IDSA News - June 2009
Vol. 19 No. 6
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IDSA Issues New Guideline for Intravascular Catheter-Related Infections
An updated IDSA guideline for intravascular catheter-related infection in adults and children provides evidence-based recommendations for diagnosis, treatment, and management.
IDSA’s updated guideline for the diagnosis and management of intravascular catheter-related infection will appear in the July 1 issue of Clinical Infectious Diseases and is now available online. The update addresses diagnostic issues, when to remove a catheter, and indications for initiating antimicrobial therapy. Organized to address specific clinical questions, the guideline includes algorithms to help manage patients with suspected or proven intravascular catheter infections. Performance measures are listed to assist in monitoring clinical practice.
“This revised guideline will assist clinicians in their thoughtful and pragmatic management of patients with intravascular catheter-related infections,” said Leonard Mermel, DO, FIDSA and lead author of the guideline. “Despite the density of the document, the revised figures and tables in particular will assist clinicians in quickly addressing management issues in an effort to optimize the care of patients with these complex infections.”
Several sections have been extensively revised, particularly those dealing with these infections in patients receiving hemodialysis through a catheter, pediatric patients, and patients with long-term catheters in whom catheter salvage is attempted using antibiotic lock therapy. Separate figures and tables are devoted to these patients and their unique management issues, as well as dosage recommendations for antibiotic lock therapy.
Despite the attention drawn to such serious and costly infections more than 30 years ago by Dennis Maki, MD, FIDSA and others, many unanswered questions remain for clinicians who manage patients with such infections, such as:
- What is the additional benefit and optimal duration of antimicrobial lock therapy?
- How should patients with positive blood cultures drawn through catheters but with negative percutaneously-drawn cultures be managed?
- What is the optimal duration of systemic antibiotics for catheter-related bloodstream infections when catheters are kept in place or removed?
All of these questions underscore the high importance of prevention, and Dr. Mermel, professor of medicine at the Warren Alpert Medical School of Brown University and medical director in the department of epidemiology & infection control at Rhode Island Hospital, reports that an updated guideline related to prevention is in the works. Additionally, he says, clinical trials are sorely needed to address the unresolved management issues and to further improve the care of patients with these infections.
The guideline is available online. Other IDSA guidelines also are available on the Standards, Practice Guidelines, and Statements page of our website.
Pandemic Designation Doesn’t Alter H1N1 Response (Yet)
ID experts continue to monitor the virus as it circulates in the Southern Hemisphere so that current recommendations can shift as necessary.
The World Health Organization’s (WHO) June 11 declaration that the novel influenza A:H1N1 virus is now a pandemic didn’t catch anyone by surprise. Nor did it change U.S. preparedness and response activities, which were already in full gear. What the announcement did do was signal to other countries that now is the time to dust off their pandemic plans, and underscore the importance of maintaining ongoing U.S. efforts.
More than 75 countries and every U.S. state are now reporting cases of human infection with the novel flu. Worldwide, more than 35,000 cases had been reported as of mid-June, according to WHO. The pandemic designation reflects the fact that there are now ongoing community level outbreaks in multiple parts of world. WHO’s decision is based on the spread of the virus, not the severity of illness caused by the virus. The Centers for Disease Control and Prevention (CDC) is focusing its efforts on determining where the virus is spreading, with emphasis on protecting the most vulnerable populations, including young children, pregnant women, and those with underlying health conditions.
Infectious disease experts in the U.S. and abroad continue to monitor the virus as it circulates in the Southern Hemisphere so that current recommendations and response strategies can shift if evidence suggests that transmission dynamics are changing. Earlier this month, IDSA endorsed a statement developed by the Society for Healthcare Epidemiology of America that urges a shift in CDC’s interim guidance on infection control towards adopting the same practices recommended for the prevention of seasonal influenza.
