IDSA News - July/August 2016
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Updated IDSA Guideline on Valley Fever Published in CID

Every year, an estimated 150,000 people are infected with coccidioidomycosis, originally nicknamed San Joaquin Valley fever, and about 160 die, note updated guidelines by IDSA on Valley fever, published in Clinical Infectious Diseases. Valley fever is endemic in desert regions ranging from western Texas, Arizona and northern Mexico to the central San Joaquin Valley in California, as well as an area in south central Washington State. Some areas in Central and South America harbor the fungi as well. 

 
The fungi that cause the infection – Coccidioides immitis and Coccidioides posadasii – live in desert soil. The fungal spores become airborne when wind blows the dust around, are easily inhaled and settle deep in the lungs, causing pneumonia. 
 
The updated guidelines are now much more geared towards primary care clinicians who typically are the first to see and treat patients with pneumonia, but who may overlook valley fever as a potential cause of the illness and prescribe unnecessary tests and therapy. 
 
While 60 percent of people with valley fever have a mild infection with few or no symptoms, others may have fever, fatigue, cough, headache, chest pain, skin rash and joint aches. In extreme cases it can cause severe pneumonia, holes in the lungs (cavities), lung nodules, skin sores and meningitis. Pregnant women and people who are immunosuppressed (those with HIV, who had an organ transplant or are taking medication for rheumatologic disease) or have diabetes have a very high risk of complications. 
 
Fifty to 80 percent of people infected don’t require medication. Their immune systems eventually will rid their bodies of the infection and they will become immune. However, patients may benefit from physical therapy and should be seen by a health care provider regularly for two years to ensure their symptoms aren’t worsening, the guidelines say. 
 
Those who do need therapy should be treated with an anti-fungal medication such as fluconazole. The medication does not cure the infection, but suppresses symptoms. The guidelines note that some patients with more serious illness, including coccidioidal meningitis, will need to remain on antifungal therapy for life. 
 
The updated guidelines recommend treatment with fluconazole for women with complications from valley fever who are in their second or third trimester of pregnancy. That is a change from the previous guidelines (published in 2005), which recommended pregnant women be treated with amphotericin B, which does not harm the fetus but is highly toxic for the mother and requires intravenous treatment three times a week. Fluconazole is not toxic to the mother, can be taken orally and, while not recommended during the first trimester, appears safe during the second and third trimester, the guidelines note. 
 
The guidelines note valley fever can be diagnosed with simple blood tests called enzyme-linked immunosorbent assays (EIA), which test for antibodies to the fungus. Because it may take weeks or months for an EIA to show a positive result, taking a culture of the fungus from the sputum is another option. The guidelines panel includes infectious disease, pulmonary, critical care and rheumatology specialists, as well as thoracic surgeons and neurosurgeons. 
 
In addition to lead author, John N. Galgiani, MD, FIDSA; the guidelines panel includes Neil M. Ampel, MD; FIDSA; Janis E. Blair, MD, FIDSA; Antonino Catanzaro, MD; Francesca Geertsma, MD; Susan E. Hoover, MD, PhD; Royce H. Johnson, MD, FIDSA; Shimon Kusne, MD;Jeffrey Lisse, MD;Joel D. MacDonald, MD; Shari L. Meyerson, MD; Patricia B. Raksin, MD; John Siever, MD; David A. Stevens, MD, FIDSA; Rebecca Sunenshine, MD and Nicholas Theodore, MD.

As with other IDSA guidelines, the coccidioidomycosis guidelines will be available in a smartphone format and a pocket-sized quick-reference edition. 

Drug-Susceptible Tuberculosis Guidelines Now Available

New guidelines developed by IDSA, the American Thoracic Society (ATS) and Centers for Disease Control and Prevention (CDC) state that simultaneous treatment of HIV and tuberculosis (TB) saves lives. The guidelines on the treatment of drug-susceptible TB are now available in Clinical Infectious Diseases

 
People with HIV or diabetes, who are taking immune-suppressing medications, or who smoke or abuse drugs are at higher risk for developing TB disease once infected. Patients often are diagnosed with HIV and TB at the same time. In 2003, when previous TB guidelines were developed, patients with HIV usually did not start anti-retroviral therapy (ART) until after TB treatment was completed, unless the immunosuppression from HIV-infection progressed. Recommendations for timing of ART initiation have since changed. The new guidelines are intended for use in the United States and other areas with similar diagnostic and management resources and replace the 2003 guidelines published in CDC’s Morbidity and Mortality Weekly Review (MMWR).  
 
If patients do not receive ART during treatment of TB, the new guidelines recommend that TB treatment should be extended to eight months or longer, to reduce risk of relapse. 
 
After two decades of steady declines, the number of new TB cases in the US rose slightly in 2015, according to provisional data released by CDC. TB is one of the world’s deadliest diseases: in 2014, it is estimated that 9.6 million people worldwide fell newly ill with TB, and 1.5 million died. 
 
The new guidelines recommend comprehensive care of all patients with TB disease (known as case management), including the use of directly observed therapy (DOT), which improves treatment success. To be consistent with the principles of patient-centered care, the guidelines recommend that decisions regarding the use of DOT be made in partnership with the patient. DOT should be provided by trained health care workers in the doctor’s office, clinic, or the patient’s home, place of employment, school or other site convenient for the patient. For all TB patients, case management is essential to ensure treatment is effective, the guidelines note. 
 
Although the guidelines focus on drug-susceptible TB, following the recommendations can help stem the growing problem of acquired drug resistance, researchers note. This includes recommendations related to avoiding highly intermittent therapies, and using case management strategies such as DOT.  
 
Because rapid killing of the TB bacteria reduces the risk of death and the spread of the disease, the guidelines note that TB treatment (currently a combination of four medications) should begin as soon as the patient is suspected of having active TB disease, even before test results confirm the diagnosis. They also recommend therapy be given daily, rather than intermittently. 
 
The guidelines panel included: Payam Nahid, MD, MPH, lead author of the guidelines; Andrew Vernon, MD; Susan E. Dorman, MD; Narges Alipanah, MD; Pennan M. Barry, MD, MPH; Jan L. Brozek, MD, PhD; Adithya Cattamanchi, MD, MAS; Lelia H. Chaisson, MPH; Richard E. Chaisson, MD, FIDSA; Charles L. Daley, MD; Malgosia Grzemska, MD, PhD; Julie M. Higashi, MD; Christine S. Ho, MD; Philip C. Hopewell, MD; Salmaan A. Keshavjee, MD, PhD; Christian Lienhardt, MD; Richard Menzies, MD; Cynthia Merrifield, RN; Masahiro Narita, MD; Rick O’Brien, MD; Charles A. Peloquin, PhD; Ann Raftery, RN; Jussi Saukkonen, MD; H. Simon Schaaf, MD; Giovanni Sotgiu, MD; Jeffrey R. Starke, MD, FIDSA; and Giovanni Battista Migliori, MD. 
 
The guidelines are also endorsed by the European Respiratory Society (ERS) and US National Tuberculosis Controllers Association (NCTA).

