IDSA and HIVMA guide legislation responding to opioid ID impacts

As key Committees in Congress turned their attention to the opioid crisis, IDSA and HIVMA ensured their legislation addressed the intersection of infectious diseases and substance use disorders, as well as the need to build ID and HIV provider capacity into the response.

The Senate Health, Education, Labor and Pensions Committee modified its Opioid Crisis Response Act in response to IDSA/HIVMA recommendations to include infective endocarditis in addition to viral hepatitis and HIV in new surveillance activities and to include clinicians caring for patients with infectious diseases related to substance use in new loan repayment opportunities through the National Health Service Corps. Because of our advocacy, the bill also now authorizes infectious diseases testing through comprehensive opioid recovery centers that would be created under the bill. The HELP Committee approved this important legislation on April 24, and the full Senate is expected to consider it this summer. Read More.

May 15 webinar to offer advocacy tips
 
IDSA, HIVMA, and PIDS have scheduled an advocacy webinar on ways to engage policymakers at home and in Washington, DC-and you're invited. In addition to practical tips on building relationships with elected officials as well as their staff members, and conducting productive meetings, IDSA and HIVMA member advocates will share their experiences with members of Congress, discuss the ways that advocacy can make a difference, and take questions. Read More.

Educate policymakers on 340B and ID/HIV

In January 2018, the Centers for Medicare and Medicaid Services reduced 340B reimbursement for Medicare Part B drugs to some participating hospitals, potentially cutting support for services provided to uninsured and underinsured patients at these facilities. In addition, Congressional members have indicated an interest in making changes to the program with similar bills being introduced in the House and Senate that would put a moratorium on new participating hospital sites and impose new data reporting requirements. Read More.

IDSA & HIVMA weigh in as House begins work on FY 2019 federal funding bills 

As lawmakers confront a White House budget plan proposing deep cuts to research, public health and global health programs, and consider their priorities for the year to come, IDSA and HIVMA leaders are weighing in. 

HIVMA board member Dr. Marwan Haddad testified April 26 at the House Appropriations Labor, Health and Human Services, and Education subcommittee public witness hearing on the need to increase funding for Ryan White Part C clinics and to leverage Ryan White clinics in responding to national opioid epidemic. His testimony can be found onlineRead More.

The 5th Annual St. Jude-PIDS Pediatric Transplant ID Symposium entitled “Bench to Bedside” was held at the Marlo Thomas Center, St. Jude Children’s Research Hospital in Memphis, TN, on March 9, 2018, with over 160 attendees present. The symposium featured excellent talks by amazing faculty, as well as case presentations, oral abstracts and poster sessions, and 3 clinical breakout sessions discussing bacterial, fungal, and donor question issues.

The morning sessions included lectures on transplant immunology by Allan Kirk, MD, PhD, Duke University School of Medicine; HHV-6 in the transplant recipient by Danielle Zerr, MD, MPH, Seattle Children’s Hospital; cell therapy with genetically modified T cells by Stephen Gottschalk, St. Jude Children’s Hospital, vaccines in transplant patients by Klara Posfay-Barbe, MD, MS, University Hospitals of Geneva, and NIH transplant for primary immmunodeficiencies by Alexandra Freeman, MD, NIH, NIAID. This was followed by a poster session (with a good lunch!) and a session on biomarkers for post-transplant lymphoproliferative disorders by Olivia Martinez, PHD, Stanford University School of Medicine, and three challenging cases in Transplant ID. These cases included a challenging case of CMV resistance and children presenting with RSV and rhinovirus infection pretransplant, which were discussed by panelists Klara Posfay-Barbe, Danielle Zerr, and Michael Green. Following selected oral abstracts by Joy Hazleton, MD, PhD, from University of Colorado and William Muller, MD, PhD, from Northwestern University Feinberg School of Medicine, we had breakout sessions discussing interesting and challenging cases in immunocompromised hosts including evaluation of risk for donor-derived infecitons. Finally, research presentations and proposals by the PIDS Transplant Research Network showing results of multicenter research on respiratory viruses in solid organ transplant recipients (Lara Danziger-Isakov), C. difficile (Gabriela Maron, MD), and a proposed CMV immune biomarker study (Michael Green and Daniel Dulek) were presented and discussed.

The Organizing Committee, Lara Danziger-Isakov, Janet Englund, Brian Fisher, Hayley Gans, Betsy Herold, Gabriela Maron, and Elaine Tuomanen, would like to thank St. Jude and PIDS staff for helping with this meeting. A supplement for JPIDS is being planned featuring some of the topics discussed at this meeting as well as selected abstracts.

SAVE THE DATE: 6th Annual St. Jude-PIDS Pediatric Transplant ID Symposium will be held on March 7, 2019 at the Marlo Thomas Center at St. Jude Children’s Research Hospital. Suggestions for topics for next year’s meeting are welcome – click here to submit your suggestions!

 

My wife will say that it is when she first knew that I would specialize in pediatric ID. During my final year of medical school in Memphis, I attended the John Erskine Lecture at St. Jude Children’s Research Hospital and I was hooked. Over the last two decades, I have attended nearly every St. Jude/PIDS Pediatric ID Research Conference and each year I am equally enamored by the breadth and depth of research within our field.

The conference is intended to showcase field leading infectious diseases research, highlight luminaries in our field, and honor those whose work transcends disciplines, as with the annual John Erskine Lecture. The meeting focuses principally on basic discovery, with this year’s frontier lecturers ranging from the molecular evolution of Enterococci, to systems serology, HIV therapeutics, and new approaches to S. aureus. As the first morning concluded, Dan Portnoy, PhD, an expert in Listeria pathogenesis was honored as the John Erskine Lecturer in Infectious Diseases.

