  The MacArthur Fellows Program awards unrestricted fellowships to talented individuals who have shown extraordinary originality and dedication in their creative pursuits and a marked capacity for self-direction. The purpose of the MacArthur Fellows Program is to enable recipients to exercise their own creative instincts for the benefit of human society. Dr. El-Sadr has developed a multi-pronged approach to treating HIV/AIDS and tuberculosis (TB). She is also recognized internationally for her leadership in preventing maternal-child HIV transmission. Dr. El-Sadr is currently the director of the International Center for AIDS Care and Treatment Programs at Columbia University Mailman School of Public Health.

Kathryn M. Edwards, MD, FIDSA, has been elected to the Institute of Medicine (IOM) of the National Academies.  Comprised of top health experts and life scientists, the IOM serves as an adviser to the nation to improve health and promote health-related research.  Dr. Edwards is currently professor of pediatrics at Vanderbilt University Medical Center.

Welcome, New IDSA Members!

Members

Bischofberger, Norbert, PhD
Dawid, Suzanne, MD, PhD
Gibson, Geneen, PharmD, MS
Malek, Mark, MD
Mohr, John, MD
Smith, Terri, PharmD

Associate

Bryant, Kendrea, PharmD
Claassen, Cassidy, MPH
DiPompo, Lisa, PharmD
Kirkwood, James, MPH
Muendel, Ted

Members-in-Training

Adakun, Akello, MD
Adetiloye, Oniyire, MD, MPH
Bagdasarian, Natasha, MD
Como, James, MD
Dasan, Samanya, MD
Fordyce, Marshall, MD
Francis, Arije, MD
Gideon, Mugisa, MD
Horan, Jennifer, MD
Imasiku, Docus, MD
Iqbal, Tariq, MD
Isaac, Ssinabulya, MD
Kapelusznik, Luciano, MD
Katusiime, Christine, MD
Kim, Holly, MD
Kwikiriza,  Maureen, MD
Koteesa, Monica, MD
Leung, Victor, MD
Malloy, Allison, MD
Mbabali, Phoebe, MD
McKinnell, James, MD
Mugenyi, Andrew, MD
Mugerwa, Shaban, MD
Mulwana, Johnie, MD, MB, ChB
Nerima, Caroline, MD
Okoli, Obi, MD
Okongor, Tino, MD
Patient, Myango, MD
Rijhwani, Tanuja, MD, MPH
Sachdev, Anjali, MD
Semakula, Daniel, MD
Sethi, Vishal, MD
Siddiqi, Ameera, MD
Tadele, Mahlet, MD
Tenywa, Emmanuel, MD
Tusiime, Charles, MD, MB, ChB
Twinomujuni, Moses, MD
Warkentien, Tyler, MD
Yalamanchili, Santhi Priya, MD
Yen, Catherine, MD

New NIH Grant Submission Policy Allows Only One Resubmission

Steve Baragona

Beginning January 25, 2009, the National Institutes of Health (NIH) will allow grant applications to be amended and resubmitted only once. The intention is to allow high-quality research to be funded earlier.

One of the key findings of an NIH internal review was that the proportion of grant applications approved on the first submission is declining, while the proportion approved after multiple amendments has increased. With funding tightening, NIH expects that decreasing the number of resubmissions will allow more high-quality grants to be funded on first submission. The policy also is intended to reduce the burden on reviewers, as well as applicants.

Under the new policy, grant applications that are not funded after one resubmission should be redesigned substantially. More information on the policy change is available online.

Spanish Version of Aspergillus Guidelines Published

Rebecca Dotson

Clinical Infectious Diseases has published a Spanish version of the IDSA Aspergillosis guidelines released in February 2008.  The Spanish version can be found online.

This is the first IDSA guideline to be published in Spanish, and more are planned for the future.