Updated Guideline on Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia Now Available

An updated guideline on hospital-acquired pneumonia and ventilator-associated pneumonia developed by IDSA and American Thoracic Society (ATS), has been published in Clinical Infectious Diseases. According to the guideline, both types of pneumonia – which account for 20 to 25 percent of hospital-acquired infections – should be treated with shorter courses of antibiotics than they typically are. The recommendation of seven or fewer days of antibiotics for most of these infections reflects a change from previous guidelines to ensure safe and effective treatment while limiting the development of antibiotic resistance.
 
The new guideline also recommends that each hospital develop an antibiogram, a regular analysis of the strains of bacteria causing pneumonia infections locally as well as which antibiotics effectively treat them. When possible, the antibiogram should be specific to the hospital's intensive care unit patients, according to the guideline. Antibiograms should be updated regularly, and the most appropriate frequency should be determined by the institution, the guidelines note.
 
Published in 2005, the previous guideline recommended different lengths of treatment time for antibiotic therapy based on the bacterium causing the infection. The 2016 guidelines recommend seven days or fewer for all bacteria. Newer evidence suggests that the shorter course of treatment does not reduce the benefits of therapy; in addition this can reduce antibiotic-related side effects, the risk of Clostridium difficile, antibiotic resistance, and costs. In some cases, such as when a patient doesn't improve or worsens, longer treatment may be necessary.
 
The guidelines panel featured experts from around the globe including infectious disease, pulmonary and critical care specialists, surgeons, pharmacologists, microbiologists, professional librarians and methodologists. In addition to Andre Kalil, MD, MPH, FIDSA and Mark Metersky, MD, (Co-Chairs), the guidelines panel includes: Michael Klompas, MD, FIDSA; John Muscedere; Daniel A. Sweeney, MD; Lucy B. Palmer; Lena M. Napolitano, MD; Naomi P. O'Grady, MD, FIDSA; John G. Bartlett, MD, FIDSA; Jordi Carratalà; Ali A. El Solh; Santiago Ewig; Paul D. Fey, PhD; Thomas M. File, Jr., MD, FIDSA; Marcos I. Restrepo; Jason A. Roberts; Grant W. Waterer; Peggy Cruse; Shandra Knight and Jan L. Brozek.
 

HCV Guidance Website Updated to Reflect Latest Drug Developments

HCVguidelines.org, a website developed by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) to provide up-to-date guidance on the treatment of hepatitis C (HCV) has updated several sections of the website based on newly available therapies and data.

 
The latest version of the HCV Guidance provides new recommendations regarding the optimal use of antiviral agents for hepatitis C in the wake of the approval by the Food and Drug Administration of sofosbuvir/velpatasvir. It also integrates recent trial data for other combinations of direct-acting antiviral agents, particularly in unique groups of patients, including those who have impaired kidney function, have undergone liver transplantation, or have HIV co-infection. 
 
“We believe that the updated recommendations will help caregivers with regimen choice not only in common treatment scenarios, but will also importantly provide guidance in cases where randomized trial data or specific FDA labeling may be lacking,” said Raymond Chung, MD, co-chair of the guidance panel. 
 
“The latest updates to HCVguidelines.org bring a trusted document up to date with the latest therapeutic options. The guidance now offers more than one front-line regimen for each viral genotype and updates recommendations for patients of high complexity. Most treating clinicians will find workable treatment options for the majority of their patients,” said Hugo Vargas, MD, guidance panel co-chair. 
 
The update also offers guidance regarding the prudent use of HCV resistance testing, a source of considerable confusion for practitioners. Important information regarding the monitoring of patients with cirrhosis who are undergoing therapy with direct acting antivirals is also provided. Tables highlighting important potential drug-drug interactions between HCV antivirals and commonly prescribed medications, including antiretroviral and antirejection agents, have also been updated. 
 
“As more patients gain coverage for curative therapies, our panel hopes that the updated guidance allows more providers to join the fight against this deadly and expanding epidemic,” said Arthur Kim, MD, guidance panel co-chair. 
 
Visit www.HCVguidelines.org for updates regarding the release of this and other sections of the guidance.

IDSA Partners with AGA on New Registry to Track Fecal Microbiota Transplants

IDSA is partnering with the American Gastroenterological Association (AGA) in a new initiative to develop the first national registry for short- and long-term patient outcomes associated with fecal microbiota transplantation (FMT).

The National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) is funding the new initiative, which will enable researchers to identify potential adverse outcomes and possible safety concerns of FMT.

Rapidly accumulating evidence suggests that modifying gut microbiota may promote health or treat disease, with FMT for Clostridium difficile infection being the first successful clinical application of this concept. Researchers are now exploring FMT for conditions beyond C. difficile.  However, the early adoption and expansion of FMT in clinical practice has outpaced scientific study, resulting in a lack of understanding of the potential health risks from humantohuman transfer of stool. Eventually, the data collected through the registry will provide long-term uses in understanding how manipulation of the gut microbiota could treat disease and promote overall health.

Additional partners in the initiative are the Crohn’s and Colitis Foundation of America and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. 

CLSI Updates on Antimicrobial Susceptibility Testing Are Now Available

Teaser here

IDSA recognizes the importance of access to up-to-date antimicrobial susceptibility breakpoints for ID physicians and is pleased to announce that the Clinical Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing (M100 document) with all the most current breakpoints for common bacteria is now available for free in an online searchable version.  IDSA is also continuing policy and advocacy efforts to improve and speed up the process through which the Food and Drug Administration (FDA) sets breakpoints.
 
At its June 2016 meeting, the CLSI AST Subcommittee, which includes an IDSA liaison, addressed the following issues:
 
+ Due to recent reports of Enterococcus faecium treatment failures with daptomycin, recently defined resistance mechanisms, and modifications in pharmacokinetics/pharmacodynamics (PK/PD) with altered dosing strategies, the committee moved to re-examine the current susceptibility only breakpoint of ≤ 4µg/mL for daptomycin versus Enterococcus spp.    
 
+ Colistin clinical breakpoints were revised for Acinetobacter sp. and Pseudomonas aeruginosa at ≤ 2 µg/mL susceptible, ≥ 4 resistant (the intermediate category was eliminated). A recommendation was also made to add a comment to the report to remind clinicians to use colistin with an initial loading dose, at maximum doses and in combination with other agents.
 
+ Two Epidemiologic Cutoff Values (ECV or ECOFF) for clinically relevant bacteria were established.  An ECV is not a clinical breakpoint and is only based on wild type distribution of characterized isolates within a species against a specific antimicrobial. A clinical breakpoint differs from an ECV because breakpoints are also based on pharmacokinetic/pharmacodynamics, animal model efficacy and clinical outcomes. ECVs can be important for detection of the emergence of resistance.  
 