Also this month, IDSA joined other public health groups in supporting additional emergency federal funding in response to the pandemic. Writing in a June 2 letter on behalf of the Working Group on Pandemic Influenza Preparedness, the organizations called for more than $2 billion in FY2009. The groups also urged lawmakers to consider other pressing needs, including additional funding for the purchase and administration of a vaccine for H1N1, and more money for state and local health departments to complete their antiviral stockpiles, purchase personal protective equipment, and reinforce their workforce, among other issues. Congress has answered by approving a total of $7.7 billion in emergency spending for pandemic influenza preparedness and response activities, including $5.8 billion in a multi-year, non-expiring contingency account.
The need for such funding was supported by a June 4 report by Trust for America’s Health, the Center for Biosecurity, and the Robert Wood Johnson Foundation. The groups’ analysis, Pandemic Flu: Lessons From the Frontlines, found that initial response to the H1N1 outbreak showed strong coordination and communication and an ability to adapt to changing circumstances from U.S. officials. But the response also showed how quickly the nation’s core public health capacity would be overwhelmed if an outbreak were more severe or widespread. The report found that although investments in pandemic planning and stockpiling have paid off, public health departments did not have enough resources to carry out their plans.
IDSA Journal Club
This month: TMP/SMX as a treatment option for S. aureus osteomyelitis; antibiotics for SSTI in children; intravenous tigecycline for severe refractory C. difficile; refusal of pertussis immunizations associated with increased risk for pertussis infection in children.
In this feature, a panel of IDSA members identifies and critiques important new infectious diseases studies in the current literature that have a significant impact on the practice of infectious diseases medicine.
Oral Rifampin Plus Trimethoprim-Sulfamethoxazole: A Treatment Option for S. aureus Osteomyelitis?
Reviewed by Sara Cosgrove, MD
Oral rifampin plus trimethoprim-sulfamethoxazole (TMP/SMX) may be an alternative to parenteral anti-staphylococcal penicillins for the treatment of debrided non-axial methicillin susceptible S. aureus osteomyelitis, according to a study published in the June issue of Antimicrobial Agents and Chemotherapy.
Fifty patients were enrolled in the study between 1991 and 1996; 22 received cloxacillin parenterally for six weeks followed by oral cloxacillin for two weeks, and 28 received rifampin and TMP/SMX orally for eight weeks. All patients underwent extensive surgical debridement and removal of foreign material when possible (90 percent of the 20 patients with foreign bodies had hardware removed). Patients were followed through April 2007. One patient in each arm of the study was lost to follow up. In the intent to treat analysis, 19 of the 21 evaluable patients who received cloxacillin and 24 of the 27 evaluable patients who received rifampin plus TMP/SMX were cured (90.5 percent and 88.9 percent, respectively). Similar results were noted in the per-protocol analysis. Retained foreign body and incomplete treatment were independent predictors of failure on multivariate analysis.
Because of the small numbers of patients in this single center study, it is difficult to draw definitive conclusions regarding the efficacy of oral rifampin plus TMP/SMX for treatment of osteomyelitis relative to conventional parenteral therapy. Nevertheless, it does provide some evidence that oral therapy with this regimen may be a viable alternative for some patients. Important caveats are that no patients in the study had methicillin resistant S. aureus, all patients had surgical debridement, and patients with vertebral osteomyelitis were not included.
(Euba et al. Antimicrob Agents Chemother 2009 Jun;53(6):2672-6.)
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Multiple HIV Resistance Mutations Detected in Malawian Patients who Failed First-line Antiretroviral Regimen
Reviewed by Nina Kim, MD
Stavudine, lamivudine and nevirapine (d4T/3TC/NVP) comprise the most widely used first-line antiretroviral therapy (ART) in the developing world today, largely because the generic formulations are among the least expensive. Additionally, many resource-limited settings rely on clinical and immunologic rather than virologic monitoring to assess treatment failure. A study of the Malawian ART program, published in the June issue of AIDS, calls both of these cost-saving practices into question.
