IDSA News - April 2016
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Lyme Disease Guideline Panel Responds to Public Comments

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IDSA, the American Academy of Neurology (AAN) and the American College of Rheumatology (ACR) are jointly developing a systematic review and clinical practice guideline on treatment of Lyme disease. 
 
The guideline panel held a public comment period last spring requesting input on a project plan that laid the ground work for the new Lyme disease guideline. The panel has published its response (PDF) to input received during the public comment period.
 
In addition to representatives from IDSA, AAN, and ACR, the panel also includes representation from the American Academy of Family Physicians (AAFP), American Academy of Pediatrics – Committee on Infectious Diseases (AAP-COID), American Academy of Pediatrics – Section on Emergency Medicine (AAP-EM), American College of Physicians (ACP), Association of Medical Microbiology and Infectious Diseases – Canada (AMMI-CA), Child Neurology Society (CNS), Pediatric Infectious Diseases Society (PIDS), Entomological Society of America (ESA), and European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Members representing the disciplines of cardiology, microbiology, pathology, and a methodologist with expertise in GRADE are also included. In addition, the panel includes a healthcare consumer representative, three patients with confirmed Lyme disease, and a parent of a pediatric patient with confirmed Lyme disease. 
 
After a draft of the full guideline is developed, it will also be posted on the IDSA website for a 45-day public comment period. Additional information on the timing and availability of this draft will be posted to the IDSA website.
 

What ID Researchers Should Know About PCORI Funding

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IDSA continues to engage with the Patient Centered Outcomes Research Institute (PCORI) on the importance of infectious diseases (ID) comparative effectiveness research. Following up on our joint IDSA-PCORI webinar highlighting PCORI funding opportunities, IDSA has developed an educational resource on our website for members interested in pursuing PCORI funding. The guide directs members to PCORI’s resources, provides advice when considering an ID proposal, and lists contact information for ID-funded PCORI investigators. IDSA will continue to update the website as more resources are developed.

  
Research on Community-Acquired Pneumonia: Proposals Due May 4
Just announced: PCORI is looking to fund new research on “comparing the effectiveness and safety of alternative antibiotic regimens in the empiric outpatient treatment of adults with community-acquired pneumonia” (see page 21 of PCORI’s announcement (PDF) for its second round of 2016 funding). IDSA has long highlighted the importance of PCORI-funded infectious disease research and strongly supports PCORI’s prioritization of this research topic. Letters of Intent for proposals are due by 5 pm, EST May 4 and can be submitted through PCORI’s online portal.

National Academies Seeks to End Transmission of Hepatitis B and C in US

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The National Academies of Sciences, Engineering, and Medicine has released a new report examining the feasibility of ending the transmission of hepatitis B and C in the US and preventing further sickness and deaths from the diseases. Eliminating the Public Health Problem of Hepatitis B and C in the United States is the first report of a two-phase study. The second report, due to be released in early 2017, will outline a strategy for meeting the goals set in this report. IDSA will provide some financial support for phase two of the study.

Now’s the Time to Double-Check CMS’s Data on You

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2015 data submitted to the Centers for Medicare and Medicaid Service’s (CMS) Open Payments program will be released publicly on June 30. Prior to publication, physicians and teaching hospitals have the opportunity to review and dispute records attributed to them by registering with Open Payments. The review period opened April 1 and will last 45 days. Open Payments is a federally run program under The Affordable Care Act that collects and makes available to the public information about financial relationships that doctors and hospitals have with drug and device manufacturers. These relationships can include money for research activities, gifts, speaking fees, meals, or travel.

Have a Question About Billing and Coding? Ask the Coder Can Help!

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Ask the Coder, an online coding resource, helps IDSA members and their office staff with coding questions. The coding rules and regulations governing services such as inpatient consultations, subsequent hospital visits, and prolonged services are complicated, and choosing the appropriate CPT® code may be difficult. 


Ask the Coder can help with questions regarding the use of Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes. If you have a question about evaluation and management (E&M) codes or other codes within the CPT and HCPCS code set, take advantage of this member benefit by filling out the form on the Ask the Coder webpage (login required). IDSA staff will review and research your question and respond personally. 
 
In addition to Ask the Coder, IDSA also assists IDSA members and their office staff with other billing and coding questions through the Manage Your Practice website
 
Disclaimer: Given the inherent subjectivity of choosing the most appropriate CPT code or HCPCS code for services provided to patients, the answers supplied via Ask the Coder are provided for informational purposes only. Readers must use their independent, professional judgment in making coding decisions. IDSA assumes no risk in providing coding information and all risks are assumed by the provider, physician, or other qualified healthcare professional. CPT is copyright of the American Medical Association.

CMS Waives Certain Restrictions for Telehealth Services

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The Centers for Medicare and Medicaid Services (CMS) recently implemented a Comprehensive Care Joint Replacement (CCJR) Payment Model that aims to support better and more efficient care for beneficiaries undergoing hip and knee replacements, the most common inpatient surgeries for Medicare beneficiaries. This model tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery. 

 
Under this new model, certain provisions of CMS’ telehealth regulations are waived. Patients may now receive telehealth services in their homes or other places of residence, and may be located in any geographic location. Therefore this waiver allows for the provision of Medicare approved telehealth services to patients (captured in the CCJR payment bundle) without requiring patients to travel long distances or even leave their homes for services and follow-up care. All other regulations for the provision of telehealth services remain unchanged. For more information, see the IDSA website.

