IDSA News - December 2008
Vol. 18 No. 12
(Print All Articles)
Guideline on Fever/Infection in Long-Term Care Facilities Updated
IDSA’s guideline for the evaluation of fever and infection in older adult residents of long-term care facilities (LTCFs) was recently updated.
IDSA’s guideline for the evaluation of fever and infection in older adult residents of long-term care facilities (LTCFs) was recently updated.
Key updates include an expanded discussion of the importance of functional decline as a clinical sign of possible infection; targeted evaluations of specific infectious syndromes including scabies, norovirus, and C. difficile; methods for proper diagnosis of serious viral infections; and an outline of how to evaluate suspected outbreaks of infectious diseases.
The guideline focuses on older adults who are institutionalized and typically have multiple, chronic co-morbidities and functional disabilities—making it difficult to recognize infection in this population. What’s more, long-term care facilities often have limited on-site resources to evaluate suspected infections (e.g., urinary tract infections and pneumonia) in older adults.
The guideline provides specific recommendations regarding staffing, including which LTCF staff members are best able to recognize the symptoms of suspected infections in the elderly. Although there is often limited data to guide clinical evaluation of specific infectious syndromes in LTCF residents, the guideline provides an extensive summary of published data and makes specific recommendations regarding laboratory and diagnostic testing if resources are available.
The guidelines’ performance measures state that in order to properly diagnose serious infections, it is important to accurately measure, record, and communicate temperature, blood pressure, and respiratory rate of LTCF residents suspected of having infections. Blood counts (i.e.,
CBC with differential) should be performed within 12-24 hours, consistent with local standards of practice unless advanced directives prohibit it.
The fever and infection guideline is being published in the January 15 issue of Clinical Infectious Diseases and is now available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of the IDSA website.
IDSA Journal Club, December 2008
This month: C. diff rapid tests fall short; scoring HCAP to improve empiric antibiotic selection; new data on age and HAART; cohorting thwarted by an environmental reservoir; and trade-offs in uptake of HPV vaccine.
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.
C. diff Rapid Tests Fall Short
By Khalil Ghanem, MD
Prevalence and pre-test probability of Clostridium difficile had a major impact on the ability of rapid diagnostic tests to accurately detect the infection, according to a review in the December issue of The Lancet Infectious Diseases. The authors recommend two-step screening using a rapid test followed by a confirmatory test on positive samples to maximize accuracy.
Diarrhea caused by C. difficile is common, and a new strain may cause more aggressive disease. The authors conducted a systematic review of the literature to determine the performance characteristics (sensitivity, specificity, positive predictive value) of commonly used rapid diagnostic tests for both Type A and B toxins that are produced by the organism. Due to significant heterogeneity in the studies reviewed, the authors were unable to use formal meta-analytic methods to calculate mean sensitivity and specificity estimates for these assays.
Overall, the performance measures for most of the assays studied were lower than the manufacturers’ values. None of the diagnostic tests achieved 100 percent sensitivity or specificity. Thus, negative results do not always rule out C. difficile colitis and positive results do not necessarily indicate true disease. As with all diagnostic tests, it is up to clinicians to interpret the results of these assays carefully: When the pre-test probability of C. difficile infection is moderate to high, a positive test is more likely to be a true positive. Repeat testing following a negative test may improve sensitivity. In settings where the pre-test probability is low, follow-up with a reference test can confirm a positive rapid test result. This additional step increases accuracy but is time-consuming and expensive. (Planche et al., Lancet ID. 2008;8:777-84.)
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Scoring HCAP to Improve Empiric Antibiotic Selection?
By Sara Cosgrove, MD, MS
A scoring system to better predict which patients with health care-associated pneumonia (HCAP) have infection caused by drug-resistant pathogens is proposed in a study published in the November 10 issue of the Archives of Internal Medicine.
Pneumonia patients with recent exposure to health care are more likely to have resistant pathogens. However, the authors note there are shortcomings in the criteria used to define HCAP in the recent American Thoracic Society/IDSA guidelines that may lead to the overuse of broad-spectrum antibiotics.
Investigators examined 639 patients with bacterial pneumonia. Patients were considered to have HCAP if they met at least one of the following criteria: hospitalization in the past 90 days, residence in a nursing home or long-term care facility, undergoing hemodialysis, or immunosuppression. Patients had to have positive microbiology results suggesting pneumonia in order to be included.