More than 150,000 patients have initiated first-line ART through the national ART program in Malawi since 2001. Investigators screened participants from hospitals in Lilongwe and Blantyre over 18 months (2006-2007) and identified 94 patients who experienced ART failure based on clinical (new or progressive stage 4 condition) or immunologic (CD4 cell count decline below baseline or >30 percent decrease from highest value) criteria. These patients had confirmed serum HIV-1 RNA level >1000 copies/mL and samples available for genotyping.
The authors discovered an alarmingly high rate of broad nucleoside reverse transcriptase inhibitor (NRTI) resistance: 81 percent of samples had a 3TC-associated M184V/I mutation, and 56 percent had thymidine-analogue mutations (TAMs), associated with AZT or d4T resistance (72 percent had multiple TAMs). Tenofovir-associated mutations (K65R or K70E) emerged in 24 percent of patients exposed to d4T compared with only 7 percent of those with a history of AZT. Pan-nucleoside resistance mutations occurred in 17 percent of patients. Nearly all (96 percent) patients developed high-grade resistance to non-nucleoside reverse transcriptase inhibitors.
Both the use of d4T in subtype C virus and the delay in detection of virologic failure likely contributed to the accumulation of multiple NRTI mutations. The implications of these data are profound and should inform future World Health Organization guidelines on ART. This study underscores the danger of extrapolating our clinical experience of subtype B HIV-1 to other subtypes.
(Hosseinipour et al. AIDS 2009; 23:1127-1134.)
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Antibiotics for Skin and Soft Tissue Infections in Children in the Age of MRSA: More Questions Than Answers?
Reviewed by Christopher J. Graber, MD, MPH
Trimethoprim-sulfamethoxazole (TMP-SMZ) was associated with a higher rate of treatment failure than either a beta-lactam or clindamycin among pediatric outpatients treated for skin and soft tissue infections (SSTI) that were not drained or cultured, even in a setting where community-associated methicillin-resistant Staphylococcus aureus (MRSA) was endemic, according to a study published in the June issue of Pediatrics. Although the findings may add to concerns that TMP-SMZ does not provide adequate coverage in SSTI caused by group A streptococci, the study should be interpreted with caution.
By using ICD-9 codes for various SSTI, the authors reviewed electronic medical records from January 2004 to March 2007 from the emergency department of a metropolitan children’s hospital and its five affiliated pediatric primary care centers for patients presenting with a new SSTI. The review was limited to those treated with a beta-lactam, clindamycin, or TMP-SMZ, excluding patients who had a drainage procedure, wound culture, or admission on the day of their initial visit.
Among the 2,096 patients that met the criteria, the authors identified 104 cases of treatment failure, defined as eventual hospitalization, drainage procedure, or change of or extension of antibiotic course. Four hundred and eighty treatment successes, roughly matched to the same time period, were randomly selected for comparison. In multivariate models that attempted to adjust for confounding by indication, receipt of TMP-SMZ was associated with an approximately two-fold greater probability of treatment failure as compared to receipt of beta-lactams or clindamycin. Even among patients presenting with induration or abscess, which was also consistently associated with treatment failure, the study found a higher rate of failure with TMP-SMZ.
This study suffers from a number of important limitations, most notably that the retrospective case ascertainment and analysis may not adequately differentiate the broad spectrum of type and severity of outpatient SSTI in the pediatric population. Minor, localized skin infections, such as impetigo, may not require oral antibiotics, and uncomplicated abscesses may only require drainage without antibiotics.
MRSA SSTI are clearly becoming much more common in the pediatric population, as evidenced by a recent study of more than 40 children’s hospitals published in the July 1 issue of Clinical Infectious Diseases. The study showed a steady increase in children hospitalized with MRSA SSTI from 2002 to 2007. Thus, if antibiotics are deemed necessary in the empiric treatment of SSTI in children where S. aureus is a suspected etiologic agent and a culture cannot be performed, anti-MRSA coverage remains warranted pending further studies.