The afternoon was filled with original research presentations by PIDS Fellowship Award recipients and meeting participants, including a poster presentation and wine/cheese reception. The evening concluded with dinner at the newly renovated National Civil Rights Museum.

The second day of the meeting included insights into RSV pathogenesis and a deeper look into vaccine regulatory considerations, presented by this year’s Luminary in Pediatric Infectious Diseases, Dr. Larry Pickering. These were followed by career development presentations, career pathway talks, and breakout sessions focused on K-awards, loan repayment, grant writing, and understanding how jobs are created. This latter portion is one of the unique aspects of the meeting and follows a 3-year curriculum developed by members of the PIDS Research Committee.

The meeting enjoyed record attendance this year, with over 220 participants. We remain deeply grateful for the generous support that St. Jude provides year after year and for their leadership and organizational commitment to this meeting.

We encourage you to attend next year’s meeting, which will be held March 8-9, 2019. Registration will open in November and we encourage you to attend. Suggestions for topics for next year’s meeting are welcome – click here to submit your suggestions! If you are a fellow, limited funds are available for travel stipends that can offset the cost of travel. The 2019 meeting promises to be a great opportunity for faculty, fellows, residents, and students to attend the only PIDS-specific meeting in the US.

We look forward to seeing you in Memphis next year!

C. Buddy Creech, MD, MPH
Chair, PIDS Research Committee
PIDS Secretary-Treasurer

 

Each year, the St. Jude / PIDS Pediatric Infectious Disease Research Conference includes a series of career development presentations. These sessions are planned based on changes in the field and feedback from our members and attendees. At the 2018 St. Jude / PIDS Pediatric Infectious Disease Research Conference, we presented a breakout session on “Unlocking the Black Box of Pediatric ID FTEs” to empower our residents, fellows and junior faculty in negotiating academic positions. In this session, participants and session leaders Kari Simonsen and Stephanie Stovall discussed the meaning of Full Time Employment in our field, and some of the potential opportunities for building a career of your own design.

The session began with explaining the concept of “Full Time Equivalents” and the most common elements of FTE in pediatric infectious careers, including clinical, educational, research, administrative and service FTE allocations. Understanding the variations in how clinical FTE is defined and allocated across practice settings including large and small academic centers, community hospitals, and private practice were discussed.  Comparing clinical FTE allocations across settings requires consideration of hospital size, practice setting, team complement, and support staff resources. Niche clinical expertise including the role of the Pediatric Transplant, HIV, and/or Immunocompromised host expert is also an important potential distinguishing characteristic when demonstrating expertise in the field of clinical Pediatric ID.  The concept of clinical productivity targets as measured by wRVUs (work-based Relative Value Units) was introduced, and the need to understand how these productivity targets may be incorporated into discussions of FTE, or included in compensation metrics.

Most pediatric infectious disease physicians consider education a key component of our role as clinicians and scientists. In defining an academic position, there is an important distinction between time spent educating learners during clinical activities versus having an explicit role as an educator.  We navigated the discussion of having clearly defined FTE for a titled position (Pediatric Clerkship Director, Residency Director, Fellowship Director) and that these titles should come with an expectation of FTE allocation, guaranteed salary support for this time and effort, as well as anticipated demonstration of outcomes in education for the role.

As we discussed Administrative or Service FTE, we included important aspects of practice management such as Division Chief, or Clinical Service Chief, and hospital-based positions such as Directorships of Medical Microbiology, Antimicrobial Stewardship, or Hospital Epidemiology. These titled roles are of critical importance to hospitals and health systems, and should provide both FTE allocation and guaranteed salary support.

Protected time for research is essential for success as a physician scientist. We strategized initial negotiation of protected time and expansion of that FTE allocation through extramural funding sources. As with the other elements of FTE, success in a research career requires consideration of other support such as funds, personnel, space and equipment in addition to FTE. It is also important to define what is necessary and expected for success on a physician-scientist career path at each institution, versus what is a reasonable offer or expectation for someone anticipating a career as a clinician educator or primarily in a clinical role.

A better understanding of the building blocks of professional time allocation empowers fellows and junior faculty identify and negotiate a position that is best suited for long term success and professional fulfillment. The St. Jude / PIDS Pediatric Research Conference provides a valuable opportunity to ask peers, mentors, and others in the field questions such as these to build a rewarding career in pediatric infectious disease.

 

For those who were able to stay until the very end of the St. Jude/PIDS conference, attendees were treated to one of the newest elements in this annual meeting, the Global Health session. The goal is to address the increasing interest in global health among pediatric infectious diseases specialists and engage the large entourage of international infectious disease experts who attend the course as part of the St. Jude Global Academy Infectious Diseases Training Seminar.

To begin, we heard from two pediatric infectious diseases leaders who have created successful and rewarding careers in global health. Dr. Edwin Asturias explained how his specialty training in infectious diseases and his desire to improve public health in his home country of Guatemala led him to pursue research in vaccine preventable illnesses in Guatemala. He told a fascinating story of the history of oral polio virus vaccination in Latin America. Next, Dr. Fernando Polack briefly told his story of leaving his home country of Argentina for training and beginning his career and then return to Argentina to build a successful research career. Dr. Polack offered his top ten key lessons for succeeding for physician-scientists who leave their home country for training and plan to return and pursue an academic career. We have summarized the top ten list here.

At the end of the session, the group divided into teams for a competitive but lively game of infectious disease jeopardy. Categories included “picture perfect” (photographs of pathogens or pathognomonic presentations), “defenseless” (infections of the immunocompromised) and “new menaces” (emerging pathogens). The questions covered infections throughout the world, so specialists from the United States and abroad were essential for each team’s success.

