IDSA News - November 30, 2016
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New IDSA Guideline on Leishmaniasis Now Available

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Driven by burgeoning ecotourism and military campaigns in Iraq and Afghanistan, a parasitic infection called leishmaniasis is showing up in more U.S. patients, often stumping doctors. Rapid diagnostic tests and innovative treatments are among the strategies to address leishmaniasis highlighted in new guidelines released by IDSA and the American Society of Tropical Medicine and Hygiene (ASTMH) and published in the journal Clinical Infectious Diseases.

The bite of the nearly invisible sand fly – one-third the size of a mosquito – transmits the Leishmania parasite. The parasite is found in more than 90 countries around the world – including Mexico and those in Central and South America, Asia, Africa, the Middle East and southern Europe. The infection rarely occurs in the United States, although a few cases have been reported to have been acquired in Texas and Oklahoma. The growth of travelers, soldiers and immigrants with leishmaniasis being seen by U.S. doctors and the complicated diagnosis and management of the disease drove the creation of these guidelines, the first in the United States.

Because it’s still relatively uncommon in the United States, many doctors are unfamiliar with leishmaniasis and don’t suspect it when diagnosing patients. The sore at the site of an infected sand fly bite often is painless and symptoms of the infection may not show up for a month or longer, further complicating the diagnosis. There are more than 20 types of Leishmania parasites that cause human infection. The three main clinical syndromes, often determined by the specific parasite, are:

  • Cutaneous leishmaniasis (CL) – CL causes skin sores, such as bumps or lumps that may turn into ulcers with a central crater or scab over. This is the most common type of leishmaniasis, with an estimated 700,000 to 1.2 million cases worldwide every year, according to the Centers for Disease Control and Prevention (CDC).
  • Mucosal leishmaniasis (ML) – CL can metastasize, or spread, to mucous membranes, especially the mouth and nose, resulting in ML. ML most often occurs when the patient is infected by Leishmania parasites from Central or South America. Untreated, ML can cause serious scarring and deformity.
  • Visceral leishmaniasis (VL) – The most serious form, active VL is a systemic infection that is almost always fatal if not treated. Symptoms include weeks to months of high fevers, significant weight loss, an enlarged spleen and low blood counts. CDC estimates there are 200,000 to 400,000 new cases of VL a year.

When doctors see infections with these symptoms, they should ask if the patient has traveled outside of North America. CL can be tested by polymerase chain reaction (PCR) or by doing a culture to identify the type of Leishmania and determine how aggressively it should be treated. A blood test called rK39 provides a rapid result if VL is suspected, which would be confirmed with PCR or culture.

Oral miltefosine was approved by the Food and Drug Administration (FDA) in 2014 for specific cases of cutaneous, mucosal and visceral leishmaniasis. Additionally, the ThermoMed™ device can be used to heat treat CL. FDA-approved liposomal amphotericin B is given intravenously (IV) for VL. While more than 80 percent effective, these therapies don’t always eradicate the parasite, and sometimes additional treatment is necessary.

Despite the name, the fly that transmits the parasite also lives in rotting vegetation in jungle areas. The sand fly most often bites exposed skin at night, transmitting the parasite. While there are no vaccines or preventive medications for leishmaniasis, people traveling to areas where the parasite exists should use protective measures to avoid infection. That includes wearing protective clothing (long sleeves and pants), applying insect repellents containing DEET and using insecticide-impregnated bed nets.

Lead author Naomi Aronson, MD, FIDSA, was joined on the guidelines panel by: Barbara L. Herwaldt, MD, MPH; Michael Libman, MD; Richard Pearson, MD, FIDSA; Rogelio Lopez-Velez, MD, DTM&H, PhD; Peter Weina, MD, PhD, FIDSA; Edgar Carvalho, MD; Moshe Ephros, MD, DTM&H, FIDSA; Selma Jeronimo, MD; and Alan Magill, MD, FIDSA.