(Elliott et al. Pediatrics 2009; 123(6):e959-e966 and Gerber et al. CID 2009; 49:65-71.)
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The Use of Intravenous Tigecycline for Severe Refractory C. difficile
Reviewed by Khalil Ghanem, MD, PhD
Intravenous tigecycline may be useful as an alternative or adjunctive therapy for severe refractory Clostridium difficile infection, according to a report published in the June 15 issue of Clinical Infectious Diseases. This conclusion is based on preliminary data from four patients.
C. difficile is a common and potentially life-threatening infection. There are two frequently prescribed antibiotics: Oral or intravenous metronidazole for mild to moderate infections, and oral vancomycin for moderate to severe infections. Most patients respond well to these agents, although relapse is not infrequent. Recently, tigecycline was found to have good in vitro activity against strains of C. difficile, and fecal concentrations of tigecycline were noted to be high.
The authors describe four cases of refractory, not recurrent, C. difficile colitis that did not appear to respond to metronidazole, vancomycin, or both. All cases had four or more clinical severity markers: leukocytosis, renal insufficiency, high lactate levels, hypoalbuminemia, fever, and/or signs of severe colitis. Tigecycline was added as an adjunctive agent in three cases or as an alternate agent (i.e., single agent) in one case. All four patients showed clinical improvement within one week, with no short-term relapses. Stool tigecycline levels were not measured in this study, and given the small sample size, no data on side effects or antibiotic resistance were reported.
Although intriguing, these findings are far from definitive. As such, tigecycline should not be routinely recommended for C. difficile colitis and should not delay other appropriate adjunctive measures, such as surgery, when appropriate. However, given the limited number of alternate agents that are available for severe refractory C. difficile, and given the increasing incidence and severity of this infection, it’s worth keeping tigecycline in mind as an option when other measures have failed.
(Herpers et al. CID 2009;48:1732-35.)
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Vaccine Refusal Associated With Increased Risk for Pertussis Infection
Reviewed by Jason Weinberg, MD
A new report in the May issue of Pediatrics should give pediatricians more data to help counter the increase in parental refusal of childhood vaccinations. Children whose parents refused pertussis immunizations are at increased risk for pertussis infection, according to the study, the first of its kind to identify such a direct link using patient data about vaccination and disease status.
The authors conducted a case-control study of children ages 2 months to 18 years who were enrolled in a Colorado health plan over a 12-year period. Confirmed pertussis cases were selected based on positive PCR or culture results for Bordetella pertussis in conjunction with the presence of ICD-9 codes for B. pertussis. Vaccination status was determined by medical chart review. Children were classified as “vaccine refusers” if it could be determined that their parents had refused one or more pertussis immunizations.
The investigators found that vaccine refusal was strongly associated with pertussis infection, leading to a 23-fold increased risk for pertussis compared to children of parents who accepted pertussis vaccination. The investigators determined that 11 percent of pertussis cases in the study population were attributed to vaccine refusal. Similar findings emerged in a secondary analysis of an additional cohort of patients who were continuously enrolled in the medical plan from ages 2 months to 20 months, reducing the potential for misclassification due to unavailable vaccine records.
The results of this study seem straightforward and intuitive: Unvaccinated children are at increased risk for B. pertussis infection. As the authors point out, however, the study is the first to directly link individual patients’ data on vaccination and disease status in a non-outbreak setting rather than rely on less accurate sources such as school records and census data.
Some important data was potentially missed in the analysis. For instance, unvaccinated children who remained uninfected were not included in the study. However, the results of this study should provide pediatricians with useful data to support their continued efforts to encourage childhood vaccinations, particularly when parental refusal of vaccinations has increased in recent years, and pertussis cases have become more frequent.