The specificity of the HCAP definition was only 48.6 percent and misclassified one-third of patients. Not all risk factors conferred equivalent risk for infection with a resistant pathogen: 82 percent of patients with recent hospitalization had a resistant pathogen, compared to only 10 percent of patients on hemodialysis, 30 percent of nursing home patients, and 35 percent of immunosuppressed patients.
The authors created a scoring system that gives a patient 4 points for recent hospitalization, 3 points for nursing home residence, 2 points for hemodialysis, and 1 point for needing ICU care. Seventy-five percent of patients with a score of 6 or more had resistant pathogens, compared to 20 percent of patients with a score of 0-2.
The scoring system is a good first step in guiding antimicrobial therapy in HCAP, but it must be viewed with caution as it is derived from data from a single site without split-sample or external validation. It is also important to note that this study only looks at patients in whom a pathogen was detected in a disease that is notoriously difficult to diagnose microbiologically. Both issues may limit the generalizability of the study.
(Shorr et al., Arch Intern Med. 2008;168:2205-2210.)
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New Data on Age and HAART
by Sabrina Kendrick, MD
Time to virologic suppression after HAART initiation was shorter in older patients compared to younger patients, although CD4 response did not differ, according to a study published in the November 12 AIDS issue.
This retrospective analysis followed an observational cohort of HAART-naïve patients from an urban outpatient clinical setting. The cohort included 670 patients under 40 years old and 149 patients 50 or more years old.
Older patients were more likely to be on nonnucleoside reverse transcriptase inhibitors (NNRTI) versus protease inhibitors (PI) than younger patients (42 percent vs. 29 percent), and had fewer AIDS-defining opportunistic infections (OIs) (22 percent vs. 31 percent). However, they had higher overall mortality (36 percent vs. 27 percent) and shorter survival (36.2 months vs. 58.5 months) than younger patients. AIDS-related deaths were similar between the two populations, which suggests younger patients had more non-fatal OIs than older patients. NNRTI-based regimens significantly increased the likelihood of virologic suppression.
This is one of the first studies to examine the effect of HAART regimen type on clinical response by age group. Limitations include the small sample size of older patients, which may account for the inability to detect immune response differences between the study populations. Duration of HIV infection, co-morbid conditions’ influence on disease progression, and mortality cause in relation to long-term HAART therapy outcomes in older HIV-infected patients are considerations for future studies. (Greenbaum et al., AIDS. 2008;22:2331-2339.)
Predictors of Change in Total Bone Mineral Density in HIV-infected Individuals
Bone mineral density (BMD) loss was greater in HIV patients using tenofovir or ddI compared to nonusers and was less in those using d4T or saquinavir in a study in the November 1 issue of JAIDS. CD4 count and viral load were not associated with changes in BMD. Higher body mass index and strength training were associated with less bone loss.
This longitudinal cohort of HIV-infected adults 18 years or older were followed for a median of 2.5 years. A baseline measure of BMD before ART was conducted, and annual assessments with dual-energy X-ray absorptiometry, along with medical, dietary, and behavioral history were collected.
As HIV-infected patients live longer on ART, it is important to acknowledge the factors that may affect bone health in these individuals. Providers should encourage their patients to maintain adequate weight and nutritional status, while performing strength training exercises to decrease HIV-associated bone loss. (Jacobson et al., JAIDS. 2008;49:298-308.)
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Cohorting Thwarted by Respiratory Pathogen’s Environmental Reservoir
By Jason Weinberg, MD
Cohorting to prevent exposure to potentially infectious individuals was not sufficient to reduce rates of febrile respiratory illness (FRI) in a report in the November 15 edition of The Journal of Infectious Diseases.
In this study of more than 13,000 military recruits, units were classified as “closed” if they were not accepting new recruits after their initial formation, or “open” if they were accepting recruits returning from medical convalescence or other settings. Rates of FRI were monitored for each type of unit over the first four weeks of recruit training.