Year End Policy Forecast

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LPAD: Congressional leaders recently announced a bipartisan deal to pursue enactment of the 21st Century Cures Act this year. This legislation includes the Limited Population Antibacterial Drug (LPAD) approval pathway. LPAD would provide an important new approval pathway for antibacterial drugs that treat patients with serious infections and where there exists an urgent unmet medical need. The bill also includes IDSA-championed provisions to speed the updating of antimicrobial susceptibility breakpoints and to support the next generation of biomedical researchers, including ID physician-scientists. Votes in the House and Senate are expected this week, and IDSA is urging all Members of Congress to support.

Federal Funding: IDSA is urging Congress to pass final funding bills for Fiscal Year (FY) 2017 during this calendar year, which provides the best opportunity to secure the strongest funding levels possible for ID priorities. Some congressional Republicans are advocating for a continuing resolution to level fund the government through March 2017.

Public Health Emergency Fund: IDSA continues to advocate for bipartisan legislation to establish a public health emergency fund to allow for a rapid response to emergencies, such as outbreaks of infectious diseases like Zika or Ebola, without the immediate need for congressional action. It is unclear whether this legislation will be able to advance this Congress, and further advocacy in 2017 and beyond may be needed.

Antimicrobial Susceptibility Test (AST) Devices: IDSA recently expressed support for a new draft FDA guidance encouraging the coordinated development of new antimicrobial drugs and AST devices. IDSA also offered additional policy recommendations to speed the availability of AST devices.

Global AMR: Following the United Nations (UN) high level meeting on antimicrobial resistance (AMR) in September, IDSA remains at the forefront of global AMR efforts. Theoklis Zaoutis, MD, represented IDSA on a World Health Organization (WHO) panel to highlight World Antibiotics Awareness Week, November 14-20.

Drug Shortages: Several IDSA members have expressed deep concerns with persisting anti-infective drug shortages at their institutions. IDSA asked the Emerging Infections Network (EIN) to conduct a survey to quantify the scope of this problem. The survey found that despite congressional and FDA action since 2012, drug shortages persist and are negatively impacting patient care—including causing many ID physicians to prescribe broader spectrum antibiotics than would be optimal. IDSA is sharing these data with policymakers and stakeholders and exploring potential policy solutions. IDSA will continue advocating for new policies to address this serious issue.

Societies Issue Statement Against Anti-LGBT Laws

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In response to member concerns about the negative impact on public health—particularly the response to the HIV and STD epidemics--IDSA, HIVMA and PIDS released a joint policy statement last month opposing laws that discriminate against lesbian, gay, bisexual and transgender (LGBT) individuals. Such laws have been adopted or are under consideration in a growing number of states, most recently North Carolina and Mississippi. The Mississippi law, for example, would allow healthcare facilities and providers to refuse services to LGBT individuals. By taking this action, the three organizations join a number of medical organizations, including the American Medical Association, the American College of Physicians and the American Psychological Association.

Overwhelmed by Medicare Payment Reform? We Have a Webinar for You

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If you missed the IDSA/Hart Health Strategies webinar on Medicare physician payment reforms held earlier this month, you’re not too late. The Medicare Quality Payment Program (QPP) webinar is now available for members online. The webinar covers changes mandated by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 and how they affect ID physicians.

Science Speaks Conference Coverage Brings Breaking News from Around the World

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The IDSA Global Science Speaks blog hit the road in October and November to report on developments across the spectrum of infectious diseases research and responses:

From IDWeek in New Orleans, bringing a physician's account of living and working where Zika is endemic;

From the second HIV R4P Conference in Chicago, bringing news from the frontlines of biomedical HIV prevention research;

The 47th Union World Conference on Lung Health in Liverpool, England, bringing breaking news of promising new tuberculosis treatment regimens, and more;

From the American Society for Hygiene and Tropical Medicine Conference in Atlanta, news of an initiative building responses to antimicrobial resistance in low-income countries, and more.

A Steady Focus in Uncertain Times

William G. Powderly, MD, FIDSA, President

I think it is safe to say that no matter one’s political leanings, every one of us is reflecting on the recent U.S. election and political events in the U.S. and abroad. There are many questions about the priorities of the new U.S. government, but one thing is certain: IDSA’s commitment to improving the health of individuals and communities throughout the world will never change. As your new IDSA President, I will work closely with my colleagues on the Board to move forward in measurable ways on each of IDSA’s strategic priorities.