New Resource Guide for HIV/AIDS Care Providers on Billing and Reimbursement

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The National Alliance of State and Territorial AIDS Directors (NASTAD) in partnership with HIVMA has released "Billing Coding Guide for HIV Prevention: PrEP, Screening, and Linkage Services" (PDF) to assist health departments and their contracted providers in navigating billing and reimbursement for HIV prevention services. The guide is available for free online.

IDSA, HIVMA Advocate for Funding for Antimicrobial Resistance, HIV, Other ID Programs

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IDSA Capitol Hill Briefing on Antimicrobial Resistance (L to R): Jason Newland, MD, FPIDS, Washington University School of Medicine; Michael Craig, MPP, CDC; Jane M. Knisely, PhD, NIAID; Joe Larson, PhD, BARDA; Neena Anandaraman, DVM, MPH, US Dept. of Agriculture; Alicia Cole,  Antibiotic-Resistant Infection Survivor.

 
IDSA President Johann S. Bakken, MD, PhD, FIDSA, and HIVMA Board Chair Carlos del Rio, MD, FIDSA, submitted testimony this month to House and Senate appropriators, urging robust federal funding for key HIV (PDF) and infectious diseases (PDF) programs. 
 
IDSA has led advocacy efforts in support of continued funding for implementation of the National Action Plan for Combating Antibiotic-Resistant Bacteria. Following an active February that featured a congressional briefing on federal antimicrobial resistance (AR) programs and an advocacy day on Capitol Hill, in March nearly 50 groups wrote to House and Senate appropriators (PDF) asking that they continue to support funding for AR programs. 
 
IDSA members can help by using the Action Center to join in advocacy for federal funding to address AR. It only takes three minutes.

Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria Issues Assessment of National Action Plan

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The Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) last month unveiled their initial report and recommendations (PDF) on federal efforts to address antimicrobial resistance (AR). Several IDSA priorities were included: 

  • Establishing a Limited Population Antibacterial Drug (LPAD) approval mechanism for antibiotics to treat a serious or life-threatening infection for which there is an unmet medical need. 
  • Providing economic incentives (including tax credits) necessary to facilitate the research and development (R&D) and appropriate use of urgently needed new antibiotics and diagnostics. 
  • Investing in a strong ID physician workforce to implement key objectives in the National Action Plan for CARB, including leading antibiotic stewardship programs and conducting research and development for new antibiotics, diagnostics and vaccines. 
  • Providing robust federal funding for each of the agencies with responsibilities for implementing the National Action Plan for CARB. 
  • Strengthening data collection and surveillance of antibiotic use and antibiotic resistance in human and animal health settings. 
  • Expanding global coordination of AR activities, including surveillance and R&D. 
Sylvia Matthews Burwell, Secretary of Health and Human Services, also recently asked PACCARB (PDF) to comment on antibiotic, diagnostic and vaccine incentives as well as on prioritizing federal investments in AR. IDSA will continue to promote the work of PACCARB and the administration, as implementation of the National Action Plan continues forward.

Senate Committee Advances New Antibiotic Pathway and other ID Bills

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The Senate Health, Education, Labor and Pensions (HELP) Committee voted on April 6 to advance several bills that make up its biomedical innovations package—a counterpart to the House-passed 21st Century Cures bill that was approved last summer. Of particular note, the HELP Committee voted in favor of the Promise for Antibiotics and Therapeutics for Health (PATH) Act, S. 185, which would establish a new limited population antibacterial drug (LPAD) approval pathway for antibiotics to treat serious or life-threatening infections for which there exists an unmet medical need. IDSA has led stakeholder groups in advocacy for the PATH Act, including a letter recently urging the HELP Committee to include the legislation in its biomedical innovations effort. As part of the innovations package, the HELP Committee has approved other bills of interest to the infectious diseases community including: 

  • Medical Countermeasures Innovation Act of 2015 (S. 2055), which requires the Department of Health and Human Services to develop a budget plan for development of prioritized medical countermeasures, streamline the Project Bioshield procurement process, and provide priority review to encourage the development of novel treatments for agents that present a national security threat; 
  • Advancing Breakthrough Medical Devices for Patients Act of 2015 (S. 1077), which directs the Food and Drug Administration (FDA) to establish a program to expedite the development and provide for the priority review of breakthrough medical devices; 
  • Next Generation Researchers Act (S. 2014), which directs the National Institutes of Health to advance policies and programs to improve opportunities for new researchers and promote earlier research independence, and to coordinate with other federal agencies and academic institutions to improve tracking of career progress of biomedical researchers and students; 
  • Preventing Superbugs and Protecting Patients Act (S. 2503), which requires the FDA to publish a list of reusable devices that would need to provide proposed cleaning instructions as part of a 510(k) pre-market submission process; and 
  • FDA Device Accountability Act (S. 1622), which helps ensure a more consistent approach to FDA review of new devices, including diagnostic tests. 
 Advocacy efforts in support of these bills will continue as the package moves on to the full Senate for consideration. 
 