  • Epidemiologic Cutoff Value (ECV) of ≤ 1 µg/mL was established for N. gonorrhoeae and azithromycin to detect early signals of resistance.  
  • The committee felt that there was still not enough data to set a clinical breakpoint for colistin and Enterobacteriaceae due to issues of testing accuracy, outstanding data on PK/PD and resistance prediction. However, due to the potential for increased colistin/ polymyxin resistance in light of plasmid mediated spread, an ECV was established for Enterobacteriaceae (≤ 2 μg/mL) to detect non-wild type isolates which may harbor resistance mechanisms.  
The CLSI Subcommittee on Antimicrobial Susceptibility Testing appreciates input from IDSA members.  More information about how to contact CLSI and participate in its work is available here
 
About CLSI:
The Clinical Laboratory Standards Institute (CLSI) is a non-profit membership organization that develops clinical laboratory testing standards based on input from and consensus among industry, government, and health care professionals. CLSI meetings are open to all interested parties.  CLSI has a subcommittee on antimicrobial susceptibility testing (AST), and its decisions are made by a group of volunteers representing the government, industry, and the professions that evaluate contemporary issues and construct the recommendations included in CLSI documents. The subcommittee is comprised of microbiologists, infectious diseases physicians (including an IDSA liaison), pharmacists, public health specialists, and others. Meetings are twice a year at different locations around the country. 
 
 

CDC Issues Travel Warning for Area in Miami Due to Locally Transmitted Zika Virus; Generic Version of Tamiflu Approved by FDA

The Centers for Disease Control and Prevention (CDC) issued a first-ever travel warning for a 150-square meter area in Miami due to active local mosquito-borne Zika transmission. Pregnant women and their partners are advised to avoid the area with active mosquito-borne transmission. 

 
A new generic version of oseltamivir (Tamiflu) has been approved by the FDA. This is the first generic version of the influenza drug that has been approved and put on the market. 
 
You can get timely updates from FDA and CDC by subscribing to one of IDSA’s members-only email alert services. Content includes a range of topics, including drug warnings, recalls, and outbreak investigations. Recent alerts have included: 

FDA Approves First Generic Version of Widely Used Influenza Drug (8/4/2016, FDA Alert) 
 
Updated Interim Zika Clinical Guidance for Pregnant Women and Data on Contraceptive Use to Decrease Zika-affected Pregnancies (8/4/2016, CDC Alert) 

CDC Update for Guidance for Travel and Testing of Pregnant Women (8/2/2016, CDC Alert) 
 
Fluoroquinolone Antibacterial Drugs for Systemic Use: Drug Safety Communication - Warnings Updated Due to Disabling Side Effects (7/26/2016, FDA Alert) 
 
Updated CDC Clinical Zika Recommendations: July 25, 2016 (7/25/2016, CDC Alert) 
 
CDC Assisting Utah Investigation of Zika Virus Infection Apparently Not Linked to Travel (7/18/2016, CDC Alert) 
 
FDA Announces Voluntary Nationwide Recall of Oral Liquid Docusate Sodium Manufactured by PharmaTech and Distributed by Rugby Laboratories (7/18/2016, FDA Alert) 
 
A compilation of CDC alerts and additional resources related to the Zika virus outbreak can be found on the IDSA website.

Virtual Supervision of “Incident To” Services

IDSA Outlines Implications for OPAT 

 
The American Medical Association (AMA) circulated a resolution at its Annual House of Delegates Meeting in June regarding “incident to” services—defined as services or supplies furnished as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness. The AMA’s resolution “supports pilot programs in the Medicare program to enable virtual supervision of ‘incident to’ services that require direct supervision if those programs abide by certain principles.” 
 
AMA’s resolution may have implications to IDSA members in clinical practice, including those who provide outpatient parenteral antibiotic therapy (OPAT), which IDSA believes requires some supervision by an ID physician. AMA’s resolution states:
  • The physician billing the “incident to” services must meet requirements of direct supervision of “incident to” services, which includes seeing the patient and initiating the course of treatment, and providing services that shows active management and participation in the course of treatment.
  • Supervision by the physician should conform to all applicable state laws.
  • Non-physician practitioners must follow all state licensing laws and state medical practice laws during the provision of the “incident to” services.
  • State scope of practice laws must be followed and the physician must be connected through real-time audio and video technology with the room where the service is provided, and to ensure that the physician is immediately able to provide assistance. 
  • Virtual supervision of “incident to” services must follow evidence-based practice guidelines when available.
  • The physician providing the virtual supervision should visit the sites where the “incident to” services will be performed.
  • Physicians providing virtual supervision of the “incident to” services must establish protocols for arranging emergency services “including having an agreement with a physician at the site at which the ‘indecent to’ services are provided, to ensure immediate assistance.” 

IDSA has developed a position statement (PDF) that says virtual supervision of services such as OPAT should only be allowed if there is a practitioner on site to provide immediate assistance in case of adverse events such as an allergic reaction during an IV infusion. For infusions covered under the “incident to” rules, IDSA states that the first infusion should be provided to the patient during a face-to-face encounter with the supervising physician, but that it may be possible, for subsequent infusions to be supervised virtually.

IDSA’s position is that virtual supervision cannot provide “hands on” assistance that is needed for services such as IV infusions. Furthermore, in cases of infusion of OPAT, IDSA believes it is important for an ID physician to provide input and consultation on the use of OPAT, but that the ID physician does not have to be physically present as long as another physician is physically onsite to provide immediate assistance, if needed, during the initial OPAT treatment. 
 

Take 3 Minutes to Tell the UN to Take Global Action on Antimicrobial Resistance

The United Nations intends to hold a high-level meeting on antimicrobial resistance in September. This is a once-in-a-lifetime opportunity to drive coordinated global change to address this public health crisis. 

 
Earlier this summer, IDSA was one of a select handful of organizations to present to the UN on this issue. Please continue to help amplify our voice and increase the momentum for global intervention on antimicrobial resistance by signing our petition. 
 
Just click on the link below and enter your contact information. Please forward this link to your ID colleagues and encourage them to take action as well.
 
Sign the Petition!
 
There is a separate petition for the public, please share this with your colleagues, friends, and anyone you think would be willing to sign: https://www.change.org/p/united-nations-urge-the-united-nations-to-combat-antimicrobial-resistance.  Anyone can sign, and the more signatures, the better!

As US Cases Mount, IDSA Continues To Push for Zika Funding

Even as the Centers for Disease Control and Prevention (CDC) was issuing an alert advising pregnant women to avoid areas of Miami where Zika transmission had been confirmed, efforts to fund the federal response to Zika were stymied in Washington, DC. IDSA’s official statement on the arrival of local transmission in the US can be found here.

IDSA continues to advocate for robust funding to address Zika, to provide Zika resources to our members, and to report on the latest Zika developments through the Center for Global Health Policy’s Science Speaks blog

After months of negotiations, Congress was unable to pass emergency funding for Zika before leaving for a seven week recess in July. IDSA and other health groups are strongly urging Congress to pass a bill immediately upon its return from recess. Please take a few minutes to use this action alert to contact your congressional representatives in support of swift passage of a Zika funding bill that does not repurpose existing funding intended for other public health priorities.

Key federal experts continue to underscore the need for new funding to address Zika. CDC Director Tom Frieden, MD, MPH, has noted that the response effort could have been more robust if emergency funding had passed.

On August 11th the Administration reprogrammed an additional $81 million dollars to ensure vaccine development can continue. This funding includes $34 million for the National Institutes of Health and $47 million for the Biomedical Advanced Research and Development Authority budget. The Administration emphasized that this funding in no way replaces or reduces the need for the $1.9 billion dollars they originally asked for in February. This funding comes at a critical time in vaccine development as one of the four vaccine candidates begins Phase 1 testing and the preparations are being made for its Phase 2 launch in the coming months. The other three are all still in the research stage, but there is hope that with additional funding one or more of them may begin clinical trials by the end of the year.