(Glanz et al. Pediatrics 2009; 123:1446-51.)
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IDSA Lyme Disease Review Panel Hearing Scheduled for July 30
IDSA will hold an all-day hearing of its Lyme Disease Review Panel on July 30, from 8 a.m. to 5 p.m. Eastern Daylight Time, to hear testimony from patients, physicians, and scientists regarding IDSA’s current Lyme disease guidelines.
Although in-person attendance is by invitation only, the hearing will be broadcast live via webcast and will be archived on the IDSA website. Information on how to view the webcast will be posted on the IDSA website no later than one week before the hearing. For more information about the hearing, please visit this page. Also see this item for an update on legislation in Connecticut related to Lyme disease treatment.
SHEA Issues Statement on H1N1 Infection Control
Based on the current state of knowledge, IDSA and the Association for Professionals in Infection Control and Epidemiology (APIC) have endorsed the Society for Healthcare Epidemiology of America’s (SHEA) Position Statement: Interim Guidance on Infection Control Precautions for Novel Swine-Origin Influenza A H1N1 in Healthcare Facilities. This science-based statement expresses strong support for updating CDC guidance on recommended infection prevention and control in health care settings for the current wave of the novel H1N1 outbreak. The statement specifically endorses implementing the same practices recommended to prevent the transmission of seasonal influenza. Specifically, SHEA recommends:
- identifying suspected cases of novel H1N1 as soon as possible
- using standard and droplet precautions for suspected or confirmed cases
- placing surgical masks on patients with suspected or confirmed novel H1N1 infection at the point of contact with the health care facility
- putting such patients in a single room, if available, or placing them with other infected patients (negative pressure rooms are not routinely needed)
- adhering strictly to hand hygiene, respirator hygiene, and cough etiquette
- restricting visitors and health care workers with febrile respiratory illness
- the use of surgical masks by health care workers for respiratory protection during routine patient care activities, as opposed to continued universal use of N95 particulate respirators
The SHEA document does support current recommendations for enhanced respiratory protection when performing certain aerosol-generating procedures on patients with suspected or confirmed infection, including wearing a fit-tested N95 particulate respirator, gloves, eye protection, and a gown when performing these activities. However, SHEA notes these recommendations should be re-evaluated as more data become available.
SHEA has provided its statement to Thomas Frieden, MD, director of the Centers for Disease Control and Prevention (CDC), and to a top official at the Occupational Safety and Health Administration. A federal advisory group, the Healthcare Infection Control Practices Advisory Committee, is also expected to weigh in the months ahead regarding the use of surgical masks and respirators.
In addition to other recommendations, CDC officials continue to urge that health care workers with influenza symptoms stay home from work. (See this related item from the Morbidity and Mortality Weekly Report (MMWR).) For updated guidance documents from CDC and other sources on diagnostics, infection control, antiviral use, and related matters, see the H1N1 page on the IDSA website. To sign up to receive the latest notices from CDC’s Health Alert Network and the Food and Drug Administration—on H1N1 and other timely topics—click here (you must be logged in to have access to this link).
Drug Approvals, Recalls, Adverse Events Update
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). Content normally includes a range of topics, including new drug approvals and warnings. Recent alerts have included:
IDSA members can sign up for these services online. (You must be logged in to have access to this link.)
Is Your Facility Experiencing Antibiotic Shortages?
Report these to FDA and IDSA.
New “Ask the Coder” Service Answers CPT Questions
IDSA has a new resource to help answer your tough coding questions. Launching July 1, the “Ask the Coder” e-mail portal will send your questions to a certified professional coder for a response. This service is available to IDSA members and their staff.
Evaluation and management (E&M) service codes and other current procedural terminology (CPT) codes commonly used by infectious diseases specialists are prone to frequent billing and coding errors. Some of the errors are due to the subjective nature of picking the right code level for E&M service codes. A lack of familiarity with the rules governing inpatient consultations, subsequent hospital visits, prolonged services, and “incident to” billing can cause other errors.