IDSA members are encouraged to visit the Action Center, where in just three minutes you can send an email urging senators to approve the PATH Act.

Ryan White Care Providers Take to the Hill

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RWMPC Steering Committee Members (L to R): Linda M. Gorgos, MD; Jeanne Keruly, MS, CRNP; Bill Keeton; Andrea Weddle; Georgina Osorio, MD; Anna Person, MD; Barbara Gripshover, MD; Alice Thornton, MD

 
The Steering Committee of the Ryan White Medical Providers Coalition (RWMPC) took to Capitol Hill April 15 to conduct nearly 50 meetings arranged by HIVMA with key House and Senate offices and educate legislators about the value and importance of the Ryan White program. Ryan White provides a comprehensive system of care that includes medical care and essential support services for people living with HIV who are uninsured or underinsured. 
 
RWMPC leaders also met with key administration officials from the Health Resources and Services Administration, HIV AIDS Bureau, the Health Resources and Services Administration, Bureau of Primary Health Care, the Substance Abuse and Mental Health Services Administration, and the Office of Management and Budget.

HIVMA Hails the First U.S. HIV+ to HIV+ Organ Transplant

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When Johns Hopkins University became the first U.S. medical center to successfully conduct an organ transplant from an HIV-infected deceased donor to a recipient living with HIV infection, the news was greeted with applause from HIVMA. 

 
HIVMA helped lead the charge toward enactment of the HIV Organ Policy Equity (HOPE) Act in 2013, which ended the long-standing ban on transplants with HIV positive organs, even for research purposes. “HOPE modernized outdated federal law to reflect the current medical understanding of HIV infection,” said HIVMA Board Chair Carlos del Rio, MD, FIDSA. “For patients living with HIV, deceased donors with the same infection represent a unique source of organs holding the potential to save the lives of hundreds of HIV-infected patients struggling with liver and kidney failure each year. We look forward to seeing this medical breakthrough offer hope to more people living with HIV infection who are in need of organ transplants.” 
 
For further background, please see HIVMA’s 2011 policy statement and FAQ (PDFs) on HIV+ to HIV+ organ transplantation.

IDSA’s Continued Work on Zika Virus

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Advocacy for Zika Funding 

As policymakers in the US and abroad grapple with how to respond to the ongoing Zika virus outbreak, IDSA is making the case for having a robust, sustainable public health and medical research infrastructure in place to respond to any outbreak or emerging infection. 
 
IDSA has joined with other groups in recent weeks in urging Congress to immediately advance President Obama’s request for $1.9 billion in emergency supplemental funding to address the Zika virus, both in Zika endemic countries and within the United States. In support of the federal response, IDSA has participated in congressional visits, White House strategy meetings, and a stakeholder summit held by the Centers for Disease Control and Prevention (CDC). The requested funding would increase global as well as domestic capacity for surveillance, as well as expand the Field Epidemiology Training Program, laboratory testing, and healthcare provider training. The supplemental funding would also accelerate research and development for medical countermeasures, including vaccines and diagnostics. In the absence of congressional action, the administration has redirected about $500 million from Ebola efforts to respond to the Zika outbreak, but these resources are insufficient and threaten to undermine responses to ongoing Ebola outbreaks in affected countries. 
 
Visit IDSA’s Action Center to join efforts to advocate for funding to address Zika and other infectious disease threats. 
 
Global Backgrounders on Zika, Ebola
The IDSA Center for Global Health Policy has developed papers on the history, impacts and responses to Zika and Ebola. The Zika paper (PDF) provides facts surrounding the current outbreak, with background and current information on data, findings, research needs and responses while the Ebola paper (PDF) provides background and the present status of the West Africa Ebola outbreak that began at the end of 2013, and continues in episodic flare-ups in the three most affected countries: Guinea, Liberia and Sierra Leone. The papers are the first in a series the Global Center is developing to help IDSA members inform policymakers and opinion-shapers about the impacts of the diseases and the efforts needed to mount and sustain effective responses.
 
Guidance for Clinicians 
IDSA continues to update its Zika Guidance web page, which provides a summary of the clinical aspects, diagnostics and treatment of Zika as well as current CDC advisories regarding the outbreak. For more information on Ebola, see IDSA’s Ebola Resources. IDSA offers two email services to help members stay informed of updates from FDA and CDC. Content includes a range of topics, including drug warnings, recalls, and outbreak investigations. To subscribe, please click here (member log-in required).

Science Speaks Reports a Range of Developments in Global Infectious Diseases

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Science Speaks, the official blog of the IDSA Center for Global Health Policy, covered breaking news across the global health spectrum in the last month with research and developments on the current Zika outbreak, Ebola in West Africa, gaps highlighted in a yellow fever outbreak, and new challenges in HIV and TB that are demanding, and getting, attention. Coverage included: 

New ABIM Survey Indicates Physician Interest in Potential Changes to MOC Assessment

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The American Board of Internal Medicine (ABIM) announced findings this month from its recent survey about potential changes to the current Maintenance of Certification (MOC) assessment. All ABIM Board certified physicians were invited to participate in the survey, and more than 9,200 responded. 

 
ABIM is considering physician-guided recommendations about options for updating the MOC assessment process as well as a timetable to seek feedback from physicians, launch a pilot, evaluate the pilot and ultimately implement changes. ABIM will share the timetable later this spring.
 