Massachusetts Passes Troubling Lyme Legislation

IDSA Provides New Resources for State Lyme Advocacy


The Massachusetts state legislature late last month voted to overturn the veto of Governor Charlie Baker and enact
a new law requiring health insurers to cover long-term antibiotic treatment for Lyme disease, despite a strong push from the Massachusetts ID Society to block this legislation.  Rhode Island and Connecticut have similar laws in place.

IDSA is providing resources to our members and to state and regional ID societies that wish to educate their state lawmakers and governors about Lyme disease and advocate against such harmful policies. IDSA has updated its primer on Lyme disease (PDF) geared toward state policymakers, which we are also distributing via the National Council for State Legislators and the National Governor’s Association. 

As reported previously in IDSA News, IDSA along with the American Academy of Neurology (AAN) and the American College of Rheumatology (ACR) are jointly developing a systematic review and clinical practice guideline on the treatment of Lyme disease. Announcements regarding the development of this guideline will be posted to the IDSA website

Party Platforms Include IDSA Priorities

The Democratic and Republican party platforms that were ratified last month at the two parties’ conventions both contain proposals related to IDSA’s strategic priorities. The Democratic party platform speaks to health care workforce issues, and funding for the National Institutes of Health (NIH) and public health.  It also pledges to advance several domestic and global HIV priorities and to address prescription drug costs. The Republican party platform commits support for federal and private investment in biomedical innovation, explicitly noting Ebola, Zika, chikungunya and antibiotic resistant pathogens as key priorities.  It also promises reform of the Food and Drug Administration (FDA) to better foster innovation and expresses support for AIDS relief under PEPFAR and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. 

IDSA and HIVMA are non-partisan and continue to work with elected officials from both parties to advance the Society’s priorities.

Relevant excerpts from both party platforms are below:

Democratic Party Platform

Healthcare Workforce:  “Democrats also know that one of the key ingredients to the success of these health centers is a well-supported and qualified workforce in community-based settings. We will fight to train and support this workforce, encourage providers to work with underserved populations through the National Health Service Corps, and create a comprehensive strategy to increase the pool of primary health care professionals.”

Prescription Drug Prices:  “We will crack down on price gouging by drug companies and cap the amount Americans have to pay out-of-pocket every month on prescription drugs. We will prohibit anti-competitive “pay for delay” deals that keep generic drugs off the market, and we will allow individuals, pharmacists, and wholesalers to import prescription drugs from licensed pharmacies in Canada and other countries with appropriate safety protections. Democrats will also fight to make sure that Medicare will negotiate lower prices with drug manufacturers.”

NIH Funding:  “We recognize the critical importance of a fully-funded National Institutes of Health to accelerate the pace of medical progress.”

Public Health Funding:  “Democrats will fight for increased investments in public health to better address emerging threats and the needs across our country. To further that end, the Democratic Party will continue to oppose Republican attempts to cut public health services and funding. We will ensure adequate funding of public health education at the undergraduate, graduate, and medical school levels as well as adequate funding of residency training programs in public health, preventive medicine, and its subspecialties.”

Zika and Pandemic Preparedness:  “While the Republican Party refuses to fund important measures that could contain and address the Zika pandemic, Democrats are ready to limit the reach of Zika—just as we did with Ebola—and support funding for diagnostic tests for the virus, vaccine, and treatment. We will also prepare for potential pandemics, like avian influenza and H1N1, by working with first responders and health officials to reduce the risks associated with unintentional or deliberate outbreaks of infectious diseases.”

HIV/AIDS:  “…we will implement the National HIV and AIDS Strategy; increase research funding for the National Institutes of Health; cap pharmaceutical expenses for people living with HIV and AIDS; reform HIV criminalization laws; and expand access for harm reduction programs and HIV prevention medications, particularly for the populations most at risk of infection. Abroad, we will continue our commitment to the President’s Emergency Plan for AIDS Relief and increase global funding for HIV and AIDS prevention and treatment.”

Republican Party Platform

Research:  “American medicine is poised to enter a new era of technological advance. Federal and private investment in basic and applied biomedical research holds enormous promise, especially with diseases and disorders like autism, Alzheimer’s, and Parkinson’s. Just as we today take for granted wonders that seemed impossible a few decades ago — MRIs and CAT scans, robotic surgery, and in utero treatment — patients a decade hence will have care and treatment that will make much of today’s medicine look primitive. Modern miracles involving genetics, the immune system, cures for deadly diseases, and more are in the research pipeline.  This is the consequence of marrying significant investment, both public and private, with the world’s best talent, a formula that has for a century given the American people the world’s best healthcare.  We are determined that it should continue to do so, especially as we confront new dangers like Ebola, Zika, chikungunya, and antibiotic-resistant pathogens.”

FDA Reform:  “The FDA needs to return to its traditional emphasis on hard science and approving new breakthrough medicines, rather than divert its attention and consume its resources trying to overregulate electronic health records or vaping. We pledge to restore the FDA to its position as the premier scientific health agency, focused on both promoting and protecting the public health in equal measure, so we can ensure that Americans live longer, healthier lives, that the United States remains the world leader in life sciences and medical innovation, that millions of high-paying, cutting-edge device and drug jobs stay in the United States, that U.S. patients benefit first and most from new devices and drugs, and that the FDA no longer wastes U.S. taxpayer and innovators’ resources through bureaucratic red tape and legal uncertainty.”

Global HIV/AIDS:  “The Republican Congress has extended to 2025 the African Growth and Opportunity Act, and President George W. Bush’s health initiatives — AIDS relief under PEPFAR and the Global Fund to Fight AIDS, Tuberculosis, and Malaria — continue to save millions of lives. Peace Corps volunteers and U.S. Seabees teach and build in villages that know firsthand our country’s idealism.” 

Live from Durban: Science Speaks Covers AIDS 2016

IDSA’s Global Health Science Speaks blog covered breaking news, research and policy reviews and discussions at AIDS 2016, the 21st International AIDS Conference in Durban, South Africa. Coverage included:

Results from the SEARCH trial showing that UNAIDS 90-90-90 goals for HIV testing, treatment and viral suppression could be exceeded in two years with community outreach and immediate links to care;

Updates on tuberculosis care, treatment and vaccine development, including coverage of a two-day TB preconference event.

A look at global infectious disease workforce issues from HIVMA Chair Dr. Carlos del Rio.

Stipends Available to ID Medical Student Interest Groups

In an effort to educate medical students and residents about the field of infectious diseases, IDSA will provide $500 stipends to infectious disease student interest groups at medical schools.

This initiative provides new and existing student groups the opportunity to hold various informational or networking events to increase awareness of the field of infectious diseases.

For additional information on requirements and to fill out an application, visit the Medical Student Interest Groups webpage. The deadline to apply for funding for the fall semester is September 15. 