There was no statistically significant difference between rates of FRI in open and closed units. However, units with larger populations tended to have higher FRI rates independent of their classification (i.e. open versus closed). Viable adenovirus, the predominant cause of FRI in this population, was found in environmental samples obtained from housing units and medical clinics. These results suggest that person-to-person spread was not the primary means of transmission. Rather, environmental persistence of adenovirus is a likely reservoir that facilitates ongoing transmission and high rates of FRI in this setting.
This study only addressed adenovirus type 4, and its generalizability to other organisms such as other respiratory viruses, enteric viruses, and methicillin-resistant Staphylococcus aureus remains to be determined. Nonetheless, this study may help to shape policies and strategies to reduce environmental transmission of pathogens in daycares, long-term care facilities, dormitories, and similar settings. This study reinforces the importance of environmental cleaning in reducing the rates of FRI.
And wash your hands, too.
(Broderick et al., J Infect Dis. 2008;198:1420-6.)
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Lower HPV Vaccine Cost Could Offset Barriers Raised by Promiscuity Concerns
By Melinda Pettigrew, PhD
Public perception that HPV vaccination increases sexual promiscuity may prevent HPV vaccination levels from reaching optimal targets, according to a study published in the December issue of the Proceedings of the National Academy of Sciences. But the study found lowering the cost of the vaccine can offset that effect.
The researchers applied game theory to explore how external factors such as a fear of increased promiscuity and vaccine cost influence equilibrium vaccination levels. Results from a survey of 326
U.S. adults showed that the majority of respondents believed that the risk of cervical cancer and genital warts are lower with the HPV vaccine. But survey respondents also reported that adolescent sexual activity would nearly double among those receiving the vaccine—an increase that the authors note has never been observed.
Cost also influenced the decision of whether to vaccinate. Even with financial assistance, the average family had to spend $181 for all three doses of vaccine when administrative fees, doctor’s office fees, and time lost from work were also considered. The authors estimated that a price reduction of $55 per dose would increase vaccination levels.
While mathematical models cannot predict behavior, study results indicate that clinicians should address parental concerns about increased promiscuity when encouraging parents to vaccinate their children. (Basu, S. et al., PNAS. 2008;19018–23.)
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EIN: Vancomycin for Pacer Prophylaxis?
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.
An EIN member asked whether others were switching from cefazolin to vancomycin as pre-operative prophylaxis for pacemaker insertion due to high rates of methicillin-resistant Staphylococcus aureus (MRSA).
Several respondents said they do use vancomycin, and given the high rate of MRSA at the member’s institution, they recommend it. “The rationale comes from our experience with patients referred for extraction of infected devices,” said a member in Ohio. In those situations, methicillin-resistant coagulase-negative Staphylococcus is the most common isolate at that respondent’s institution.
“If you are having MRSA pacer pocket infections, that probably makes sense, and I would look into preoperative screening and possibly decolonization before placement,” said a respondent in Washington. “However, if overall infection rate is low and the infections are not MRSA, then changing does not make sense.” The respondent referred to a study that found no advantage in vancomycin over cefazolin for open heart surgery. (Finkelstein et al., J Thorac Cardiovasc Surg. 2002;123:326-32).
A respondent in Iowa had recently considered switching to vancomycin and ceftriaxone prophylaxis for pediatric cardiothoracic surgeries. “Since literature on this was very sparse, we reviewed five years of our infection prevention database for bloodstream and surgical-site infections for children undergoing heart surgery. Our data did not support such a move, so our surgeons continue to use cefazolin, including for pacemaker implants.”
"Let data drive the use,” said a respondent in Kentucky. MRSA rates are high at this respondent’s two hospitals with active cardio departments, but between the two there has been only one pacemaker infection in 15 years. “We use cefazolin. Only 1.5 percent of pacer candidates are colonized [with MRSA] pre-operatively in our facilities. Each facility should look at their data and move appropriately.”
The respondent warned that the increase in vancomycin use for Clostridium difficile infection (CDI) and pre-operative prophylaxis may push up rates of vancomycin-resistant enterococci (VRE). “A look at our VRE colonization in those having received vanco for CDI is alarming,” the respondent said.
EIN members have previously discussed vancomycin prophylaxis for prosthetic joints. A searchable archive of EIN discussions can be viewed at: ein.idsociety.org/search/. (You must be logged in to use the search function.)
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.