  1. Train formally and intensely. Fellowship can greatly enhance your clinical skills, but it will often be up to you to make your research experience an opportunity to acquire real tools to think for yourself. And this may be your only chance to do it for free.
  2. Do not leave the US as soon as you graduate from fellowship. Beyond clinical duties, the roles of faculty and fellows are very different. The most important assets – such as writing successful applications for funding, interpreting how to communicate your work orally and in writing, networking- may not be obvious to you during fellowship. And you need to learn them well (at least to a certain extent) before you migrate to regions where you may be unable to find mentors to help you. In other words, if you were to visit the Queen of England, you can be smarter than Einstein but will look like a fool if you ignore the protocol.
  3. Have a plan. Do not leave without a plan that sounds reasonably logical and safe to other international scientists. Be cognizant that different people may look at your plans from different angles, even at times from the wrong angle. Be smart in selecting your advisors.
  4. Understand your environment. Do not allow homesickness to blind you into the dangerous belief that all will be easy and wonderful upon returning. The better trained and more experienced you are (while relatively young), the smoother your re-insertion in terms of creating a safe zone for yourself.
  5. Be quick to recognize challenges and solve them creatively. Do not be stubborn. If you detect a menace, be quick to act and find solutions. While the developing world is often full of unpredictable challenges, people are often more flexible to alternative solutions (in part because everybody does more than one thing to survive and therefore nothing is as ”fixed” as in industrialized nations). Always have an alternative plan in hand.
  6. Do not delude yourself. Most extraordinary promises will never materialize. Given that research programs can be less structured than in the industrialized world, people’s genuine hopes for participating in novel experiences may lead them to promise you fabulous returns for your efforts: hundreds of participants for an observational study that turn out to be 5 subjects, incredible samples that were lost years ago, etc. Be rational when using this information to plan your efforts.
  7. Never negotiate the quality and standards of your work. You are into this to be first class scientists. Not to be pat in the back by the President. Your eyes should always be set in your academic colleagues worldwide, never to lose reference.
  8. Be smart selecting your questions. The logic of funding for the developing world is different from that for industrialized countries, and often even different from the logic of funding for US investigators conducting research in developing countries from the US. Know the players and keep them in mind when planning your program.
  9. Enjoy your impact. It is not a minor achievement to succeed in science from a satellite country. Stop once in a while to feel good about recognition in reputed academic forums, to wonder whether you may be a factor of change in your community’s health status, and to marvel when your trainees succeed.
  10. Groom the next generation. Then your work will take root and multiply.

 

04/25/18

The Infectious Diseases Society of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society commend House and Senate panels approving legislation this week that demonstrated a commitment to confronting the opioid crisis comprehensively and effectively. As societies comprising more than 12,000 infectious diseases, pediatric and HIV physicians, we deeply appreciate provisions in the bills responding to the escalating incidence of infections including HIV, hepatitis C, hepatitis B, bacterial endocarditis and other communicable health threats that accompany the epidemic of opioid use and other addictive substance use disorders. Testing and treatment for infections transmitted through injection drug use must be integrated into responses to the opioid epidemic to avert some of the most serious consequences of this crisis.

The bills put forward by the Senate HELP Committee and the House Health Subcommittee of the Committee on Energy and Commerce recognize that responses to the opioid crisis must address accompanying threats to individual and public health. The Senate Opioid Crisis Response Act and the House Eliminating Opioid Related Infectious Disease Act both address needs for expanded and coordinated surveillance of infections associated with substance use disorders. The inclusion, in both bills, of surveillance of infective endocarditis, represents an important and urgently needed advance. Rates of this serious heart valve infection, which generally requires costly inpatient care, are increasing dramatically among young people who inject drugs, but there is currently no system for monitoring it.

Both the Senate Committee and House Subcommittee also recognize the need for a ready, trained and sufficient health workforce to detect, control and deliver coordinated care for the infections that accompany the opioid epidemic. The Senate Committee bill and the Substance Use Disorder Workforce Loan Repayment Act, approved by the House Health Subcommittee would provide loan repayment for clinicians whose primary role is caring for patients with substance use disorder, including treating infectious diseases associated with substance use. These bills address a significant factor leading to fewer physicians pursuing training in infectious diseases and HIV care, at a time when the need for that expertise is increasing. In addition, the House Eliminating Opioid Related Infectious Disease Act also authorizes provider training to coordinate care for infectious diseases and addiction.

The Senate bill also addresses demonstrated needs for expanded access to interventions critical to addressing and treating substance use disorders and infectious diseases among individuals who inject drugs. A provision that includes testing for diseases commonly associated with substance use disorders in Comprehensive Opioid Recovery Centers will ensure that individuals with viral hepatitis and HIV will be diagnosed faster, leading to more prompt treatment that will improve their health outcomes and help stop transmission. Provisions easing restrictions on access to medication assisted treatment for substance use disorder will help optimize use of a proven intervention that can reduce opioid-related deaths by half.

We applaud the panels for the leadership they have shown in confronting the combined public health threats of the growing opioid epidemic and the infectious diseases that continue to spread in its wake. The needs noted in their bills will continue until the resources, policies, healthcare access and workforce are in place to address all the health impacts of the opioid crisis. We strongly support these bills and urge our legislators to move forward swiftly to bring them to fruition to make a difference in the many communities across the country confronting these devastating epidemics.

Contact

IDSA: Jennifer Morales This email address is being protected from spambots. You need JavaScript enabled to view it.

PCI Public Relations (312) 558-1770 This email address is being protected from spambots. You need JavaScript enabled to view it.