Look for an e-mail with more details about this new service. Please also see IDSA’s other online billing and coding resources.
Deadline for Identify Theft Policies Extended to Aug. 1
Physician practices now have until Aug. 1 to set up policies to protect against patients’ identity theft under a new Federal Trade Commission (FTC) rule. The rule was originally scheduled to go into effect May 1 (see the April issue of IDSA News). FTC has extended this deadline to give creditors (including physicians) and financial institutions more time to develop and implement written identity theft prevention programs.
New PQRI Reporting Period Begins July 1
It is not too late to start participating in Medicare’s Physician Quality Reporting Initiative (PQRI) and potentially qualify to receive incentive payments for reporting on applicable quality measures. A new half- year reporting period begins July 1.
To qualify for the incentive payment for the half-year reporting period, ID physicians must use the registry-based reporting option of individual PQRI measures. First, review the list of “Medicare-qualified” registries and pick a registry that allows for reporting of the PQRI measures most applicable to your practice. For example, if you have a large HIV patient population, you may want to select a registry that allows for reporting of the HIV measures. Once you’ve selected a registry , you must report on at least three individual 2009 PQRI measures for at least 80 percent of your applicable Medicare patients seen during the last 6 months of 2009.
For more information about how to participate in this voluntary program and qualify for a 2 percent incentive payment through Medicare, please visit IDSA’s Quality Improvement Resources and Tools web page. Click on the PQRI Measures Specifications tool for a list of measures that are applicable to the infectious diseases specialty. Contact Jason Scull of IDSA staff with any questions.
Global Center Urges U.S. Response to HIV/AIDS and TB Co-Infection
Infectious disease experts called on President Obama and Congress to mount a concerted and comprehensive response to the deadly alliance between HIV/AIDS and tuberculosis during a June 25 briefing on Capitol Hill. The briefing highlighted a new report by the Center for Global Health Policy, “Deadly Duo: The Synergy Between HIV/AIDS & Tuberculosis.”
The briefing and the report highlighted the fact that policymakers have not treated HIV-TB co-infection as an issue needing an emergency response despite an enormous death toll. Without action, presenters at the briefing warned, lives rescued from AIDS through access to lifesaving HIV treatment will be lost to TB, a painful, debilitating disease.
“TB is the greatest threat to the miracle of HIV therapy,” said Diane Havlir, MD, professor of medicine at the University of California, San Francisco, and chief of the HIV/AIDS Division and Positive Health Program at San Francisco General Hospital. Dr. Havlir also serves on the Center’s Scientific Advisory Committee.
The Center’s report details steps the U.S. government should take to aggressively lead the response to the worldwide threat of HIV/AIDS and TB co-infection, including:
- Provide $6.5 billion in funding for bilateral HIV/AIDS programs, consistent with the Lantos-Hyde Act, to ensure the scale-up of antiretroviral therapy
- Greatly increase funding for research and development to battle co-infection, including doubling spending at the National Institutes of Health to $320 million for TB research
- Ensure that TB control funding levels through various programs match the seriousness of the co-infection epidemic
The document also calls on the White House to launch a Presidential Initiative on Tuberculosis to ensure a concerted, comprehensive response to the disease. And it calls on the Office of the U.S. Global AIDS Coordinator to ensure that HIV patients are screened for TB and treated for TB disease or with TB preventive therapy in settings with appropriate infection control measures in place.
In addition to Dr. Havlir, the briefing also featured Carol Dukes Hamilton, MD, FIDSA , co-chair of the Center’s Scientific Advisory Committee and a senior director of research at Family Health International. Dr. Hamilton gave a detailed presentation on the TB epidemic, while Dr. Havlir described HIV and TB co-infection. Rosemary Mburu with the Kenya AIDS NGOs Consortium provided a first-person perspective drawn from her work as an AIDS advocate in Kenya. Christine Lubinski, vice president for global health at IDSA, moderated the session, which was attended by congressional staff who work on foreign policy and health issues, along with advocates from the global health community.