William G. Powderly,
MD, FIDSA, President

I think it is safe to say that no matter one’s political leanings, every one of us is reflecting on the recent U.S. election and political events in the U.S. and abroad. For us, they leave us wondering what it means for medical research, public health and our patients’ access to quality medical care. There are many questions about the priorities of the new U.S. government, but one thing is certain: IDSA’s commitment to improving the health of individuals and communities throughout the world will never change.

As your new IDSA President, I will work closely with my colleagues on the Board to move forward in measurable ways on each of IDSA’s strategic priorities. Our Society’s staff and leadership are reaching out to the new Administration and Congress to help shape their understanding of critical health care challenges and opportunities, including efforts to improve patient safety, lead cutting-edge biomedical research, strengthen public health infrastructure, and guide the development of critically needed new antibiotics and diagnostics.

The strategic priorities of the Society are rooted in science and in our shared commitment to meet the needs of the infectious disease community and the patients whom we serve. Working together, we will continue to:

  • Promote the value of the ID specialist
  • Attract the best and brightest to the field of infectious diseases
  • Promote leadership in antimicrobial resistance and antimicrobial stewardship
  • Produce useful, timely, and relevant guidelines
  • Promote ID and HIV research and its clinical translation
  • Advocate for funding of prevention and public health programs in ID and HIV

The IDSA Board of Directors includes strong representation from women and men whose experience and perspectives reflect the diversity of our field, including clinical practice, public health, and research. Your representatives on the Board for 2016-2017 are:

Paul Auwaerter, MD, MBA,FIDSA
President-Elect, IDSA
Johns Hopkins University
School of Medicine
Baltimore, MD

Thomas Fekete, MD, FIDSA
Temple University Medical School
Philadelphia, PA

Cynthia Sears, MD, FIDSA
Vice President, IDSA
Johns Hopkins University
School of Medicine
Baltimore, MD

Lawrence Martinelli, MD, FIDSA
Covenant Health
Lubbock, TX

Larry Pickering, MD, FIDSA
Secretary, IDSA
Emory University
School of Medicine
Atlanta, GA

Daniel McQuillen, MD, FIDSA
Lahey Hospital & Medical Center
Burlington, MA

Helen Boucher, MD, FIDSA
Treasurer, IDSA
Tufts Medical Center
Boston, MA

Thomas Moore, MD, FIDSA
IDC of Kansas
Wichita, KS

Johan Bakken, MD, PhD, FIDSA
Past President, IDSA
St. Luke’s ID Associates
Duluth, MN

Trish Perl, MD, MSc, FIDSA
UT Southwestern Medical Center
Dallas, TX

Angela Caliendo, MD, PhD, FIDSA
Brown University
Rhode Island Hospital
Providence, RI

Joel Gallant, MD, MPH, FIDSA
Southwest CARE Center
Santa Fe, NM

Henry “Chip” Chambers, MD, FIDSA
University of California-San Francisco
San Francisco, CA

David Kimberlin, MD, FIDSA
PIDS Liaison
University Alabama at Birmingham
Birmingham, AL

Janet Englund, MD, FIDSA
Seattle Children’s Hospital
Seattle, WA

Keith Kaye, MD, MPH, FIDSA
SHEA Liaison
University of Michigan
Medical School
Ann Arbor, MI

As your new president, I bring the perspective of someone who attended medical school and underwent residency training in Dublin, Ireland. I came to the U.S. for my ID fellowship training at Washington University School of Medicine, where I currently serve as co-director of the Division of Infectious Diseases and Director of the Institute for Public Health. I was the inaugural chair of the HIV Medicine Association of IDSA and was a founding member of the St. Louis Infectious Diseases Society.

I would like to highlight the newest additions to the Board: Angela Caliendo, MD, PhD, FIDSA; who brings expertise in diagnostics; Joel Gallant, MD, MPH, FIDSA, well known as an HIV clinician, educator and clinical researcher who will serve as our HIVMA representative ; Dan McQuillen, MD, FIDSA, a clinician who brings a wealth of understanding and experience with compensation issues; Larry Pickering, MD, FIDSA, a pediatrician and long-time leader in immunization issues; and Cindy Sears, MD, FIDSA, who has done substantial work for IDSA on guidelines, our journals, and as treasurer, and whose research interests include bacterial pathogenesis, the microbiome and colon cancer.