Paul Auwaerter, MD, MBA, President IDSA

Melanie Thompson, MD, Chair, HIVMA Board of Directors

Paul Spearman, MD, FPIDS, President PIDS

World Immunization Week from April 24-30 gives us the opportunity to celebrate one of the greatest achievements of modern medicine. Safe and effective vaccines that protect individuals against diphtheria, hepatitis B, measles, mumps, pertussis, rubella, human papilloma virus, and polio have drastically limited the incidence of these serious, sometimes life-threatening diseases in many parts of the world. Immunizations against infectious diseases that cause severe illness, disability and death save from 2 million to 3 million lives annually and prevent the spread of infections that can be resistant to treatments. This week also is a time to reflect on the public health benefits of immunization, with high rates of vaccination across communities providing indirect protection through herd immunity for populations including very young children, pregnant women, and people with weakened immune systems who cannot be vaccinated. Across the U.S. and globally, universal access to vaccines is critical to their optimal effectiveness. Gaps in coverage anywhere can pose threats of re-emerging diseases, particularly among the most vulnerable populations everywhere.

This year, World Immunization Week brings reminders that globally, vaccine coverage remains far from adequate. Currently, 19.5 million children lack access to basic vaccines against diphtheria-tetanus-pertussis and remain vulnerable to these preventable yet potentially deadly infectious diseases. And, while measles vaccinations have prevented more than 20 million deaths since the turn of this century, making that vaccine one of the most cost-effective investments in public health, measles remains one of the leading causes of death worldwide among children under five.

While the United States has made significant progress toward eliminating vaccine-preventable diseases among children, coverage continues to lag for adolescents and adults.  Every year, more than 50,000 adults in the U.S. die from vaccine-preventable illnesses. Annually, the U.S. spends $26.5 billion treating four vaccine-preventable illnesses in adults—influenza, shingles, pertussis and pneumococcal disease. In addition, ill-informed policies allowing personal belief-based exemptions for childhood immunization requirements have contributed to depressed vaccination rates in some communities, followed by predictable measles outbreaks. Travelers continue to bring measles into the U.S. where, upon reaching communities where significant numbers of people remain unvaccinated, the disease spreads.

The Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society for Healthcare Epidemiology of America support universal immunization of children, adolescents, and adults, based on current scientific evidence and according to the recommendations and standards established by the National Vaccine Advisory Committee, the U.S. Centers for Disease Control and Prevention, and the CDC’s Advisory Committee on Immunization Practices. For CDC’s advisory committee to recommend a vaccine, the vaccine must demonstrate significant patient benefit and very low risk. To secure approval from the Food and Drug Administration, vaccines are often required to present more rigorous safety and efficacy data than drugs or devices. We strongly encourage states to enact and enforce laws requiring all children without medical contraindications to be fully immunized as a requirement for school or daycare. We support robust funding for CDC immunization programs that help ensure access to immunizations and respond to outbreaks of vaccine-preventable diseases. We also support improved Medicare coverage of vaccines and increased investment in vaccine registries or immunization information systems across the lifespan to increase uptake of recommended vaccines, including for pneumococcal disease, shingles and influenza for at-risk adults, including elderly individuals. We recognize the importance of policies requiring vaccination among healthcare workers to protect their health and that of their vulnerable patients.

We call on policymakers to continue investments in vaccine research and development needed to bring new and improved vaccines, including a universal influenza vaccine, to market, and to remain invested in ensuring the availability of these critical public health tools.

Contact

IDSA: Jennifer Morales This email address is being protected from spambots. You need JavaScript enabled to view it.

PCI Public Relations (312) 558-1770 This email address is being protected from spambots. You need JavaScript enabled to view it.

PIDS: Terri Christene Phillips, MSA This email address is being protected from spambots. You need JavaScript enabled to view it.

SHEA: Kristy Weinshel This email address is being protected from spambots. You need JavaScript enabled to view it.

Paul Auwaerter, MD, MBA, President IDSA

Paul Spearman, MD, FPIDS, President PIDS

Keith Kaye, MD, MPH, FSHEA

 

IDSA, SHEA and PIDS Announce Inaugural LEAP Fellowship Awardees 

IDSA, SHEA and PIDS are pleased to announce the first awardees of the Leadership in Epidemiology, Antimicrobial Stewardship, and Public health (LEAP) Fellowship. Currently in its inaugural year, the LEAP Fellowship is a $100,000 training award competitively granted to four promising young infectious diseases physicians. Funded by the Centers for Disease Control and Prevention, this fellowship aims to foster the next generation of Infectious Diseases leaders in public health, hospital epidemiology and antimicrobial stewardship, giving them the hands-on experience they’ll need to lead and collaborate across these disciplines of healthcare.

Awardees:

  • Milner Staub, MD, Vanderbilt University
    Leap Fellowship Project: An Assessment of Outpatient Antimicrobial Prescription Across Tennessee Based on Practice Location, Specialty and Provider
  • Dana Pepe, MD, Yale School of Medicine
    Leap Fellowship Project: Expanding Utilization of Targeted Assessment for Prevention (TAP) Strategy in Connecticut
  • Gabriella Andujar Vazquez, MD, Tufts Medical Center
    LEAP Fellowship Project: Enhanced Support for Long Term Care Facilities Participating in a Massachusetts Department of Public Health Antimicrobial Stewardship Initiative
  • Jennifer Blumenthal, MD, Boston Children’s Hospital
    LEAP Fellowship Project: Assessing and Optimizing the Utility of the Massachusetts Statewide Antibiogram

The LEAP Fellowship will commence July 1, 2018 and last one year. The Fellowship is for early career infectious diseases physicians - those in their second or third year of fellowship or up to two years post fellowship.