Key survey findings from the representative sample (29.4% response rate):
  • 86 percent responded positively to the idea of taking an assessment at home or in their office rather than in a testing center and were comfortable with potential tasks necessary to facilitate secure, remote assessment. 
  • 79 percent responded positively to the idea of taking shorter knowledge assessments that would allow them to skip the full-length MOC exam. 
  • 76 percent responded positively to the idea of using online resources during an assessment. 
  • 56 percent responded positively to the idea of shorter, more frequent knowledge assessments; responses to options regarding the preferred length and frequency of assessments varied widely. 
  • 76 percent want maintaining their Board certification to signify they are staying current in the knowledge they need to practice.
Further details on the survey results can be found here.
 
IDSA continues to be active in voicing concerns and advocating for change regarding MOC on behalf of IDSA members.
 

ABIM Seeks Physician Input into Open Book Assessments

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As part of ongoing efforts to enhance its Maintenance of Certification (MOC) program, the American Board of Internal Medicine (ABIM) is examining the possibility of providing access to online resources such as UpToDate during assessments of medical knowledge, and is seeking physician input through a Research Study on Open Book Assessments. 

 
Physicians interested in participating in the study must complete a five-hour pilot exam in one of Pearson VUE’s testing centers across the country between April 17 and September 1. Participants will receive a $250 honorarium, 20 MOC points, and complimentary access to UpToDate during the research period. 
 
To participate in the Research Study on Open Book Assessments, schedule online at www.pearsonvue.com/abim or call Pearson VUE at 800-601-3549, Mon – Fri, 7 am – 7pm CT. You must use your ABIM ID as your identification number to register. Questions about signing up can be directed to ABIM at 800-441-ABIM (2246).

Journal Club Seeks Additional Members

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IDSA is seeking to add several more panelists for Journal Club, the popular IDSA News feature that informs members about important new infectious diseases research. 

 
Each month, Journal Club members search the medical literature for new studies with a significant impact on the clinical practice of infectious diseases. The panel meets by conference call once a month to discuss the selected studies and comes to a consensus on the best three to five. Panelists then write brief reviews of the studies (about 300 words in length). IDSA staff edits the reviews, which are published in IDSA News under the writer’s byline. Consistently, Journal Club is one of the most-read articles in IDSA News. 
 
Successful candidates will have a good eye for clinically relevant research and an ability to communicate its importance clearly and concisely. Good writing skills, the ability to meet deadlines, and participation in conference calls and submission of studies for discussion at least every other month are required. The position currently requires about 3-5 hours a month. 
 
Applicants should submit a CV and a short writing sample by email to Journal Club coordinator John Heys at jheys@mailcan.com. Applications are due May 13. New panel members will be chosen by June 3.

Polish-Speaking Member Needed for Translation Assistance

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IDSA is seeking an IDSA member who is fluent in the Polish language to assist with the review of a Polish translation of an IDSA clinical practice guideline. The purpose of the review is to ensure that it is an accurate reflection of the original, English version of the IDSA guideline. Other translations of IDSA guidelines can be found on our website

 
If you speak and read Polish and are interested in learning more about this opportunity, please contact Jennifer Padberg at: jpadberg@idsociety.org. A stipend is available if the review is completed on time, as requested.

Members on the Move

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John Scott, MD, associate professor of Allergy and Infectious Diseases at the University of Washington, and member of IDSA’s Telemedicine Workgroup, has been awarded the 2015 Warren Featherstone Reid Award for Excellence in Health Care. This award honors health care providers who exhibit exceptional quality and value in the delivery of health services. Dr. Scott is receiving the award for his work with Project ECHO (Extension for Community Health Outcomes), which has brought cost-effective, quality care to many people who would otherwise be unable to access care. He has also worked to make case conferences available to rural areas of the state via videoconferencing, during times when the providers are less likely to be seeing patients.

Member Report

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IDSA welcomes the following new members:

 
MEMBERS
Allen, David, PharmD
Blok, Willem, MD, PhD
Carr, James, PharmD
Duttaroy, Nina, MD
Garrison, Mark, PharmD
Giddings, Stanley, MBBS
Gordon, Lori, PharmD
Mattappallil, Arun, PharmD
Smith, Adrienne, PharmD
So, Wonhee, PharmD
Waqar, Sana, MD
Yildirim, Inci, MD, MSc, PhD
 
MEMBERS-IN-TRAINING
Abrantes, Jessica, MD
Campion, Maureen, PharmD
Doke, Purwa, MD
Gandhi, Kamana, MD
Geffert, Sara, MD, MS
Ghatak, Arindam, MD
Gupta, Manoj, MD
Gustave, Sugira Ngabo, BCh
Hasan, Nour, MD
Janson, Sonja, MBBS
Kalia, Rohit, MD
Lee, Joonkee, MD
Luo, Ruihong, PhD
Mankar, Sanjay, MD
Martinez, Kristin, PharmD
Maskarinec, Stacey, MD
Naranjo, Maria, MD
Poole, Claudette, MD
Rhie, Kyuyol, MD
Victoria, Katrina, MD
 
RESIDENTS
Shoff, Christopher, MD
Stromich, Jeremiah, MD
Vo, Ngoc, PharmD
Waldner, David, MD
 