During our most recent meeting in October, the Board of Directors discussed several important initiatives related to our strategic priorities. The Board reviewed and discussed the results of an IDSA-funded survey of recent graduates of ID fellowship programs which looked to assess demand for ID physicians entering the job market and also explored opportunities to provide federal loan repayment for ID physicians who work in public health through new legislation. The Board approved a recruitment and retention campaign that will build a solid structure for our efforts to raise awareness of and attract talented young doctors to our field. In addition, I am pleased to announce that the Board approved a Gender Disparities in ID Task Force, which will be chaired by former Board member, Judy Aberg, MD, FIDSA.

I very much look forward to working with this talented group of individuals to promote the field of infectious diseases, and I urge each and every one of you to reach out to the Society to lend your perspective and expertise to work with us on our strategic priorities. Please volunteer your time and expertise, and join the dialogue at MyIDSA.

Continuing to Work for You in Improving ABIMís MOC Program

The American Board of Internal Medicine (ABIM) is currently re-evaluating and rebuilding its maintenance of certification (MOC) program as part of its Transforming ABIM initiative. IDSA, along with other internal medicine subspecialty societies, has been actively providing feedback and input to the ABIM in an effort to make the MOC process as formative and unobtrusive as possible. Some of the key points from the 2016 IDSA Position Paper on MOC include:

  • Support for the objective of lifelong learning for physicians in order to effect improvement in knowledge and practice competence
  • Support and suggestions for ABIM’s efforts to improve the periodic specialty and subspecialty knowledge assessments to make them less burdensome and more formative and relevant to practice
  • That the goal of MOC should be to provide updated information in the science and practice of medicine and fill physician knowledge gaps using methodology beyond “high stakes” examination
  • That there should be no practice assessment, patient safety, or “patient voice” component of MOC

Christopher Ohl, MD, chair of IDSA’s Education Committee talks through IDSA’s objectives in this two-minute video.

IDSA offers several ways for members to earn ABIM MOC points:

  • IDWeek 2016 attendees can earn MOC point credit equal to CME credit for 13 separate 2016 IDWeek Sessions (December 2 deadline).
  • IDSA offers Knowledge Modules in general and specific infectious diseases topics (http://www.idsociety.org/MOC/).
  • IDWeek 2017 will include additional opportunities to earn MOC points.

IDSA will continue to be involved and partner with other subspecialty societies to examine alternatives to the current MOC process. We will keep members apprised of any further changes or updates. Once ABIM officially announces changes to the program, Dr. Ohl will host an “Ask Me Anything (AMA)” session on the member-only online community, MyIDSA. During this session, Dr. Ohl and other IDSA volunteers will answer questions members may have about the changes. Stay tuned for more details on the timing of this session.

Congratulations to the Winners of the 2016 IDSA and HIVMA Society Awards

IDSA, the IDSA Education and Research Foundation, and HIVMA honored 11 dedicated individuals for outstanding achievements during the recent IDWeek 2016 in New Orleans.

Among the honors is the Alexander Fleming Award, a lifetime achievement recognition granted to IDSA members or fellows for a career that reflects major contributions to the acquisition and dissemination of knowledge about infectious diseases. This year’s honorees are Carol J. Baker, MD, FIDSA, FSHEA, FPIDS, a strong advocate for children’s health who has greatly advanced the understanding of group B streptococcal (GBS) disease, and P. Frederick Sparling, MD, FIDSA, a recognized leader in the study of Neisseria gonorrhoeae and sexually transmitted infections (STIs).

Carol Baker, MD, FIDSA, FSHEA, FPIDS: Children’s Health Advocate

A tireless advocate for newborns and their families, Dr. Baker recognized the devastating effects of early and late GBS infections in infants in 1973. Her research and advocacy paved the way for universal screening and treatment of GBS in pregnant women, leading to an 80 percent decline in this disease among newborns. Additionally, her efforts contributed to the development of a vaccine given to women to prevent neonatal GBS infections, which is in late phase clinical trials.