Vaccines Virtual Collection from CID

Clinical Infectious Diseases (CID) regularly publishes articles about vaccines in its special section on this important topic. You can browse a collection of these invited articles, managed by CID Section Editor Stanley A. Plotkin, MD, through the Vaccines Virtual Collection. Articles have explored prepandemic immunization to combat future influenza pandemics, deaths reported to the Vaccine Adverse Event Reporting System, and vaccines for the prevention of malaria, enterovirus 71, and rotavirus, among other immunization-related issues. Readers can also access a comprehensive list of additional invited content in CID related to vaccines here.

Upcoming Webinar on Antibiotic Drug Development

A free webinar on Aug. 24 will feature a discussion of approaches to address the need for antibiotic development, including recommendations designed to advance clinical trials for antibiotics to treat hospital-acquired and ventilator-associated bacterial pneumonia. The recommendations, developed by the Clinical Trials Transformation Initiative (CTTI), appeared in a recent Clinical Infectious Diseases supplement. Established by Duke University and the Food and Drug Administration, CTTI includes member organizations working to develop and drive the adoption of practices that will increase the quality and efficiency of clinical trials.

For more information about the webinar, “Antibacterial Drug Development in a Time of Great Need: Global Expert Panel,” scheduled for noon to 1 p.m. EDT, on Aug. 24, visit CTTI’s website

IDSA, HIVMA Seek Clinical Practice Guidelines Editor

Application Deadline: August 31 

 
IDSA and HIVMA have begun a search for a Clinical Practice Guidelines Editor, a new position to provide support to the development of evidence-based clinical practice guidelines for the Society. 
 
Development of timely, expert, up-to-date, and easy-to-use practice guidelines is one of the Society’s strategic priorities, and the guidelines are highly valued by IDSA members. Their value lies in the expert advice that members rely on to improve their medical practice and in the influence these guidelines have on administrative, regulatory and legal bodies. 
 
This position was created by IDSA to facilitate the work of the Standards and Practice Guideline Committee (SPGC) to more efficiently and effectively serve the needs of the IDSA membership for evidence-based clinical guidelines. The Clinical Practice Guidelines Editor will work with IDSA staff, the SPGC, and multi-disciplinary teams of experts in support of evidence-based clinical practice guidelines. S/he will help ensure the quality, consistency and timeliness of IDSA’s clinical practice guidelines.
 

Process and Timeline
IDSA has appointed a Search Committee to receive and review applications and nominations, which are due via email to jpadberg@idsociety.org by August 31, 2016. Short-listed candidates will be informed of their status by September 30, 2016 and will be interviewed during IDWeek in New Orleans on Monday, October 24, 2016.

The successful candidate will be notified by November 1, 2016, with duties to commence shortly thereafter. A 3-5 year term is envisioned.

Applications and Nominations
Those interested in the position should provide a CV and a 2-4 page statement of qualifications, a basis of interest in this position, availability to devote considerable time and energy to the clinical practice guideline process, and information to address the following criteria:

  1. Academic and Publishing Record
    Evidence of experience in data analysis and scientific writing with a robust list of publications in relevant fields. 
  2. Leadership and Editorial Experience
    Leadership experience working with broad range of individuals and experience as an Editor or Associate Editor (or similar) of an indexed journal in a related field are desirable. 
  3. Experience in Guideline Development
    Prior experience working with panels or guideline development committees is preferred.

For more information, including a description of the Standards and Practice Guideline Committee’s current workload and guideline development and review process, please contact:

Jennifer Padberg
Vice President, Guideline Development, IDSA
jpadberg@idsociety.org
(703) 299-0201

Cynthia L. Sears, MD, FIDSA
Chair, Taskforce on Guideline Development
csears@jhmi.edu
(410) 614-0141

IDSA Advocacy on ID-Led Stewardship—More Progress on our Strategic Priorities

IDSA and the Society for Healthcare Epidemiology of America (SHEA) are urging the Centers for Medicare and Medicaid Services (CMS) to establish antimicrobial stewardship programs (ASPs) as a condition of participation in Medicare and Medicaid, and in so doing, making our case for why these programs should be led by infectious diseases physicians. ID physician leadership of ASPs is a top priority of the Society and we are encouraged by this progress by CMS given our advocacy efforts.

Positioning ID specialists as the leaders of antimicrobial stewardship programs (ASPs) across the health care system is one of IDSA’s top strategic priorities (see my earlier President’s message on this theme).

We have many irons in this fire, and the latest (perhaps the hottest one) is this: IDSA and the Society for Healthcare Epidemiology of America (SHEA) are urging the Centers for Medicare and Medicaid Services (CMS) to establish ASPs as a condition of participation in Medicare and Medicaid, and in so doing, making our case for why these programs should be led by infectious diseases physicians. Our two societies recently made this case in our joint comment letter (PDF) in response to CMS’s recent proposed rule.  Given the significant changes to infection prevention and control programs and the proposal to establish ASPs in all acute care and critical access hospitals, our Societies highlighted the patient safety aspects of these activities and the multi-disciplinary teams involved.  We now await CMS’ finalization of the conditions of participation, and we hope our recommendations will prevail. 

The Joint Commission has already specifically cited the involvement of ID physicians in ASPs in their new Antimicrobial Stewardship Standards for hospitals and nursing homes, which is important as The Joint Commission accredits almost 80 percent of all hospitals.  This is a crucial and satisfying recognition given our long-term advocacy on antimicrobial stewardship and the looming threat of resistance. 

As we wait for the final rule from CMS, we continue our work to support your efforts to lead antimicrobial stewardship activities at the local level. IDSA is developing numerous resources, including an ASP Policy and Procedure template with suggested language describing procedures, personnel composition, interventions, and surveillance. You can find these resources in The Value of ID Toolkit (member login required). IDSA’s Joint Antimicrobial Stewardship Task Force, comprised of members from IDSA, SHEA, and the Pediatric Infectious Diseases Society (PIDS), fielded a survey last month to members who lead ASPs at their respective facilities. The findings from this survey will help to benchmark current stewardship resources across various types of facilities.  We are also working on an instructional video that demonstrates how a tele-stewardship program can be implemented to extend ID physician leadership of ASPs to remote facilities.

Promoting ID leadership in ASPs is just one of IDSA’s strategic priorities. I encourage you to read more about the IDSA strategic priorities  and to take an active role in the Society—your Society. You have an immediate opportunity to do so by casting your vote in the upcoming election for the Board of Directors.

Another unique opportunity to share your thoughts and opinions on the activities of the Society will be at the first-ever IDWeek Town Hall: Securing the Future of ID. I will be joined by other leaders from IDSA and HIVMA in talking about important activities aimed at promoting the value of the ID specialty and attracting the best and brightest to our field. The most important aspect of the Town Hall, in my opinion, is its interactive nature. YOU will have an opportunity to be heard. We need to hear about the challenges you face as an ID physician and your thoughts on what the Society can be doing to help you address those challenges. The Town Hall is just the kick-off to what we expect to be an ongoing dialogue with our members, so please join us at IDWeek 2016 and look for continuing online discussions about the issues raised.