Societal Leadership Weighs In:

IDSA : “I am proud that we have partnered with SHEA and PIDS along with the CDC who is sponsoring LEAP so that infectious disease fellows or early career clinical ID physicians may gain experience and tools to foster collaboration between academic institutions and public health departments. With antimicrobial resistance a more pressing concern then ever, we wish the awardees success during their fellowship and look to their future for inspired leadership in stewardship, epidemiology and public health.” – Paul Auwaerter, MBA, MD, FIDSA, President of IDSA

SHEA : “The ability to effectively share knowledge and experience among professionals in public health, infection prevention and antibiotic stewardship and to form fruitful collaborative partnerships is critical in improving patient care and reducing antimicrobial resistance. By offering research support and professional opportunities, the Leadership in Epidemiology, Antimicrobial Stewardship, and Public health (LEAP) Fellowship will help to train future leaders in healthcare epidemiology. We are extremely excited to join IDSA and PIDS in awarding these inaugural LEAP Fellowships,” – Keith Kaye, MD, MPH, president of SHEA

PIDS : “The LEAP fellowships recognize outstanding young ID physicians who are poised to become leaders in public health, hospital epidemiology and antimicrobial stewardship. The Pediatric Infectious Diseases Society (PIDS) is excited to be a part of the inaugural LEAP fellowship awards, and would like to congratulate the four awardees. This is an area of great importance to the future of ID and to the health of our nation.”– Paul W. Spearman, MD, FPIDS

For more information on the LEAP Fellowship, please contact, Michele Wagner, MPH, LEAP Fellowship Project Manager at This email address is being protected from spambots. You need JavaScript enabled to view it.. For more information from CDC, please contact Karima Hunter, Project Manager at This email address is being protected from spambots. You need JavaScript enabled to view it..

On behalf of the National Foundation for Infectious Diseases (NFID), the latest NFID Call to Action: Improving Healthcare Personnel Immunization Rates, addressing how to best optimize practices that will lead to improved immunization rates among healthcare personnel. The recommendations in this Call to Action are based upon the discussions at a November 2017 Summit convened by NFID which included representatives from professional healthcare organizations active in infection prevention and control, occupational health, and immunization.

It is well recognized that vaccination is among the most cost-effective clinical preventive services currently available in the US. In looking specifically at healthcare personnel (HCP), vaccination efforts have been shown to reduce or eliminate the spread of disease to prevent illness among patients served and to reduce the need for medical visits, missed days of work, productivity loss, and medical errors. Those benefits are identified throughout the 2011 US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommendations for HCP immunization.
 
How PIDS Members Can Get Involved

Upcoming Complimentary NFID Webinar 

Thursday, April 5, 2018 at 12:00 PM ET

Improving Healthcare Personnel (HCP) Immunization Rates

Join NFID Medical Director William Schaffner, MD; Ruth M. Carrico, PhD, NP, CIC, University of Louisville; and Patricia A. Stinchfield, RN, MS, CPNP, CIC, Children’s Minnesota, for engaging presentations on specific strategies and best practices to increase HCP immunization in various healthcare settings. 

At the conclusion of this activity, participants will be able to:

• Review the current US recommendations for healthcare personnel and immunization rates

• Understand issues, challenges, and opportunities that may impact HCP immunization acceptance

• Discuss best practices and practical strategies to increase HCP immunization rates in various healthcare settings

There is no fee to participate in this activity but pre-registration is required: https://cc.readytalk.com/r/58ofavyuv6x7&eom.

Nearly a third of all antibiotics prescribed for hospitalized children globally were intended to prevent potential infections rather than to treat disease, according to the results of a worldwide survey published in the Journal of the Pediatric Infectious Diseases Society. A large proportion of these preventive, or prophylactic, prescriptions also were for broad-spectrum antibiotics or combinations of antibiotics, or were for prolonged periods, which can hasten the development of antibiotic-resistant bacteria and drug-resistant infections.

“This pattern and high rate of prophylactic prescribing indicates a clear overuse of antibiotics,” said study author Markus Hufnagel, DTM&H, of the University of Freiburg in Germany. “Hopefully, our study results will help to raise awareness among health professionals about appropriate prescribing of antibiotics in children,” Dr. Hufnagel said.

The study provides a snapshot of antibiotic prescriptions for 6,818 children who were inpatients at 226 pediatric hospitals in 41 countries, including four hospitals in the United States, during one day in 2012. There were 11,899 total prescriptions for antibiotics, and 28.6 percent of these were for prophylactic use, researchers found. Among hospitalized children who received at least one antibiotic prescription, 32.9 percent (2,242 children) were prescribed an antibiotic to prevent a potential infection rather than to treat a current one.

Of the antibiotics prescribed for prophylactic use, 26.6 percent were to prevent potential infections associated with an upcoming surgery, and the vast majority of these antibiotics were given for more than one day. The remaining 73.4 percent of the prophylactic prescriptions were intended to potentially prevent other types of infections. Approximately half (51.8 percent) of all preventive antibiotic prescriptions were for broad-spectrum antibiotics. In 36.7 percent of cases, two or more systemic antibiotics were prescribed at the same time.

These patterns contradict current recommendations for appropriate prophylactic antibiotic use. Guidelines often call for using narrow-spectrum antibiotics for shorter periods, in an effort to limit the development of antibiotic resistance. The study findings suggest clear targets for improving antibiotic prescribing in pediatric patients, according to the authors. These include reducing prolonged, preventive antibiotic use before surgery, limiting the use of broad-spectrum and combinations of antibiotics, and reducing antibiotic use, overall, for prophylactic rather than therapeutic use.

Additional education for clinicians and improved implementation of current guidelines for antibiotic use to prevent surgical infections are needed, Dr. Hufnagel said. More in-depth guidelines that address the use of prophylactic antibiotics for a broader range of medical conditions than current guidelines do are also needed, as well as efforts to communicate these guidelines to health care providers and to analyze how the recommendations are used.