STUDENTS
Lee, Rebecca
Ni, Bin
Ventura, Meredith
 
ASSOCIATES
Al Maghrabi, Reem, MD
Baker, Sheri, PharmD
Barwatt, Joseph, MD
Byrd, Timothy, MD
Cahuayme-Zuniga, Lizbeth, MD
Carlisle, Steven, PharmD, RPh
Castaneda, Clara, MD
Das, Padma, MD
Fletcher, Paul, PharmD
Gaikwad, Ujjwala, MD, MBBS
Gordon, Lynne, MPH
Harmon, James, NP, MSN, RN
Haswani, Neha, MD
Hawkins, Betty
Kelly, Amanda, PA-C
McCluskey, Edward, MD
Mohamedy, Imran, MBBS
Orlov, Diane, NP
Saravu, Kavitha, MD, MBBS, DTM&H
Scott, Cyndy, BSN, RN
Williams, Marissa, PharmD
Wright, Kelly, PharmD
Zacholski, Donna, MT
 

From the President: Christopher D. Busky, CAE Named Next CEO of IDSA

Following an extensive search process overseen by a committee appointed by the Board of Directors, Chris Busky has been selected to replace Mark Leasure upon his retirement in June. Chris has worked with organizations to harness the collective knowledge of members to drive new program development.  At IDSA, one of Chris’s top priorities will be to engage stakeholders to establish a clear value proposition for the ID professional. Learn more about IDSA’s incoming CEO.

It is my pleasure to announce that Christopher D. Busky, CAE, has been appointed to serve as IDSA’s new Chief Executive Officer, upon the retirement of Mark Leasure, who has served the Society with distinction since 1998. 

 
Chris has been engaged in association management since 1989 and has served in a leadership position for the past decade at the Heart Rhythm Society (HRS), which represents healthcare professionals who specialize in prevention and treatment of heart rhythm disorders. Most recently, he was HRS’s Executive Vice President and Chief Operating Officer. 
 
Chris has worked with organizations to harness the collective knowledge of members to drive new program development. He has worked with Boards and committees to develop operational plans and budgets that align with strategic priorities. He has innovatively generated new revenue by growing membership, grant support, sponsorships, and annual meeting attendance, both domestically and internationally. By strategically expanding existing relationships and developing new collaborations, he has grown organizations globally. Prior to his work at HRS, Chris served in leadership roles at the Association Management Group, the Equipment Leasing and Finance Association, and the Manufactured Housing Institute. 
 
 At IDSA, one of Chris’s top priorities will be to engage stakeholders to establish a clear value proposition for the ID professional. 
 
Chris earned his Master of General Administration, Financial Management at the University of Maryland-University College, and a Bachelor of Science in Business Administration at Frostburg State University. He is a long-time member of the American Society of Association Executives (ASAE) and has served on ASAE’s Finance, Human Resources and Business Operations Section Council. He has been a Board member and Chairman of the Finance and Administration Roundtable. 
 
The IDSA Board of Directors selected Chris after an extensive executive search process that was overseen by a search committee appointed by the Board. There will be a one-month transition period in June, after which Chris will officially take office on July 1. 
 
As you may know, the Society saw tremendous growth during Mark’s tenure. He was responsible for expanding the staff from five to more than 40, doubling membership and professional attendance at the annual meeting, and tripling the Society’s net assets. 
 
I hope you will join me in welcoming Chris and thanking Mark for his years of service. We are fortunate to have found Chris and grateful to have benefited from Mark’s leadership.

IDSA and SHEA Release New Guideline on Antibiotic Stewardship

New guidelines on antibiotic stewardship are now available from IDSA and the Society for Healthcare Epidemiology of America (SHEA). The guidelines provide recommendations to ensure antibiotic stewardship programs are most effective in reducing the emergence of antibiotic resistance, including that they be led by ID physicians and pharmacists, who have the expertise and education to ensure the right drug is being prescribed at the right time for the right diagnosis.

New guidelines on antibiotic stewardship are now available from IDSA and the Society for Healthcare Epidemiology of America (SHEA). Published in Clinical Infectious Diseases, the guidelines provide recommendations to ensure antibiotic stewardship programs are most effective in reducing the emergence of antibiotic resistance, including that they be led by ID physicians and pharmacists, who have the expertise and education to ensure the right drug is being prescribed at the right time for the right diagnosis. 

 
Preauthorization of broad-spectrum antibiotics and prospective review after two to three days of treatment should be the cornerstone of antibiotic stewardship programs, according the new guideline. Additional recommendations include using syndrome-specific interventions over attempting to improve all infections at once, and the use of rapid diagnostic testing to determine if the cause is viral, thereby reducing the inappropriate use of antibiotics. 
 
The guidelines also call for reduction of the use of antibiotics associated with high risk of development of Clostridium difficile disease, implementation of antibiotic time-outs and other strategies to encourage prescribers to perform routine reviews of regimens, and the use of computerized clinical decision support where possible. 
 
Passive educational materials are insufficient in implementing antibiotic stewardship programs, according the guideline recommendations, because improvement is unlikely to be sustained. Lectures and brochures should be used to supplement strategies such as preauthorization and prospective audit and feedback. 
 