Don’t Miss These IDSA Guidelines Updates

IDSA's Standards and Practice Guidelines Committee has been hard at work finalizing several guidelines that are critical to the work of our members. Look to the Patient Care and Science section of this issue of IDSA News to find updates on the following guidelines:

  • Coccidioidomycosis (Valley Fever)
  • Drug-Susceptible Tuberculosis
  • Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia
  • Hepatitis C Virus Infection

IDSA’s Standards and Practice Guidelines Committee has been hard at work finalizing several guidelines that are critical to the work of our members. Look to the Patient Care and Science section of this issue of IDSA News to find updates on the following guidelines:

Coccidioidomycosis (Valley Fever)

Drug-Susceptible Tuberculosis

Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia

Hepatitis C Virus Infection

IDSA Honors 111 Distinguished Physicians, Scientists with FIDSA

Join IDSA in congratulating the outstanding physicians and scientists who have been awarded Fellow status by the Society. Each of these 111 individuals have achieved professional excellence and provided significant service to the field of ID and are leaders in their institutions and communities. FIDSA status is awarded annually by the IDSA board of directors.

IDSA recognizes the distinguished physicians and scientists from around the world who were elected this year to be Fellows of IDSA.

Fellowship in IDSA honors those who have achieved professional excellence and provided significant service to the profession. “Each one of these physicians and scientists is to be commended for the contributions they have made to the field of infectious diseases—a field that each and every day demonstrates its value to the public, particularly as we confront new and emerging infectious challenges such as the Zika and Ebola virus diseases and antimicrobial resistance. IDSA Fellows are recognized leaders in their communities and institutions, whether it be a hospital, clinic, research laboratory, or public health setting,” said IDSA President Johan S. Bakken, MD, PhD, FIDSA.

Applicants for IDSA Fellowship must be nominated by their peers and meet specified criteria, including continuing identification with the field of infectious diseases, national or regional recognition, and publication of their work. Nominees are reviewed and elected by the IDSA Board of Directors. Fellows of IDSA work in many different settings, including clinical practice, teaching, research, public health, and health care administration.

This year, the following individuals were honored as Fellows of IDSA:

Cybele Abad, MD, FIDSA
University of the Philippines, Philippine General Hospital, Manila, Philippines

Maria Alcaide, MD, FIDSA
University of Miami Miller School of Medicine, Miami, FL

William Alexander, MD, FIDSA
Alexander Pharma Consulting, LLC, Cary, NC

Jaffar Al-Tawfiq, MD, FIDSA
Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia

Gonzalo Bearman, MD, FIDSA
Virginia Commonwealth University Health, Richmond, VA

Scott Bergman, PharmD, FIDSA
University of Nebraska Medical Center, Omaha, NE

Jorge Bertran, MD, FIDSA
University of Puerto Rico School of Medicine, Guaynabo, PR

Nikhil Bhayani, MD, FIDSA
Texas Health Resources Arlington Memorial Hospital, Colleyville, TX

Adarsh Bhimraj, MD, FIDSA
Cleveland Clinic Foundation, Cleveland, OH

Raymond Blum, MD, FIDSA
Infectious Disease Consultants, P.C., Denver, CO

Jonathan Blum, MD, FIDSA
Kaiser Permanente Medical Center, Santa Clara, CA

Robert Bonomo, MD, FIDSA
Veterans Affairs Medical Center, Cleveland, OH

P. Brandon Bookstaver, PharmD, FIDSA
South Carolina College of Pharmacy, University of South Carolina, Columbia, SC

Mitchell Brodey, MD, FIDSA
Upstate University Hospital, Syracuse, NY

Michael Calderwood, MD, FIDSA
Dartmouth-Hitchcock Medical Center, Lebanon, NH

Julio Cardenas, MD, FIDSA
Infectious Disease Associates, PA, Boca Raton, FL

Beata Casanas, DO, FIDSA
Tampa General Hospital, Infectious Diseases Center, Tampa, FL

David Cennimo, MD, FIDSA
UMDNJ-NJ Medical School, Newark, NJ

Luke Chen, MBBS, FIDSA
Duke University Medical Center, Durham, NC

Eunhwa Choi, MD, FIDSA
Seoul National University College of Medicine, Seoul, Republic of Korea

Jimmy Chua, MD, FIDSA
Trios Health, Richland, WA

Wendy Chung, MD, FIDSA
Dallas County Health and Human Services, Dallas, TX

Susan Coffin, MD, FIDSA
Childrens Hospital of Philadelphia, Philadelphia, PA

Deblina Datta, MD, FIDSA
Centers for Disease Control and Prevention, Atlanta, GA

Louise Dembry, MD, FIDSA
Yale University/VA Connecticut Healthcare System, West Haven, CT

Marie dePerio, MD, FIDSA
Centers for Disease Control and Prevention, Cincinnati, OH

Lisa Dever, MD, FIDSA
Rutgers New Jersey Medical School, Newark, NJ

Shireesha Dhanireddy, MD, FIDSA
University of Washington, Seattle, WA

Douglas Drevets, MD, FIDSA
University of Oklahoma Health Sciences Center, Oklahoma City, OK

Hana El-Sahly, MD, FIDSA
Baylor College of Medicine, Houston, TX

Mushira Enani, MBBS, FIDSA
King Fahad Medical City, Riyadh, Saudi Arabia

Moshe Ephros, DTM&H, MD, FIDSA
Carmel Medical Center, Haifa, Israel

Lisa Esolen, MD, FIDSA
Geisinger Health System, Danville, PA

Ann Falsey, MD, FIDSA
University of Rochester, Rochester General Hospital, Rochester, NY

Vance Fowler, MD, FIDSA
Duke University Medical Center, Durham, NC

Alison Freifeld, MD, FIDSA
University of Nebraska Medical Center, Omaha, NE

Sandeep Gandhi, MD, FIDSA
Peconic Bay Medical Center, Patchogue, NY

Hayley Gans, MD, FIDSA
Stanford University Medical Center, Stanford, CA

Mayurika Ghosh, MD, FIDSA
Food and Drug Administration, Ellicott City, MD

Jessie Glasser, MD, FIDSA
San Antonio Military Medical Center, San Antonio, TX

Deborah Gold, MD, FIDSA
Kaiser Permanente, San Francisco, CA

Celine Gounder, MD, FIDSA
Mount Sinai Health System, New York, NY

Jeannette Guarner, MD, FIDSA
Emory Univerisy, Atlanta, GA

Lisa Haglund, MD, FIDSA
University of Cincinnati College of Medicine, Cincinnati, OH

Rodrigo Hasbun, MD, FIDSA
University of Texas Health, Houston, TX

Rita Helfand, MD, FIDSA
Center for Disease Control, Atlanta, GA

Cynthia Hoey, DO, FIDSA
Huntington Hospital, Northport, NY

Horace Holley, MD, FIDSA
Leidos Biomedical Research, Inc., Frederick, MD

Robert Holmes, DO, FIDSA
Wright-Patterson Medical Center, Fairborn, OH

Vito Iacoviello, MD, FIDSA
Mount Auburn Hospital, North Andover, MA

Rupali Jain, PharmD, FIDSA
University of Washington Medical Center, Seattle, WA

Seema Jain, MD, FIDSA
Centers for Disease Control and Prevention, Dulles, VA

Christine Johnston, MD, FIDSA
University of Washington, Seattle, WA

Suresh Joshi, MD, PhD, FIDSA
Drexel University College of Medicine, Philadelphia, PA