Fast Facts

  • A survey of hospitals in 41 countries suggests antibiotics are often inappropriately and excessively prescribed for hospitalized children worldwide.
  • Nearly a third of all antibiotics prescribed for these children were for preventive, or prophylactic, use, rather than to treat disease, the survey found.
  • The use of broad-spectrum antibiotics and combinations of antibiotics was also high, raising concerns about increased risk for the development of antibiotic resistance and drug-resistant infections.

Editor’s Note: The study was funded by the European Commission Directorate General for Health and Consumers and the Paediatric European Network for Treatment of AIDS. For an embargoed copy, please contact Terri Christene Phillips, MSA (This email address is being protected from spambots. You need JavaScript enabled to view it., 703-299-9865).

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Published quarterly, the Journal of the Pediatric Infectious Diseases Society represents the spectrum of peer-reviewed, scientific and clinical information on perinatal, childhood, and adolescent infectious diseases. The journal is a publication of the Pediatric Infectious Diseases Society (PIDS), the world's largest professional organization of experts in the care and prevention of infectious diseases in children.

PIDS membership encompasses leaders across the global scientific and public health spectrum, including clinical care, advocacy, academics, government, and the pharmaceutical industry. From fellowship training to continuing medical education, research, regulatory issues and guideline development, PIDS members are the core professionals advocating for the improved health of children with infectious diseases both nationally and around the world, participating in critical public health and medical professional advisory committees that determine the treatment and prevention of infectious diseases, immunization practices in children, and the education of pediatricians. For more information, visit http://www.pids.org.

In August, 2008, UpToDate®, in conjunction with Texas Children’s Hospital, established a series of pediatric subscription awards in honor of Dr Ralph David Feigin, who had been Editor-In-Chief of the Pediatrics Section of UpToDate since its inception in 1999.  The award program grants up to six, three-year subscriptions to UpToDate®  to physicians, other health care providers, or health care facilities that provide care to underserved or low-income children and who could not otherwise afford the subscription.  The deadline for applications is May 31. Awardees will be announced in June, and the subscriptions will start in July, 2018. 

Criteria

Applicants must meet all four (A, B, C, and D) of the following qualifications.

  1. Practice or teach in low-income or medically underserved areas.
    A low-income or medically underserved area is defined as meeting any one of the following:
    1. a rural area more than 50 miles from the nearest city with a population of 400,000 or more and more than 50 miles from a medical school
    2. a practice in which 50% or more of the patients are uninsured, are insured by a governmental program or are identified as minorities
    3. a community or area designated by a governmental agency or governmental representative as medically underserved or qualifies as a health professional shortage area
    4. a low income country as designated by the WHO
  2. Deliver health care to children or health education to children and their families
  3. Do not currently have access to UpToDate® and are unable to afford the initial one-year subscription of approximately $500 and the approximately $400 yearly renewal fee.
  4. Have access to a computer with internet capability.

Application Process

Applicants should complete the application below electronically.  Cells may be expanded as needed. 

Completed applications (as a word document) should be returned to Martin I Lorin, MD (This email address is being protected from spambots. You need JavaScript enabled to view it.) by May 31, 2018. Click here to download an application.

 

Parental pressure is frequently cited by pediatric practitioners as a primary reason for antibiotic overuse and inappropriate prescribing.1,2 However, a recent study published by Szymczak and colleagues in the Journal of the Pediatric Infectious Diseases Society brings these widely held beliefs into question. Their findings suggest pediatricians may overestimate the parental desire for antibiotics and that the “culture of expectation” is not as pervasive as some may think. This study, performed at four relatively diverse, hospital-affiliated practices in the Philadelphia area, explored parental perceptions about antibiotics and antimicrobial resistance. Parents accompanying their child to a sick visit for an acute respiratory tract infection (ARTI) were invited to participate in a semistructured interview prior to seeing the child’s physician. A total of 109 parents participated, with wide representation in parental age, race, and socioeconomic status.

Many important themes were revealed during this qualitative analysis. First, most parents were not necessarily expecting antibiotics at their visit. In fact, many parents were hoping their child would not need any antibiotics. Instead, they expected a clear diagnosis, reassurance that there wasn’t something more serious going on, and advice on how to mitigate symptoms. This is in line with previous studies in which a minority of parents expressed a preference for antibiotics or decreased satisfaction when antibiotics were not prescribed.1,3 Second, these parents were not planning to specifically request an antibiotic and conveyed high levels of trust in their child’s pediatrician. This is in contrast to previous studies in which clinicians believed a prescription for antibiotics would actually increase patient satisfaction and reinforce the doctor-patient relationship.1 Finally, although most parents had some knowledge of antibiotic resistance, the level of understanding varied and they were not concerned about antibiotic resistance in themselves or their child. Additionally, many parents recognized overuse of antibiotics as an important issue, but felt other parents were primarily responsible. Interestingly, this mirrors the beliefs of many pediatricians who perceive other providers as contributing to inappropriate prescribing more than themselves.

It’s important to recognize some of the potential limitations of the study. It was performed in a single area in the United States, which may limit generalizability. Additionally, as the authors point out, there may have been a selection bias since these parents generally had to arrive on time or early to their appointment in order to be included. There may also have been some social-desirability bias at play, with parents giving answers they thought would be more acceptable.

This study is a good wake-up call that when it comes to antibiotic overuse, though parental pressure and expectations are contributing factors they may not play as large of a role as some think. Instead, we all share the blame and must also share the responsibility for finding solutions. As the authors suggest, promoting ownership of the problem, with both parents and physicians, will be an important step in future efforts. Parents are key stakeholders in antimicrobial stewardship and need to be engaged in the discussion in order to make further progress, especially in the outpatient setting.