Dr. Baker is a professor of pediatrics, molecular virology, and microbiology at the Baylor College of Medicine in Houston, where she has mentored many medical students and residents and inspired them to pursue careers in pediatrics and pediatric infectious diseases. A prolific author, she has published nearly 400 peer-reviewed articles and book chapters. She received several awards for her work, including repeated recognition as one of the Best Doctors in America.

P. Frederick Sparling, MD, FIDSA: Advancing Treatment of STIs

Dr. Sparling dedicated his 45-year career to improving the diagnosis and treatment of STIs. His research, first published in the late 1970s in two influential articles – published in Science and Nature – described the groundbreaking discovery of the conjugal transfer of penicillinase-producing plasmids among N. gonorrhoeae. He continued to work to unravel the structure and function of outer membrane proteins and the molecular basis of porins, determining how these pathogens acquire iron and lead to infection. Much of what we know about N. gonorrhoeae – including the mechanisms of infection and antibiotic resistance – is due to Dr. Sparling’s tireless research.

Retired in 2014, Dr. Sparling is now an emeritus professor of medicine and microbiology and immunology at the University of North Carolina (UNC) School of Medicine. During his career, he received many awards, published more than 200 peer-reviewed articles and book chapters and co-edited several textbooks on STIs.

Other awards presented during IDWeek 2016 were:

  • The Oswald Avery Award recognizes outstanding achievement in infectious diseases by a member or fellow of IDSA who is 45 or younger. This year Susan S. Huang, MD, MPH, FIDSA, FSHEA, of the University of California, Irvine, is being recognized for her work to prevent antibiotic-resistant healthcare-associated infections. She led clinical trials to assess effective methods of decolonization, including the widely cited REDUCE MRSA trial, published in the New England Journal of Medicine in 2013.
  • The Society Citation Award is given in recognition of exemplary contribution to IDSA, outstanding discovery in the field of infectious diseases, or a lifetime of outstanding achievement in a given area – whether research, clinical investigation or clinical practice. This year awards were presented to:
    • Bruce G. Gellin, MD, MPH, FIDSA and Martin G. Myers, MD, FIDSA, FPIDS – Founder of the National Network for Immunization Information (NNii), Dr. Gellin also served as its executive director from 1998 to 2002. He launched a variety of initiatives that defined the organization, including tracking immunization issues in state legislatures, the media and in public debates; providing testimony at congressional hearings and state legislatures; publishing research on immunization issues and attitudes; and launching the NNii website, an important source of information about vaccines. Dr. Myers served as NNii’s executive director from 2003 to 2014, expanding its role to become a platform for informing the public about the safety and efficacy of vaccines. He also worked to enhance the website, including by making content available in Spanish, leading to a monthly viewership of more than 146,000.
    • Mark A. Leasure – IDSA’s recently retired chief executive officer, Leasure dedicated his nearly 20 years with the Society to elevating its profile. Under Leasure’s leadership, the Society’s membership and professional attendance at the annual meeting doubled, staff increased from five to more than 40, and the organization’s net assets tripled.
  • The Watanakunakorn Clinician Award honors the memory of Dr. Chatrchai Watanakunakorn and is given by the IDSA Education and Research Foundation to an IDSA member or fellow in recognition of outstanding achievement in the clinical practice of infectious diseases. This year’s awardee is Wilbert H. Mason, MD, MPH, FIDSA, of the University of Southern California, whose 40-year career has been dedicated to treatment, teaching and research in pediatric infectious diseases. He is known for his treatment of Kawasaki disease and served as the sole ID practitioner in Childrens Hospital Los Angeles’s Kawasaki Clinic, which has cared for more than 1,000 patients over the last 25 years.
  • The Walter E. Stamm Mentor Award, which honors late past-president Walter E. Stamm, MD, is presented to an IDSA member or fellow who has been exceptional in guiding professional growth of infectious diseases professionals. This year’s winner is Steven M. Holland, MD, FIDSA, of the National Institutes of Health. A researcher and clinician, Dr. Holland has been an exceptional mentor for 20 years to numerous post-doctoral fellows, in the clinic and the lab. Many still turn to him for advice, and in turn have been inspired to mentor others.
  • The Clinical Teacher Award honors a career dedicated to excellence in teaching fellows, residents or medical students, and motivating them to teach the next generation. This year’s honoree is Rashida A. Khakoo, MD, FIDSA, FSHEA, of West Virginia University, who has taught thousands of students, house staff and physicians who have, in turn, taught others. As assistant vice president for faculty development, Dr. Khakoo developed an innovative faculty development program used at her institution’s multiple schools, which has become a model for other medical schools.