In the IDSA Journals
New Hypervirulent Strain Causing C. Difficile Infection
Since 2005, an increase in the prevalence of Clostridium difficile infection due to PCR ribotype 078 has been noticed in The Netherlands. From February 2005 through February 2008, the proportion of infections due to type 078 strains increased from 3 percent to 13 percent, whereas the proportion of infections due to the hypervirulent type 027 strain decreased from 27 percent to 1 percent. Researchers found that patients with C. difficile infection due to type 078 were younger than those with infection due to type 027, with a higher proportion of community-associated disease and equal proportions of severe diarrhea and mortality. (Goorhuis et al., Clin Infect Dis. 2008;47:1162-1170.)
Rifampicin-miconazole-impregnated Catheters Reduce Catheter-related Bacteremia
Previous studies have found a higher incidence of central venous catheter-related bacteremia (CVC-RB) in femoral and central jugular access than in other venous sites. To evaluate a preventive device, patients were catheterized with either rifampicin-miconazole-impregnated catheters or standard catheters in femoral and central jugular venous accesses. Rifampicin-miconazole-impregnated catheters were found to result in a 77 percent reduction in CVC-RB for both of the sites. (Lorente et al., Clin Infect Dis. 2008;47:1171-1175.)
Emergence of W/Beijing strains of Tuberculosis
W/Beijing strains of Mycobacterium tuberculosis are more virulent and more resistant to conventional drugs than are other strains. To determine the extent to which such strains are emerging in southern Africa, the authors used molecular testing to genotype strains obtained from patients admitted to pediatric hospitals in
South Africa, over a period of four years, as well as strains present in archived tissue samples. W/Beijing strains were absent during 1930–1965, rare during 1966–1995, and increasingly common during 1996–2005. The proportion of W/Beijing strains among children increased from 13 percent in 2000 to 33 percent in 2003. (Cowley et al., Clin Infect Dis. 2008;47:1252-1259.)
Factors Affecting HCV Clearance, Genotype in HIV Co-infected Patients
Fewer than one quarter of HIV-positive patients with evidence of hepatitis C virus (HCV) infection spontaneously cleared HCV in the EuroSIDA cohort of nearly 2,000 patients. Spontaneous clearance was less likely in injection drug users than in men who have sex with men (20 percent vs. 39 percent), whereas clearance was more likely in those who tested positive for hepatitis B virus than those who did not (43 percent vs. 21 percent). Of those with chronic infection, more than half were infected with HCV genotype 1, which was associated with higher serum levels of HCV RNA. (Soriano et al., J Infect Dis. 2008;198:1337-1344.) According to an accompanying editorial, the study suggests most members of the EuroSIDA cohort are poor candidates for anti-HCV therapy, and early antiretroviral therapy may be the best option for these patients, in an attempt to avoid end-stage liver disease. (Bruno and Sacchi, J Infect Dis. 2008;198:1262-1264.)
More Sensitive WNV Screening Needed for Blood Supply?
Blood collection centers currently use the most sensitive WNV RNA detection method only during outbreaks or WNV season. Transfused blood contaminated with very low levels of
West Nile virus (WNV) has only rarely caused disease, leading to speculation that the presence of WNV antibodies in these samples provides protection. This study found that viremic samples containing antibodies were capable of infecting cells in culture, although less so than those without antibodies. (Rios et al., J Infect Dis. 2008;198:1300-1308.) An accompanying editorial says the results raise the question of whether blood should routinely be screened using the most sensitive method to detect WNV RNA. However, the author says that the benefits may not outweigh the costs. (Katz et al., J Infect Dis. 2008;198:1258-1261.)
More from the literature: the IDSA Journal Club
The IDSA Journal Club helps you stay up to date on the infectious diseases literature. Each month, the Journal Club features brief summaries of key infectious diseases studies in the previous month’s major journals.