For more coverage of the briefing, see this post on the Global Center’s Science Speaks blog.
Highlights from the HIV/AIDS Implementers’ Meeting in Namibia
The Center for Global Health Policy provided provocative, in-depth coverage of the HIV/AIDS Implementers’ Meeting, held June 11-14 in Namibia. On the Center’s blog, Science Speaks, John Donnelly, a former Boston Globe reporter, filed more than a dozen posts on a range of hot topics—from the slow implementation of male circumcision to the effects of a looming funding crisis for global AIDS programs.
The coverage also featured insights from guest bloggers, including Buck Buckingham, the PEPFAR country coordinator for Kenya; Barbara de Zalduondo, chief of the Programmatic Priorities Support Division with UNAIDS in Geneva; and Caroline Ryan, director of program services and chief technical officer in the Office of the U.S. Global AIDS Coordinator.
One of the most interesting items was Donnelly’s interview with Kevin De Cock, the World Health Organization’s director of HIV/AIDS programs, who made waves at the opening of the meeting when he said that some people, “no matter how unfairly,’’ may draw comparisons between AIDS treatment in the developing world today and the infamous Tuskegee study, in which researchers failed to appropriately treat syphilis among African American men in Macon County, Ala., between 1932 and 1972.
Click here to read the interview with De Cock and other items from the conference.
Other recent posts include:
- Analysis of a congressional spending proposal for vital global health programs. On June 17, the House Appropriations subcommittee marked up its foreign operations spending bill, which includes funding for HIV and tuberculosis global health programs. The Senate will mark up its version of the legislation in July.
- Coverage of the nomination hearing for Eric Goosby, MD, who has been confirmed as the new U.S. Global AIDS Coordinator.
HIVMA Supports Public Plan Option for Health Care Reform
The HIV Medicine Association (HIVMA) strongly supports a public plan option as part of any effort to reform the nation’s health care system. Earlier this month, as lawmakers in Washington began drafting legislation, HIVMA issued a position statement outlining why such an insurance option is so important for HIV patients, nearly 30 percent of whom have no insurance. The public plan option would help ensure that those living with HIV across the country have affordable access to comprehensive, cost-effective and lifesaving care and treatment. HIVMA expressed concern that private insurers will discourage HIV patients from enrolling in private plans by excluding HIV clinicians and programs from their provider networks. HIVMA also issued a set of health care reform principles for meeting the needs of HIV patients. As part of comprehensive health care reform legislation, IDSA has also advocated for the adoption of Medicare coverage of home-based antimicrobial infusion services, a fix to the “sustainable growth rate” (SGR) formula for physician payments, the establishment of accountable care organizations that provide incentives for ID physicians to meet infection control benchmarks, increased immunization coverage, and a strengthened public health infrastructure.
Other IDSA advocacy items include:
- HIVMA released a joint statement on the HIV medical workforce with the American Academy of HIV Medicine and unveiled recommendations for ensuring a robust HIV medical workforce during a congressional briefing earlier this month.
- IDSA and several other public health organizations applauded the introduction of a bill in Congress that would create new incentives for the recruitment and retention of public health professionals. The Public Health Workforce Development Act of 2009 (S. 1143/H.R. 2620) would create scholarship and loan repayment programs for public health practitioners who agree to serve for a specified amount of time in a public health setting. A letter of support was sent to Sen. Richard Durbin (D-Ill.) and Rep. Doris Matsui (D-Calif.), who introduced the legislation.