References

  1. Lucas PJ, Cabral C, Hay AD, Horwood J. A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care. Scandinavian journal of primary health care. Mar 2015;33(1):11-20.
  2. Szymczak JE, Feemster KA, Zaoutis TE, Gerber JS. Pediatrician perceptions of an outpatient antimicrobial stewardship intervention. Infection control and hospital epidemiology. Oct 2014;35 Suppl 3:S69-78.
  3. Vaz LE, Kleinman KP, Lakoma MD, et al. Prevalence of Parental Misconceptions About Antibiotic Use. Pediatrics. Aug 2015;136(2):221-231.
  4. Julia E Szymczak, Sarah B Klieger, Matthew Miller, Alexander G Fiks, Jeffrey S Gerber; What Parents Think About the Risks and Benefits of Antibiotics for Their Child’s Acute Respiratory Tract Infection, Journal of the Pediatric Infectious Diseases Society. 2017 Sept 14

Statement of the Infectious Diseases Society of America, HIV Medicine Association and the Pediatric Infectious Diseases Society

ARLINGTON, VA. (December 18, 2017) – We are deeply concerned about reports that budget documents submitted to Congress from the Centers for Disease Control and Prevention (CDC) may be censored for certain terms that include “science-“ and “evidence-based,” “transgender” “diversity” “entitlement” “vulnerable” and “fetus.” We find this unacceptable and disturbing. We strongly urge elected officials to prohibit any form of censorship that interferes with accurate communications by CDC, other Department of Health and Human Services agencies and other federal agencies.

As physicians and scientists, our work in patient care and research is based on findings gathered through quality scientific methods that seek to minimize bias. By starting on an objective and a neutral foundation, trust may be established so that patients and therefore the nation’s public health may be protected and advanced.

Censorship driven by political means vested in ideology rather than science threatens to disrupt a prime goal of government: protecting public safety. No different than protecting our shores from military invasion or policing internal strife in our communities, loss of clear and impartial research and recommendations compromises the CDC and the work of other federal agencies. For example, CDC will be deprived to fully conduct safeguarding work essential against new and emerging infections as well as understanding health concerns in all sectors of our society. The impact of censoring science and scientists at the federal level will be serious and far-reaching, not only for the country’s health, but also trust in government itself.

Suppression of language in budget documents suggests further intent--thwarting a federal agency from requesting funding for public health initiatives based on sound science, yet controversial in the political arena. Transgender Americans, for example, have multiple health challenges that impact not only their personal health but also have potential direct impact on a wider community, ranging from sexually-transmitted infections to higher risk for mental health issues and cancer that also increase costs to the health system. While there is, unfortunately, ideological controversy surrounding the rights of transgender persons, facts regarding their health should not be expunged.

Likewise, “fetus” is a scientific word necessary to describe efforts to investigate the health of pregnant women and infants, whether to prevent birth defects caused by the emerging Zika virus infection or to curtail the opioid epidemic’s devastating impact on infant and child health and mortality. While politicians may debate funding for initiatives based on ideology, no elected official should tolerate censoring health science communications, including science-based budget requests from its federal agencies.

We also are concerned that restricting budget documents may lead to additional problems driven by potential censorship. When ideology, fear, and ignorance dominate discourse in the public health arena, consequences are deadly. More than three decades ago when HIV first appeared in the U.S., the federal government’s unwillingness to acknowledge the epidemic and to allocate resources allowed the HIV epidemic to expand further and faster. These early, federal inactions were not based on science but rather grounded in ideology and politics. Timely intervention could have saved many thousands of lives.

If as reported, the current administration recommended the substitution of “science in consideration with community norms and standards” to replace “evidence-based” and “science-based” this is dangerous and misleading. This substitution, perhaps unintentionally, will stifle innovation and lead to dangerous consequences. If community sentiment results in higher rates of unimmunized schoolchildren, there will be more outbreaks such as the recent measles epidemics in California and Ohio all attributed to children not receiving the vaccine. Conversely, our national responses to Ebola virus and more recently Zika virus demonstrate how outbreaks can be quickly and effectively controlled using evidence-based techniques. While community concerns should be acknowledged, they should not override compelling scientific findings.

The CDC is our premier public health agency and serves as a leader worldwide in tackling serious challenges including antibiotic resistance, the opioid epidemic, HIV, sexually transmitted infections, tuberculosis, viral hepatitis, and emerging threats such as Ebola and Zika. The CDC must be fully engaged to prepare for the next infectious threat to our country. The agency’s critical work saves lives from newborns to seniors because it is, and must be, informed by worthy science. If the agency and its scientists and public health officials and those from other federal agencies are banned from, or encouraged to avoid, using scientifically accurate terms, their work will be greatly compromised, and the public will be gravely disserved.

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About IDSA

The Infectious Diseases Society of America (IDSA), based in Arlington, Va., is a professional society representing more than 11,000 physicians and scientists who specialize in infectious diseases. IDSA’s purpose is to improve the health of individuals, communities, and society by promoting excellence in patient care, education, research, public health, and prevention relating to infectious diseases. For more information, visit www.idsociety.org. Follow IDSA on Facebook and Twitter.

About HIVMA

HIVMA is an organization of nearly 5,000 clinicians and researchers whose professional focus is HIV medicine. HIVMA’s mission is to promote quality in HIV care by advocating policies and supporting programs that ensure a comprehensive and humane response to the AIDS pandemic informed by science and social justice. Nested within the Infectious Diseases Society of America, HIVMA's work includes creating clinical and educational tools and resources; supporting clinical training and research opportunities to build HIV workforce capacity; and promoting policies and programs to improve access to HIV prevention and care.