In addition, the “In This Issue” section of each issue of
Clinical Infectious Diseases (CID) highlights several important studies from that journal. (Click for December 1 or December 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:
- Neurosyphilis and HIV Infection
- Amoeba, Mamavirus, Sputnik, and Ever-Smaller Fleas: Virophage Make Their Debut
- Abacavir (and Didanosine) and Acute Myocardial Infarction
- Adjunctive Rifampin for Staphylococcal Endocarditis
- Vancomycin “Just Can't Get No Respect”
- Vancomycin, metronidazole, Clostridium difficile, and Vancomycin-Resistant Enterococci (VRE)
Get Paid for Reporting Quality Indicators–While It’s Still Voluntary
Eligible physicians not yet participating in the Centers for Medicare and Medicaid Services’ (CMS) Physician Quality Reporting Initiative (PQRI) have an incentive to start before the program becomes mandatory. Participating physicians can earn an incentive payment of 2 percent of their total allowed charges for professional services paid under the Medicare physician fee schedule in 2009.
Currently, PQRI is a voluntary program in which physicians collect and report practice data from a set of performance measures. PQRI will eventually transition to a mandatory pay-for-performance program. IDSA encourages its members to take advantage of the current voluntary nature of PQRI to gain experience with reporting quality metrics.
Although PQRI is still voluntary, CMS will begin publicly reporting the names of providers who successfully participate in the 2009 PQRI at www.medicare.gov/physician. Once pay-for-performance is mandatory, CMS may also publicly report physicians’ quality and efficiency data online.
Some participating physicians have reported that they did not receive incentive payments in 2007 and are reluctant to participate in 2009. According to CMS, easily avoidable reporting errors were among the reasons that physicians did not receive incentive payments for quality reporting last year. These errors included reporting the incorrect diagnosis code or codes, reporting the incorrect age or sex of the patient, or failing to include appropriate provider identifiers on the claim.
In some cases, billing software split a claim into smaller claims. When this has happened, one claim may have included the quality data codes while the other claims contained the CPT service and diagnosis codes. In some cases Medicare could match split claims together by National Provider Identifier, date of service, and other data—but often could not.
Several new measures have been added to PQRI for 2009 that may better enable ID physicians to participate. New quality measures include those relating to HIV/AIDS and wound care. The IDSA website has much more information about PQRI and other quality improvement efforts, including a summary of measures that might be relevant to your practice, reporting options and instructions, and information about electronic-prescription incentive payments.
Online Tools Can Help You Estimate Your Medicare Payments
ID physicians will see a modest increase in Medicare payments for 2009—more than most specialties and certainly better than the steep cuts that were originally proposed. But more payment cuts could come in future years, unless Congress takes action.
IDSA has online tools (log in required) to help ID physicians estimate the impact on their own practices for 2009.
ID physicians also can increase their total Medicare payments by an additional 2 percent by reporting quality data through the Physician Quality Reporting Initiative (PQRI) and another 2 percent by submitting prescriptions electronically. For information on how to participate in the PQRI and E-Prescribing Incentive programs, visit IDSA’s Quality Improvement Resources and Tools web page. (For more on why you should participate, see this article in this month’s IDSA News.)
IDSA members can also use an online Toolkit to support the Society’s ongoing advocacy efforts on Medicare payment.
IDSA Year-end Advocacy Wrap-up
Throughout 2008, IDSA has continued the work outlined in the “Bad Bugs No Drugs” campaign by advocating for advancements in antimicrobial research and development. Medicare and vaccine financing also were key areas of focus.
Much of the Bad Bugs, No Drugs action this year took place at the Food and Drug Administration (FDA). Following urging from IDSA and other organizations, FDA updated breakpoints for vancomycin and penicillin this spring. FDA raised the breakpoints at which S. pneumoniae is considered susceptible to penicillin and, due to growing resistance, lowered the breakpoints for vancomycin in the treatment of Staphylococcus aureus.
The Society held a joint scientific workshop with FDA in November to address uncertainty about the appropriateness of non-inferiority trials for treating skin and soft tissue infections (SSSI). Brad Spellberg, MD, FIDSA, a member of IDSA’s Antimicrobial Availability Task Force, introduced IDSA’s recommendations for reversing the trend of reduced development of antimicrobials.
Proceedings from a January 2008 IDSA/FDA workshop, which addressed the design and conduct of clinical trials of antibacterial drugs in the treatment of community-acquired pneumonia (CAP), are published in a supplement to the December 1, 2008 issue of Clinical Infectious Diseases.
In addition to antimicrobial research and development, the Society championed its views on Medicare by joining the American Medical Association (AMA) and more than a dozen specialty societies in endorsing the Medicare Improvement Act (H.R. 4992). The bill would shift all preventive vaccines into Medicare Part B.