HIVMA awards were presented to Elaine J. Abrams, MD, of Columbia University, and Vincent Lo Re III, MD, MSCE, FIDSA, of the University of Pennsylvania, for their significant contributions to the field of HIV medicine.

Dr. Abrams, received the 2016 HIVMA Clinical Educator Award, which recognizes those who have demonstrated significant achievement in the area of clinical care and provider education. Her contributions have changed practice and had an impact on pediatric and maternal HIV care worldwide.

Dr. Abrams has dedicated her career to researching mother-to-child transmission of HIV and the natural history of the disease in infants, children and adolescents. Her work contributed to the evolution of pediatric treatment from single to dual to combination antiretroviral therapy (ART). She helped develop new prevention approaches, including recommending ART for all HIV-infected pregnant and breastfeeding women. Dr. Abrams’s research in Sub-Saharan Africa and elsewhere benefited hundreds of thousands of HIV-infected mothers and their children around the world. She developed the Family Care Center in central Harlem, a comprehensive research and care program for women and children with HIV.

A teacher, advisor and mentor for young researchers, Dr. Abrams developed training modules used by thousands who provide pediatric and adolescent HIV care globally. She wrote more than 200 articles published in peer-reviewed journals and has received several honors, including the Dr. Linda Laubenstein Award for HIV Clinical Excellence from the New York State Department of Health AIDS Institute in 2006.

Dr. Lo Re received the 2016 HIVMA Research Award, which recognizes members who have made outstanding contributions to HIV medicine in clinical or basic research early in their careers. Dr. Lo Re has advanced the understanding of hepatitis infection in HIV-infected patients. He developed new methods to identify liver-related outcomes – particularly decompensated cirrhosis, acute hepatic failure and hepatocellular carcinoma – which are used by researchers throughout North America. Clinicians and policymakers cite his findings to justify initiating HCV treatment in chronic HIV-infected patients even in the absence of advanced hepatic fibrosis or cirrhosis.

Dr. Lo Re authored more than 50 articles published in peer-reviewed publications and has been a member of the Food and Drug Administration’s Antiviral Drugs Advisory Committee (now the Antimicrobial Drugs Advisory Committee) since 2014. He received numerous young investigator awards and other honors, including recognition as one of the Best Doctors in America several times.

For full awards descriptions, recipient biographies and information about other awards given to Society members this year, please visit IDsociety.org/Awards_and_Recognition and HIVMA.org/Awards_Recognition.

IDWeek 2016 Recap

IDWeek 2016 was a record-setting conference as over 7,000 professional attendees from 93 countries converged on New Orleans. The meeting showcased over 130 scientific sessions and another 130 abstract presentation sessions. The meeting also featured two exciting new programs, The Town Hall: Securing the Future of ID at which IDSA and HIVMA members had the opportunity to share their concerns and ideas about how to attract up and coming doctors to the field as well as how to ensure that the specialty is appropriately valued, and the IDWeek Bug Bowl, a high-energy, filled to capacity, game-show styled event with students from three local medical schools.

Abstracts presented in New Orleans have been permanently archived with Open Forum Infectious Diseases, IDSA’s open access journal. In addition, presentations are housed in the IDWeek Digital Library, where you can catch up on sessions you missed or want to re-watch. This feature is accessible free-of-charge to all registered attendees and can be purchased by those who were unable to attend by going to the IDWeek Post Meeting Tools. While you’re there, you can also claim your CME/CPE/MOC credits. The deadline to claim your credits is December 2!

Thank you again to everyone who came and we hope to see you next year. The IDWeek 2017 Program Committee is already hard at work planning another top notch meeting. Mark your calendars for October 4-8, 2017 in San Diego!