Bill Kapogiannis, MD, FIDSA
National Institute of Child Health and Human Development, NIH, Bethesda, MD

Ben Katz, MD, FIDSA
Northwestern University Feinberg School of Medicine, Skokie, IL

Pamposh Kaul, MD, FIDSA
University of Cincinnati, Cincinnati, OH

Allison Kelly, MD, FIDSA
University of Cincinnati, Maysville, KY

Jad Khoury, MD, FIDSA
Mercy Hospital-St. Louis, St Louis, MO

Hong Bin Kim, MD, FIDSA
Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea

Beth Kirkpatrick, MD, FIDSA
University of Vermont College of Medicine, Burlington, VT

Susan Kline, MD, FIDSA
University of Minnesota, Minneapolis, MN

Mark Knouse, MD, FIDSA
Lehigh Valley Health Network, Allentown, PA

Sophia Koo, MD, FIDSA
Brigham and Womens Hospital, Boston, MA

Stephen Kralovic, MD, FIDSA
University of Cincinnati, Cincinnati, OH

Awewura Kwara, MD, FIDSA
Miriam Hospital, Providence, RI

Brent Laartz, MD, FIDSA
West Coast Infectious Diseases, Safety Harbor, FL

Kimberly Leuthner, PharmD, FIDSA
University Medical Center of Southern Nevada, Las Vegas, NV

Todd Levin, DO, FIDSA
Garden State Infectious Diseases Associates, Voorhees, NJ

David Lintz, MD, FIDSA
Jersey City Medical Center, Westfield, NJ

Michail Lionakis, MD, FIDSA
National Institutes of Health, Bethesda, MD

Bert Lopansri, MD, FIDSA
Intermountain Healthcare/University of Utah, Murray, UT

Vera Luther, MD, FIDSA
Wake Forest University School of Medicine, Winston Salem, NC

Yukari Manabe, MD, FIDSA
Johns Hopkins University School of Medicine, Elkridge, MD

Stanley Martin, MD, FIDSA
Geisinger Health System, Danville, PA

Aneesh Mehta, MD, FIDSA
Emory University School of Medicine, Atlanta, GA

Loren Miller, MD, FIDSA
Harbor-UCLA Medical Center, Torrance, CA

Susanna Naggie, MD, FIDSA
Duke University Medical Center, Duke Clinical Research Institute, Durham, NC

Kyle Popovich, MD, FIDSA
Rush University Medical Center, Chicago, IL

Read Pukkila-Worley, MD, FIDSA
University of Massachusetts Medical School, Boston, MA

Gunter Rieg, MD, FIDSA
Kaiser Permanente South Bay Medical Center, Harbor City, CA

Jack Ross, MD, FIDSA
Hartford Hospital, Hartford, CT

Kathleen Ruggero, DO, FIDSA
Southwest Infectious Disease and Internal Medicine, Palos Park, IL

Parham Sendi, MD, FIDSA
University Hospital of Bern, Bern, Switzerland

Beverly Sha, MD, FIDSA
Rush University Medical Center, Chicago, IL

Neha Shah, MD, FIDSA
University of Illinois Chicago, Cherry Valley, IL

Darvin Smith, MD, FIDSA
Kaiser Permanente, Redwood City, CA

Jessica Snowden, MD, FIDSA
University of Nebraska Medical Center, Omaha, NE

Madhuri Sopirala, MD, FIDSA
University of Cincinnati Medical Center, Mason, OH

Lisa Spacek, MD,PhD, FIDSA
Johns Hopkins School of Medicine, Bethlehem, PA

Ann Stapleton, MD, FIDSA
University of Washington, Seattle, WA

Michael Stevens, MD, FIDSA
Virginia Commonwealth University School of Medicine, Richmond, VA

Kanta Subbarao, MBBS, FIDSA
Laboratory of Infectious Diseases, NIAD, NIH, Bethesda, MD

Mark Sulkowski, MD, FIDSA
Johns Hopkins University School of Medicine, Baltimore, MD

Barbara Taylor, MD, FIDSA
University of Texas Health Science Center at San Antonio, San Antonio, TX

George Thompson, MD, FIDSA
University of California - Davis, Sacramento, CA

Phyllis Tien, MD, FIDSA
University of California, San Francisco, San Francisco, CA

Drake Tilley, MD, FIDSA
Naval Medical Center San Diego, US Navy, Chula Vista, CA

Anne-Catrin Uhlemann, MD, FIDSA
Columbia University Medical Center, New York, NY

Julie Vaishampayan, MD, FIDSA
San Joaquin County Public Health Services, Stockton, CA

Anjali Vora, MD, FIDSA
Southern California ID Associates, Anaheim, CA

Richard Watkins, MD, FIDSA
Akron General Medical Center, Akron, OH

Lenny Weinstein, DO, FIDSA
South Shore Infectious Diseases P.C., West Islip, NY

Jeffrey Weinstein, MD, FIDSA
Kettering Medical Center, Kettering, OH

Aimee Wilkin, MD, FIDSA
Wake Forest University School of Medicine, Winston-Salem, NC

Lisa Winston, MD, FIDSA
University of California, San Francisco, San Francisco, CA

Judith Wolf, MD, FIDSA
Drexel University College of Medicine, Wynnewood, PA

Cameron Wolfe, MBBS,MD, FIDSA
Duke University Medical Center, Durham, NC

Eric Young, MD, FIDSA
Lehigh Valley Health Network, Allentown, PA

Xiaotian Zheng, PhD, FIDSA
Ann & Robert H. Lurie Childrens Hospital of Chicago, Northwestern University, Chicago, IL

Christine Zurawski, MD, FIDSA
Atlanta Infectious Diseases Group, Atlanta, GA

IDWeek 2016: Not-to-Miss Sessions Featuring the Latest on the Zika Outbreak

Three exciting sessions at IDWeek 2016 will provide lessons on diagnosing, treating, and managing the Zika outbreak by those on the front-lines. Don’t miss the Opening Plenary featuring Mauro Schecter, MD, PhD, with the Projeto Praça Onze in Rio de Janeiro, Brazil.

IDWeek 2016 promises to be a great educational opportunity for professionals to hear first-hand accounts from experts managing current infectious diseases outbreaks, with a special emphasis this year on the ongoing Zika epidemic. Learn about the newest diagnostic and treatment modalities; apply state-of-the-art science to clinical care; and network with colleagues from around the world.

The following sessions will focus on the effects of Zika and what clinicians need to know to help their patients:

Zika Zymposium I: Epidemiology, Virology, and Countermeasures will be held on Wednesday, Oct. 26 from 1:30 to 2:30 p.m. and will feature presentations from Lyle Petersen, MD, MPH, with the Centers for Disease Control and Prevention; Helen Lazear, PhD, from the University of North Carolina School of Medicine; and Mark Mulligan, MD, FIDSA, with the Hope Clinic at Emory University.

Later that same day, during the Opening Plenary from 3:45 p.m. to 5:45 p.m., there will be a presentation from the front lines titled “Zika Virus: New Lessons and Future Challenges from an Area of Endemicity” from Mauro Schecter, MD, PhD, with the Projeto Praça Onze in Rio de Janeiro, Brazil.