IDSA also joined a coalition of home infusion pharmacists, pharmaceutical companies, and patient groups urging Congress to enact the Medicare Home Infusion Therapy Coverage Act (H.R. 2567), which would provide Medicare beneficiaries with access to home infusion therapy services. This bill and the Medicare Improvement Act did not pass this session, but are likely to be re-introduced next session.
IDSA endorsed two pieces of legislation regarding vaccine financing. The Vaccines for Children Access Act of 2008 (H.R. 4990) would expand the category of children eligible for the Vaccines for Children (VFC) program to include the under-insured vaccinated at any public health clinic. The VFC program is federally funded, providing vaccines to eligible children who cannot otherwise pay.
The Vaccines for the Uninsured Adult Act of 2008 (H.R. 4993) would establish a Vaccines for Uninsured Adults Program (VFUA), providing recommended vaccines to eligible adults, and would be modeled on the successful VFC program. Though neither bill passed, they are expected to be reintroduced next year.
At a National Vaccine Advisory Committee (NVAC) meeting, IDSA presented testimony concerning draft recommendations by NVAC’s Vaccine Financing Workgroup regarding public and private financing of childhood vaccinations. IDSA asserted that the private and public sectors must support the purchase of vaccines and that health care providers must be adequately reimbursed for vaccinating children and adolescents regardless of insurance status. NVAC provides recommendations for vaccine policy to the Department of Health and Human Services.
Members on the Move
Luciana L. Borio, MD, will be joining the Food and Drug Administration (FDA), Center for Biologics Evaluation and Research (CBER), Office of Vaccines Research and Review in
Md., as a clinical reviewer. She is currently working as assistant professor of medicine at the Center for Biosecurity of the University of Pittsburgh Medical Center,
Baltimore, Md. Dr. Borio is a member of IDSA’s National and Global Public Health Committee.
Alan D. Tice, MD, FIDSA, and Michael L. Butera, MD, will be representing IDSA in the American Medical Association’s House of Delegates. Dr. Tice will move from IDSA’s alternate delegate to IDSA delegate, replacing Edward Septimus, MD, FIDSA, who is retiring. Dr. Butera will serve as IDSA’s alternate delegate to fill the position previously held by Dr. Tice. Dr. Tice runs his own practice in Honolulu, Hawaii, and Dr. Butera practices at the Pulmonary and Infectious Disease Medical Group in San Diego, Calif.
Welcome, New IDSA Members!
Alexander, Holly, PhD
Cassady, Kevin, MD
Freilich, Daniel, MD
Hobden, Jeffery, PhD
Peters, Philip, MD
Power, Edward, PhD
Sbrana, Elena, PhD
Suh, Kathryn, MD, MSc
Aronoff, Michael, MD
Eugene, MBBS, MPH
Brummel, Gretchen, MD
Cooper, Charles, MD
Coppens, Guy, MD
Duffin, Ryan, BSN
Finnmann, Ingo, MD
Lee, Andrew, MD
Moshal, Karyn, DTM&H, MBBS, MRCP
Ramirez, Maurice, MD
Riganotti, Dominic, DO
Buscher, April, MD, MPH
Curley, Eugene, MD
Herrera Guerra, Angel, MD
Mathew, Rajesh, MBBS
Rha, Brian, MD
Influenza Resources from IDSA and CIDRAP
Looking for information on influenza? IDSA has extensive material on its website:
- Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations
This section contains information on the agent, its hosts, transmission, key outbreaks in domestic avian populations, the current status in Asia, bird flu as a biological weapon, clinical features, differential diagnosis, treatment, prevention, and outbreak control.
- Avian Influenza (Bird Flu): Implications for Human Disease
This section contains information on avian influenza in humans, the 2003-2005 outbreak of H5N1 in Asia, treatment, vaccine development, World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) travel recommendations, surveillance, and infection control.
- Pandemic Influenza
This section contains information on the agent, the historical perspective, past pandemics, the current H5N1 threat, vaccine development, pandemic preparedness planning, and infection control.