About PIDS

PIDS is the world's largest organization of professionals dedicated to the treatment, control and eradication of infectious diseases affecting children. Membership is comprised of physicians, doctoral- level scientists and others who have trained or are in training in infectious diseases or its related disciplines, and who are identified with the discipline of pediatric infectious diseases or related disciplines through clinical practice, research, teaching and/or administration activities.

Welcome to our educational modules for Pediatric Transplant Infectious Diseases, developed in collaboration with the Pediatric Infectious Diseases Society and the American Society for Transplantation. We recognized that this specialized area of pediatric ID care is a rapidly changing and growing practice area, with few resources to help us in management. The modules are intended to help pediatric ID fellows and faculty in their management of these patients.

Pediatric Transplant Infectious Diseases Educational Modules (Login required)

The recent issue of JPIDS featured a notable study by Hysmith et al which makes us rethink our approach of differentiating between “harmless” pharyngeal carriage of group A streptococcus (GAS) versus actual infection. The study longitudinally assesses the human immune response to natural infection with GAS [1], and as Shulman et al point out in their accompanying editorial, the findings challenge our current understanding of pharyngeal colonization versus infection with GAS, and the immunologic responses associated with colonization versus infection [2].

Taking a subset of subjects from a larger study conducted at multiple U.S. academic centers, they looked at 41 children who experienced 51 new pharyngeal acquisitions of GAS during a two year study period [3, 4]. They defined a new acquisition as a throat culture that was positive for an emm type of GAS that had not been isolated previously, with a subsequent immune response to 1 or more of the antigens studied. The 31 GAS antigens studied included 18 M peptides and 13 other shared GAS antigens, chosen based on previous studies that indicated their immunogenicity and potential as vaccine candidates, and included streptolysin O (SLO) and deoxyribonuclease B (DNaseB). They evaluated serial throat cultures and 195 serum samples obtained on enrollment and at scheduled intervals throughout the study and when subjects had signs or symptoms of pharyngitis. Salient results included the following:

  • 32 (63%) of the 51 episodes produced an antibody response to the homologous M peptide (i.e. the M type of the strain cultured from the throat produced an antibody response to the same M type in the serum).
  • No subjects had a new acquisition of an M type against which they had preexisting antibodies to the homologous M type.
  • 65% of subjects with new acquisition of GAS were asymptomatic, but mounted immune responses to 1 or more (average 3.7) antigens.
  • 67% of new GAS acquisitions elicited an immune response to SLO and/or DNaseB.
  • 8 (20%) subjects had persistently positive throat culture results (>12 weeks) despite immune responses to homologous M peptides and/or shared antigens.
  • No shared antigen consistently evoked an immune response after a new GAS acquisition.

Given their observation that 65% of subjects had asymptomatic GAS acquisition, yet mounted an immune response to the acquisition, the majority of infections would not be detected based on symptoms alone, and therefore could cause missed opportunities for antimicrobial treatment and prevention of rheumatic fever and rheumatic heart disease. In addition, not all patients actually mount a response to SLO and/or DNaseB, the most commonly used commercially available GAS antibody tests used in the evaluation of patients with suspected acute rheumatic fever or post-streptococcal glomerulonephritis. This means that a negative ASO and/or DNaseB test does not necessarily prove a patient did not have a prior GAS infection and suggests a need to expand the panel of tests available for the clinical evaluation of patients for post-streptococcal nonsuppurative complications.

Shulman et al point out that the study gives us some answers, but also raises important questions that “challenge long standing dogma” for us in how to best prevent the sequelae of GAS [2]. They highlight the bottom line that “(1) anti-M protein protects against a new acquisition of GAS in a type-specific fashion; (2) our previous concepts about a significant GAS acquisition requiring demonstrable increases in antibodies to non-M protein antigens and/or to M protein antigens may not be true and (3) whether or not a new GAS acquisition is significant—risk for post-streptococcal sequelae, whether or not a new GAS acquisition is significant appears to be unrelated to symptomatic or symptomatic acquisition status, whether or not antibiotics were administered promptly, and whether there was or was not a clear immune response to classical streptococcal antigens.”

So perhaps to answer “Where do we go from here?” the first step is for clinicians to be aware of these important findings in their management of patients and assessment of post-streptococcal sequelae. It remains to be seen how these findings and the work that comes after will impact the availability of other GAS serologic tests, changes in GAS treatment guidelines, and the development of a GAS vaccine.

References:

  1. Hysmith ND, Kaplan E, Cleary PP, et al. Prospective Longitudinal Analysis of Immune Responses in Pediatric Subjects After Pharyngeal Acquisition of Group A Streptococci. Journal of the Pediatric Infectious Diseases Society 2017;6(2):187–96.
  2. Shulman ST, Tanz RR. Strep: Where Do We Go From Here? Journal of the Pediatric Infectious Diseases Society 2017;6 (2):197–8.
  3. Kurlan R, Johnson D, Kaplan EL. Streptococcal infection and exacerbations of childhood tics and obsessive-compulsive symptoms: a prospective blinded cohort study. Pediatrics 2008; 121:1188–97.
  4. Leckman JF, King RA, Gilbert DL, et al. Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: a prospective longitudinal study. J Am Acad Child Adolesc Psychiatry 2011; 50:108–18 e3.

As you may know, San Diego has had a rise in Hepatitis A cases, primarily among its homeless population. We are confident that travel to San Diego is safe.

We do urge visitors to follow standard good hygiene, washing your hands before eating. Vaccines to prevent Hepatitis A are also available and non-health professionals should consult their doctor or other health professional.