Finally, Zika Zymposium II: Post-Infectious Sequelae and Clinical Guidance will take place on Friday, Oct. 28 from 2:00 to 3:30 p.m.

Register now to attend any or all of these invigorating sessions.

For further session information, view the Interactive Program.

And be sure to attend the Town Hall: Securing the Future of ID on Friday, Oct. 28, from 6:00 to 7:30 p.m.

Important Dates:

Advanced Registration

September 23

Full Abstract Text Available*

October 12

*Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.

Journal Club

Isavuconazole as Another Option for Treatment of Mucormycosis; Neurologic Signs and Symptoms Common in Acute HIV Infection; Prevention of Mother-to-Child Hepatitis B Transmission with Tenofovir

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, in each issue of Clinical Infectious Diseases.
Back to Top 
Isavucanzole as Another Option for Treatment of Mucormycosis 
Reviewed by Lauren Richey, MD, MPH
 

The prognosis for mucormycosis, an opportunistic fungal infection associated with immunosuppressed patients, is poor, and mortality rates can exceed 90 percent. Present therapy consists of antifungal treatment, generally with amphotericin B, in combination with surgical debridement and treatment of the underlying disorder.  Few other treatment options currently exist. The recent VITAL study, published in Lancet Infectious Diseases, tested the use of isavuconazole, a new triazole antifungal with activity against Mucorales species and high oral bioavailability, in patients with mucormycosis.  The drug has both an oral and intravenous formulation.

In this study, 37 patients with proven or probable mucormycosis were recruited and treated with isavuconazole, including both those with pulmonary and non-pulmonary disease. The majority, 21 (57 percent), were in the primary treatment group, but the total group also included 11 with refractory disease and five patients who were intolerant to other antifungals. An independent data review committee determined the primary efficacy endpoint of overall response at day 42. Four patients (11 percent) had a partial response, 16 (43 percent) had stable disease, one (3 percent) had progression of disease, 13 (35 percent) had died, and three (8 percent) had missing data. A high rate of adverse events was seen (95 percent). The most common were vomiting, diarrhea, nausea, pyrexia, and constipation, with elevated hepatic enzymes seen in less than 10 percent of patients.

A matched case control analysis was also performed using patients from the FungiScope registry. Cases were matched on three variables: hematologic disease, severe disease (defined as central nervous system involvement or dissemination), and surgical treatment within seven days of antifungal treatment initiation. The authors found a similar crude mortality rate between the groups at day 42, 33 percent for cases and 41 percent for controls.

This study provides evidence that isavuconazole has a role in the treatment of both primary and refractory disease with mucormycosis, with outcomes that are likely similar to amphotericin. The study is limited by being single-armed and non-randomized, but it does suggest another treatment option.

(Marty et al. Lancet Infect Dis. 2016;16(7):828–837.)

 
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Neurologic Signs and Symptoms Common in Acute HIV Infection
Reviewed by Kelly Cawcutt, MD

HIV can invade the central nervous system rapidly after infection, but knowledge is limited regarding neurologic manifestations of acute HIV infection beyond fulminant diseases, such as Guillain-Barré syndrome, Bell’s palsy, encephalitis, or myelitis, which may not represent the true spectrum of disease. To better define the neurologic complications, the authors of a recent Neurology article prospectively evaluated adult patients with acute HIV from a single center in Thailand who were started on early antiretroviral therapy (ART) and evaluated via structured neurologic evaluations over 12 weeks.

Of the 197 patients enrolled, 139 had complete data with a median estimated duration of HIV infection of 19 days (range of 3-56). Of these, 73 (53 percent) had at least one positive neurologic finding reported or identified. Only one patient had a fulminant neurologic process identified as Guillain-Barré. There were 245 positive neurologic findings, with 96 percent categorized as mild. The most common findings were defined as cognitive (33 percent) and motor (34 percent). Approximately half (49 percent) of the neurologic findings were noted at the time of HIV diagnosis, prior to initiation of ART, and improved with one month of treatment. Of note, no structural abnormalities were found. Patients with neurologic findings demonstrated a statistically significant higher viral load as compared to those without (p=0.006).

Overall, the study demonstrates that mild neurologic findings are common in the first 12 weeks after acute HIV infection, are correlated with higher viral loads, and usually improve after initiation of ART. Severe manifestations, or fulminant neurologic disease, are rare in acute HIV infection.

The study is limited with the ability to comment on association but not causality. There is a lack of control arms with uninfected controls or infected participants not started on ART, thus the authors cannot attribute neurologic findings directly to HIV or improvements to ART. Illicit drug use may also have confounded the results. The study does however raise important awareness about the possibility of early neurologic manifestations and warrants future studies to better define these associations.

(Hellmuth et al. Neurology. 2016;87(2):148-54.)

 
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Prevention of Mother-to-Child Hepatitis B Transmission with Tenofovir
Reviewed by George R. Thompson III, MD
 

Vertical transmission of hepatitis B virus (HBV) occurs in 80-90 percent of infants born to mothers who are positive for hepatitis B e antigen (HBeAg). The efficacy of postnatal passive and active immunization reduces the rate of mother-to-child transmission, however this practice fails a significant number of infants. Prenatal antiviral treatment has the potential to further reduce transmission.

The results of a recent study evaluating the efficacy tenofovir disoproxil fumarate (TDF) for the prevention of maternal hepatitis B transmission were recently published in the New England Journal of Medicine. In this study, 200 women were randomly assigned in a 1:1 ratio to an oral dose of 300 mg of TDF or usual care without antiviral therapy beginning 30-32 weeks of gestation until postpartum week 4. Infants in both groups received 200 IU of hepatitis B immune globulin IM and 10 ug of the HBV vaccine within 12 hours of birth. The same dose of active or passive immunization was administered at week 4 and an additional HBV vaccination at week 24.

In the primary outcomes, the rate of mother-to-child transmission was significantly lower in the TDF group than in the control group, in both the intention to treat analysis (5 percent vs. 18 percent, p=0.007) and the per-protocol analysis (0 percent vs. 7 percent, p=0.01). Maternal and infant safety profiles were similar in both groups with no significant differences in birth-defect rates between groups.  Maternal HBV serologic outcomes (loss or seroconversion of HBeAg or HBsAg) did not significantly differ between groups.

This study illustrates the utility of TDF for the prevention of hepatitis B transmission with a favorable side effect profile. Although the serologic status did not differ between groups, this was not unexpected given the relatively short (approximately 12 weeks) duration of therapy.

(Pan et al. N Engl J Med.  2016;374:2324-34.)

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:

August 1
  • Improving Antibiotic Use in Primary Care Outpatients
  • Why Is Candida glabrata More Likely Than Candida albicans to Be Resistant to Antifungal Agents?
July 15
  • Is your Patient Encephalopathic Because of His or Her Antibiotic Therapy?
  • Candidalysin 
July 1
  • Vancomycin Loading Dose: Is it Safe?
  • Case Vignette: Eosinophilic Pnemonia - Do Not Inhale Flies!
  • Case Vignette: Simultaneous Complicated Pasturella multocida and Bartonella henselae Infections?