The information on avian and pandemic influenza was developed and provided by the Center for Infectious Disease Research and Policy (CIDRAP) at the
Minnesota, with input from IDSA’s Rapid Communications Task Force. If you have suggestions on how to improve the content or make it more relevant to ID clinicians, please contact Diana Olson at firstname.lastname@example.org.
Additional influenza information is available at www.idsociety.org/pandemicinfluenza.htm, including:
- A CME monograph for IDSA’s 2008 Seasonal and Pandemic Influenza meeting
- The agenda and registration information for Seasonal and Pandemic Influenza 2009 (to be held Feb. 2-9 in
- Summaries of IDSA’s policy and advocacy efforts related to pandemic influenza
- Links to other helpful influenza resources
Looking For A New Job or Employee?
The ID/HIV Career Center can help job seekers and employers connect online and in person at IDSA meetings.
Job seekers: Whether you are actively searching for a job or just curious about other opportunities, IDSA’s Career Center provides you with multiple benefits. View hundreds of searchable jobs from all types of health care employers—not just IDSA members. The ID/HIV Career Center is part of the HEALTHeCAREERS Network, which enables employers of all types and sizes from across the nation to come to the IDSA website to post their jobs. New jobs are posted on the network every day, and you can sign up to receive e-mail alerts notifying you of new postings that match your own specialty-based and geographic preferences.
Employers: Through our partnership with the HEALTHeCAREERS Network, your job postings on the ID/HIV Career Center are also cross-posted to multiple sites such as MedHunters.com, bizjournals.com, and dozens of health care association career centers, allowing you to recruit cost-effectively and fill any open position within your practice.
Both employers and job seekers have access to Conference Connection, allowing you to indicate your attendance at the upcoming Clinical Practice Meeting and set up face-to-face meetings while on site–all through the ID/HIV Career Center.
Both employers and job seekers benefit from personal customer service to help ensure that you present your qualifications—or your opportunity—in the best possible way.
We have the job or candidate you are looking for and the tools to help you both connect. Visit the ID/HIV Career Center to learn more!
New HIV/TB Funding Available
A new source of product development funding has opened up for HIV, TB, and other neglected diseases. The
United Kingdom's Department for International development (DFID) has announced a new $300 million fund for public-private partnerships to develop drugs, vaccines, and other technologies for priority diseases. The fund is open to researchers from any country. Applications for the next round will open in early January, and details will be posted on the DFID website. For more information, to sign up for alerts, or to view the application form for the previous round, visit the DFID website.
Apply Now for the 2009 Joint Research Awards
IDSA is now taking applications for the 2009 Infectious Diseases Society of America Education and Research Foundation (IDSA ERF)/National Foundation for Infectious Diseases (NFID) Joint Research Awards. Applicants and their sponsors must be members of IDSA unless otherwise noted.
IDSA members-in-training are encouraged to apply for the following:
- Merle A. Sande/Pfizer Fellowship Award in International Infectious Diseases
sponsored by Pfizer Inc.
- This award is intended to encourage young physicians interested in international medicine. Note: The applicant's sponsor must be from the resource-limited country and does not necessarily have to be an IDSA member.
Junior faculty members (those who are not more than four years out of a training program) are encouraged to apply for the following:
- Association of Specialty Professors – IDSA Young Investigator Award in Geriatrics
sponsored by the Atlantic Philanthropies, Inc. and the John A. Hartford Foundation
- This award provides support to infectious diseases faculty within the first four years of appointment who are interested in academic careers focused on the geriatric medicine aspects of the subspecialty.
- Astellas Young Investigator Awards
sponsored by the Astellas
- These awards provide funding to young investigators who have demonstrated outstanding research in any area of current interest in the field of infectious diseases.
- Wyeth Young Investigator Award in Vaccines Development
sponsored by Wyeth Vaccines Research
- This annual award provides funding for outstanding research in vaccine development, either through clinical or laboratory investigation.
The application deadline is February 13, 2009.
These awards grow more competitive every year as the number of applicants increases. Apply now!
For more information or to download an application, visit the IDSA website, or call IDSA at (703) 299-0200.
Correction: The Joint Research Awards brochure that was mailed to IDSA members incorrectly listed the sponsor for the Merle A. Sande/Pfizer Fellowship Award in International Infectious Diseases. The award is sponsored by Pfizer Inc. IDSA regrets the error.