- The Connecticut Legislature passed a bill in early June prohibiting state licensing boards from disciplining physicians who prescribe long-term antibiotic therapy in treating Lyme disease. IDSA had opposed the legislation, which the governor signed into law June 21. Also in June, IDSA sent a letter to all members of the House of Representatives opposing the Lyme and Tick-Borne Diseases Prevention, Education, and Research Act (H.R. 1179), legislation that would encourage public health policy to be based on views not based on scientific evidence. For more information about IDSA’s July 30 hearing on Lyme disease practice guidelines, see this related story.
- The U.S. Supreme Court has asked the Obama administration to weigh in regarding a Georgia case that could threaten the federal no-fault vaccine injury compensation system. The Georgia Supreme Court decision would allow cases alleging injury from childhood vaccines to be decided by state juries, circumventing the federal system. Earlier this year, IDSA and several other groups signed on to a “friends of the court” brief from the American Academy of Pediatrics (AAP) urging the U.S. Supreme Court to overturn the Georgia decision. The court still has to decide whether to hear the case.
- The American Medical Association’s House of Delegates adopted a report at its annual meeting earlier this month that incorporated IDSA’s concerns about bundling health care providers’ payments, a key health care reform proposal that is being considered by the Obama administration and Congress. The AMA report was developed in part as a response to an earlier resolution IDSA submitted that called on the AMA to work with public and private groups to ensure that bundled payment reforms do not result in hospital-controlled payments. IDSA also sent a letter to the Senate Finance Committee in April outlining concerns about bundled provider payments as part of efforts to reform the nation’s health care system.
Members on the Move
Kathleen Gensheimer, MD, MPH, FIDSA has been appointed director of medical and scientific affairs at Sanofi Pasteur. One of the longest serving state epidemiologists in the country, Dr. Gensheimer previously served as state epidemiologist for the Maine Department of Health and Human Services for 28 years. Dr. Gensheimer also is a member of the IDSA National and Global Public Health Committee.
Welcome, New Members!
Arthurs, Supha, MD
Becker, Marissa, MD
Bowman, Mary, MD, PhD
Chamilos, Georgios, MD, MD
Chang, Eric, MD
Dara, Jasmeen, MD
Eagye, Kathryn, MPH
Fleming, Catherine, MPH
Lucero, Cynthia, MD
Omer, Saad, PhD
Rizk, Nesrine, MD
Shah, Ruta, MD, PhD
Tran, Maryann, MD
Abadi, Amin Talebi Bezmin
Baseer, Mohammed, MD
Bhushan, Reva, PhD
Boeser, Kimberly, PharmD
Brzankalski, Gabriela, MD
Daniele, Amy, RPh
Gamero, Mario, MD
Hoey, Christopher, PharmD
Khan, Ashraf, MD
Loja, Wilmer, MD
Mandegari, Elham, MD
Melgar, Mario, MD
Painter, George, PhD
Reddy, Jag, MD
Rivadeneira, Emilia, MD
Tolia, Jill, MD
Turner, Kathryn, MPH, PhD
Voigt, Jeffrey, MBA, MPA
Yerneni, Purnachandra, MD
Apiwattanakul, Nopporn, MD
Arora, Suthep, MBBS
Braza, Mariejane, MD
Chopra, Teena, MD
DeWitt, Meredith, MD
Feemster, Kristen, MD
Green, Jaime, MD
Harris, Dana, MD
Jump, Robin, MD, PhD
Kandanati, Vivek Vardhan Redd, MBBS
Kendall, Brian, MD
Kosmidis, Christos, MD
Lee, Joon-Ho, MD
Lee, Todd, MD
Lichterfeld, Mathias, MD, PhD
Manthena, Geeta, MD
Mazumdar, Srijan, MBBS
Mobley, Victoria, MD
Palacio, Federico, MD
Patel, Shruti, MD
Reese, Lindsey, MD
Sung, Ji Yeon, MD
Vijayan, Vini, MD
Watanabe, Miki, MD
Yang, Mi Ae, MD
Abramson, Carl, MD
Morrow, Jason, MD