The new guideline is available in mobile and pocketcard versions. 
 
Co-authors of the guideline are Tamar Barlam, MD, FIDSA, FSHEA of Boston Medical Center and Sara Cosgrove, MD, FIDSA, FSHEA of Johns Hopkins University. Additional members of the guideline panel include: Lilian Abbo, MD, FIDSA; Conan MacDougall, MD; Audrey N. Schuetz, MD; Ed Septimus, MD, FIDSA, FSHEA; Arjun Srinivasan, MD, FSHEA; Timothy Dellit, MD; Yngve T. Falck-Ytter, MD; Neil Fishman, MD, FSHEA; Cindy W. Hamilton, MD; Timothy C. Jenkins, MD; Pamela A. Lipsett, MD; Preeti N. Malani, MD, FIDSA, FSHEA; Larissa S. May, MD; Gregory J. Moran, MD, FIDSA; Melinda M. Neuhauser, MD; Jason Newland, MD; Christopher A. Ohl, MD, FIDSA; Matthew Samore, MD, FSHEA; Susan Seo, MD, FIDSA; and Kavita K. Trivedi, MD.

IDSA Adopts All-In Match Policy

IDSA has moved to an “All-In” Match policy for the 2016 Match cycle, a policy change adopted to provide applicants the opportunity to fully evaluate all programs and to enable programs to compete equally for the available applicants. IDSA strongly believes that this is the appropriate policy for the ID specialty because it represents the fairest process for applicants and helps to ensure the integrity of the Match for the long term.

IDSA is supporting an “All-In” Match policy for the 2016 Match cycle—a change that was approved by the Board of Directors last fall at the recommendation of the ID Training Program Directors’ Committee and the ID Recruitment Task Force. This policy change was adopted to provide applicants the opportunity to fully evaluate all programs in order to optimally determine the program that best suits their needs, and to enable programs to compete equally for the available applicants. 

 
IDSA strongly believes that this is the appropriate policy for the ID specialty because it represents the fairest process for applicants and helps to ensure the integrity of the Match for the long term. A review of the Match data has shown that while programs are continuing to train a similar number of fellows each year in ID, the number of individuals going through the Match has declined, and a percentage of these applicants are taking positions before the Match. If this trend continues, ID could risk losing the Match altogether. “We believe this would have enormous negative implications for our applicants and programs,” says Wendy Armstrong, MD, FIDSA, who chairs the task force and committee. “We understand that this policy change will not ‘fix’ the challenges of recruiting applicants to infectious disease and are working on many other initiatives to address the critical shortage of applicants.” 
 
The Training Program Directors’ Committee and the ID Recruitment Task Force along with IDSA staff are working with program directors to answer questions regarding implementation of this policy. For more information, see the IDSA website or contact Rachel Shnekendorf, 703-299-0879, rshnekendorf@idsociety.org, or Dana Johnston, 703-740-4789, djohnston@idsociety.org.

IDWeek Mentorship Program

Encourage others to join the exciting field of ID—become a mentor! The IDWeek Mentorship Program offers opportunities for mentorship and networking through one-on-one interactions between leaders in the field and fellows, residents, and medical students during IDWeek.

The IDWeek Mentorship Program offers opportunities for mentorship and networking through one-on-one interactions between leaders in the field and fellows, residents and medical students during IDWeek.

  • Networking begins the first day of IDWeek with a meet-and-greet lunch
  • $500 travel stipend available to residents and medical students
  • Structured exclusive breakfast session with IDWeek speakers
Mentors and mentees interested in participating in the program should indicate interest during their registration for IDWeek 2016. For more information, please email foundation@idsociety.org.
 
 
When you meet with leaders in the field of ID, they tell you about their career path, and they talk about how they started off, their struggles or their accomplishments, and it makes you think that you can achieve what they have achieved. They’re all so humble and approachable. It’s just so nice to have them in the same room with you.”
— Sonali Advani, MD, MPH

Journal Club

Low Numbers, Big Impact: A Look at the Effectiveness of HPV Vaccination; Using Social Norms to Reduce Unnecessary Antibiotic Prescriptions; When Is a Narrow-Spectrum Antibiotic OK? Predicting Resistance in Pediatric UTIs; Can Multiplex PCR Testing Improve the Diagnosis and Treatment of Community-Acquired Pneumonia? An Update on Dengue Vaccine Development

In this feature, a panel of IDSA members identifies and critiques important new studies in the current literature that have a significant impact on the practice of infectious diseases medicine.
Click here for the previous edition of Journal Club. For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, FIDSA, in each issue of Clinical Infectious Diseases.
 
Low Numbers, Big Impact: A Look at the Effectiveness of HPV Vaccination
Reviewed by Terri Stillwell, MD 
 
The quadrivalent human papillomavirus (4vHPV) vaccine was licensed in 2006. Soon after, it was routinely recommended for females aged 11 to 26 years old. Recommendations for routine HPV vaccination in males 11 to 21 years old followed in 2011. Despite these recommendations, vaccine uptake remains low. A recent Pediatrics article assessed vaccine effectiveness, comparing HPV prevalence in pre- and post-vaccine time periods using data from the National Health and Nutrition Examination Survey (NHANES). 
 
NHANES performs cross-sectional surveys every year, using both a household interview and a physical exam. The survey collects various health information, including vaccine history, sexual history, and self-collected cervicovaginal swabs. During the pre-vaccine years (2003-2006), 2,587 females age 14 to 34 were interviewed and had swabs available for HPV typing; in the post-vaccine years (2009-2012), 2,061 female survey participants were available for this study. Post-vaccine data revealed receipt of at least one dose of HPV vaccine to be 51.4 percent among 14 to 19 year old females, 32.6 percent among 20 to 24 year olds, 14.7 percent among 25 to 29 year olds, and only 3.3 percent among 30 to 34 year olds. 
 
When comparing pre- and post-vaccine prevalence for HPV types found in the 4vHPV vaccine, there was a significant decrease in prevalence in females aged 14 to 19 and in those aged 20 to 24 (11.5 percent to 4.3 percent, 18.5 percent to 12.1 percent, respectively); there was no significant difference found in the later age groups. These findings held true when limiting the comparison to females who were sexually active, with an even greater prevalence decrease in sexually active, vaccinated females (18.6 percent to 2.1 percent). There was no significant change in non-4vPHV types; vaccination does not appear to provide cross-protection. 
 
This study affirms the effectiveness of HPV vaccination, despite continued low uptake in the U.S. Efforts to increase vaccination rates should continue. 
 
(Markowitz et al. Pediatrics. 2016;137(3):1-9.)
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Using Social Norms to Reduce Unnecessary Antibiotic Prescriptions
Reviewed by Michael T. Melia, MD

Alarms regarding inappropriate antibiotic use continue to sound. Because up to 90 percent of antibiotic prescriptions are written by general practitioners (GPs), targeting these providers to reduce inappropriate antibiotic use may be worthwhile. 
 
A recent article in the Lancet describes the use of publicly available United Kingdom prescribing data in concert with “social norm feedback,” the presentation of information showing that individuals are behavioral outliers in order to prompt them to adjust their behaviors to the social norm. The 1,581 GP practices in England that were within the top quintile of antibiotic prescriptions were randomized to two sequential interventions: (1) sending (or not) clinician-focused letters from England’s Chief Medical Officer to GPs informing them that their practice prescribed more antibiotics than 80 percent of neighboring practices, and offering behavioral science-based strategies to reduce prescribing, and (2) delivery (or not) of patient-focused educational posters and leaflets to the practice manager. 
 
The clinician letters reduced antibiotic prescribing by 4.27 prescriptions per 1,000 population (3.3 percent relative reduction), or an estimated 73,406 prescriptions. The effect was significant only for penicillins and macrolides. The cost to print and mail the provider intervention was estimated at 8 cents (U.S.) per prescription prevented. Patient-focused materials did not impact antibiotic prescribing rates. 
 
This study serves as a nice companion to articles described in last month’s Journal Club. Given that the intervention group provided nearly 2.2 million prescriptions during the six months of the first intervention, the reduction by 73,406 prescriptions is modest but notable, particularly given the low cost and scalability of the intervention. While an accompanying editorial mentions several caveats—the intervention requires access to prescribing data, information on individual antibiotic appropriateness and patient outcomes were not captured, and factors affecting antibiotic prescribing are complex—this effort indicates that social norm feedback may be a useful arrow in the quiver of antimicrobial stewardship. 
 
(Hallsworth et al. Lancet. 2016 Feb. 18.)
(Editorial: Gould and Lawes. Lancet. 2016 Feb. 18.)
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When Is a Narrow-Spectrum Antibiotic OK? Predicting Resistance in Pediatric UTIs
Reviewed by Terri Stillwell, MD 
 
Daily, physicians must decide which antimicrobial treatment is optimal, one that is narrow with a beneficial side-effect profile, yet likely covers the organisms of concern. With rising antimicrobial resistance, this is an increasing challenge. A recent article in The Journal of Pediatrics looked at patient characteristics in relation to antimicrobial resistance of uropathogens in pediatric patients and whether certain characteristics can predict resistance. 
 
Using data from two previous multicenter studies, this study analyzed 769 children, less than 6 years old, presenting with their first or second urinary tract infection (UTI). This cohort was 91 percent female; 49 percent were less than a year of age. Urine cultures were positive for E. coli 91 percent of the time. 
 
Interestingly, amoxicillin sensitivity was low for both E. coli and non-E. coli isolates at 55 and 61 percent, respectively. While sensitivity to a first generation cephalosporin and nitrofurantoin remained high for E. coli isolates (93 and 99 percent), sensitivity of non-E. coli isolates was less, at 72 and 40 percent. Finally, trimethoprim-sulfamethoxazole sensitivities were lower in E. coli compared to non-E. coli isolates (81 and 98 percent). Sensitivity to the boarder antibiotics was greater than 90 percent for all pathogens. 
 
When analyzing patient characteristics, uncircumcised males, those with history of bowel/bladder dysfunction, and those who had received a dose of antibiotic within the last six months had increased likelihood of having uropathogens resistant to narrow-spectrum antibiotics. Presence of vesicoureteral reflux (VUR) only impacted nitrofurantoin resistance, with higher grades of VUR having higher resistance rates; presence of VUR did not influence resistance rates of the other antimicrobials. Interestingly, Hispanic children more often presented with trimethoprim-sulfamethoxazole-resistant organisms. 
 
While this study’s patient population may not be directly generalizable to all settings, it shows that some narrow-spectrum antibiotics may still suffice as treatment for lower risk patients, though local epidemiology and antibiograms should always be taken into consideration. 
 
(Shaikh et al. J Pediatr. 2016;171:116-21.)
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Can Multiplex PCR Testing Improve the Diagnosis and Treatment of Community-Acquired Pneumonia?
Reviewed by Jennifer Brown, MD 
 
Community-acquired pneumonia (CAP) is one of the commonest infectious diseases, yet determining the etiology of CAP is an ongoing challenge. In the April 1 issue of Clinical Infectious Diseases, investigators described the results of their study in which respiratory tract specimens from adults with clinical and radiological evidence of CAP were tested by multiplex polymerase chain reaction (PCR) assays for 26 different bacterial and viral pathogens. The PCR results were compared to those of standard culturing methods. 
 
Of the 323 specimens tested, 310 (96 percent) were sputa and 13 (4 percent) were endotracheal aspirates. Overall, PCR testing identified a bacterial or viral pathogen in 280 (87 percent) of specimens. Bacteria were detected in 81 percent of specimens, with Haemophilus influenzae and Streptococcus pneumoniae identified most commonly. Thirty-two percent of specimens had more than one bacteria identified; H. influenza or S. pneumoniae were present in 92 percent of these co-detections. Viruses were detected in 30 percent of specimens, with rhinovirus and influenza A/B prevailing. Bacteria were detected in 82 percent of the specimens in which viruses were detected. In contrast to PCR testing, cultures identified a pathogen in only 127/323 (39 percent) of specimens. When a reasonable cutoff of >105 colony-forming units was used, bacteria were still detected in almost twice the number of specimens by PCR as compared to culture. Among the 268 patients who had received antimicrobials prior to specimen collection, PCR testing detected bacteria in more specimens than did culturing methods (78 vs. 32 percent, P < .0001). 
 
The investigators suggest that the enhanced sensitivity of multiplex PCR testing for detecting potential CAP pathogens can facilitate antimicrobial de-escalation. However, the lack of a control patient cohort and the possibility that positive PCR results represented oropharyngeal contamination or residual genetic material rather than active infection limit this assessment and will require further study. 
 
(Gadsby et al. Clin Infect Dis. 2016;62(7):817-823.)
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An Update on Dengue Vaccine Development

Reviewed by Sheila Mitsuma, MD 
 
With over 350 million dengue infections estimated to occur annually, and up to 3 billion people now at risk for infection worldwide, vaccine development efforts are actively underway. 
 
Last fall, in The Journal of Infectious Diseases (JID), investigators reported the results of a randomized, placebo-controlled trial evaluating the safety and immunogenicity of two live attenuated tetravalent dengue vaccines, TV003 and TV005, developed by the National Institute of Allergy and Infectious Diseases. The latter, TV005, was formulated with an enhanced dengue serotype 2 component. In this trial of 168 flavivirus-naïve adults, 60 patients received TV003, 60 patients received TV005, and 48 patients received placebo. 
 
Single doses of either vaccine induced antibody responses to dengue serotypes 1, 3, and 4 in 92 percent to 100 percent of vaccine recipients on day 90. No statistically significant difference in response was detected between vaccine formulations for these three serotypes. A higher frequency of seroconversion for dengue virus serotype 2 was observed for TV005 compared to TV003, with a detectable response at day 90 reported in 97 percent vs. 76 percent of recipients, respectively (p = 0.007). No serious adverse vaccine-related events were reported. No significant boost in antibody response was observed after a second dose at 6 months. 
 
To determine whether delaying a second dose of TV003 would increase the frequency of seroconversion or augment the magnitude of antibody responses, the same research group performed a second randomized trial, also recently reported in JID. Forty patients were randomized to TV003 at zero and 12 months; eight controls received placebo. A high frequency of seroconversion was seen for all four viral serotypes following the first dose: 89 percent for serotype 1, 95 percent for serotype 2, and 100 percent for both serotypes 3 and 4. Rates of seroconversion and multivalence of the antibody response were not augmented by a second dose. Mean antibody titers before and after the second dose increased less than the boost threshold (four-fold) in the great majority of patients across serotypes. These studies suggest that a single dose of either vaccine is highly immunogenic and that the neutralizing antibody response remains stable at 12 months without the need for booster dosing. As we do not yet know what titer of neutralizing antibody is required for protection against dengue, we anxiously await results evaluating vaccine effectiveness now underway in endemic areas. 
 
(Kirkpatrick et al. J Infect Dis. 2015;212(5):702-710.
(Durbin et al. J Infect Dis. 2016 Feb 16.)
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For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, FIDSA, in each issue of Clinical Infectious Diseases:

April 15
  • The Gut–Vascular Barrier
  • Cellulitis or Pseudocellulitis?
  • Bacterial Evolution Continues, Even in the Absence of Environmental Influences
April 1
  • Uncontacted Amerindians: Highly Diverse Microbiomes but With a Reservoir of Antibiotic Resistance Genes
  • Plasmid-Mediated Resistance to Colistin: Present in at Least 3 Continents