The use of antibiotics drives the development of antibiotic resistance, a major threat to public health worldwide. But these drugs also carry the risk of harm to individual patients, including children. According to a new analysis published in the Journal of the Pediatric Infectious Diseases Society, antibiotics led to nearly 70,000 estimated emergency room visits in the U.S. each year from 2011-2015 for allergic reactions and other side effects in children. The study helps quantify the risk posed by specific antibiotics in children across different age ranges.

“For parents and other caregivers of children, these findings are a reminder that while antibiotics save lives when used appropriately, antibiotics also can harm children and should only be used when needed,” said lead author Maribeth C. Lovegrove, MPH, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. “For health care providers, these findings are a reminder that adverse effects from antibiotics are common and can be clinically significant and consequential for pediatric patients.”

Discussions regarding “cost” and “value” seem to dominate every conversation about healthcare these days. In a recent editorial in the Journal of the Pediatric Infectious Diseases Society, PIDS immediate past-president Dr. Gilsdorf and colleagues commented that pediatric infectious disease physicians’ “compensation, which is determined by leaders of pediatric departments and hospitals, does not take into account our overall value to the hospital in clinical and nonclinical work as well as in potential cost-saving activities.” This is an appropriate lead-in to an article published in the June 2018 issue of JPIDS by researchers from Doernbecher Children’s Hospital in Portland, Oregon entitled “Utilizing a Modified Care Coordination Measurement Tool to Capture Value for a Pediatric Outpatient Parenteral and Prolonged Oral Antibiotic Therapy Program.” This article sought to determine the amount of time spent by pediatric infectious disease providers on non-reimbursable care coordination activities in the context of a pediatric outpatient antimicrobial therapy program (OPAT).

As we begin the 2019 program planning process, the PIDS Program and Meetings Committee (PMC) would like to encourage all members to consider submitting Invited Science session proposals for the Pediatric Academic Societies (PAS) and IDWeek Meetings. If you can recall, the society’s strategy for our major meetings changed to align with our priorities. For the PAS Meeting, we are encouraging programming that focuses primarily on sessions serving the clinical and educational needs of a broader audience, especially ID topics that will be useful to both ID and other specialties represented at this meeting. For the IDWeek Meeting, session proposals should focus on cutting-edge science and emerging infections. Example topic areas for both meetings are listed below.

For several years the AAP Section on Infectious Diseases has been working with the AAP Committee on Coding and Nomenclature to promote the publishing of values for the Interprofessional Telephone/Internet Consultation CPT codes (99446-99449) for specialties that frequently provide telephone advice without formal consultation from other physicians. Infectious Diseases is among the specialties most frequently providing such advice.  We are happy to announce to the PIDS membership that CPT codes for this activity approved in 2014 now have wRVUs assigned for the four codes below which vary only in the amount of time spent in consultation.

“The Challenges of Viral Respiratory Healthcare-Associated Infections in Pediatrics”
Quach C, Shah R, Rubin LG. Burden of healthcare-associated viral respiratory infections in children’s hospitals. JPIDS. 2018; 7(1): 18-24.

Many parents have questions about their children’s vaccines. Although you may not provide routine immunizations as an infectious disease specialist, you can still serve as a trusted information resource for parents. CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) has a number of resources available to help you talk with parents about vaccines:

Pediatric ID specialists are viewed by administrators and other physicians as valuable contributors to the delivery of high quality medical care, according to a new study published in Hospital Pediatrics. Their contributions in many areas, however, can be difficult to measure, which may lead administrators to overlook their value and under-allocate resources, the findings suggest.

The latest Journal Citation Reports® have recently been released, and we are excited to announce that Journal of the Pediatric Infectious Diseases Society (JPIDS) has received its first Impact Factor.  The journal's Impact Factor is 2.456.

06/25/2018

Paul Auwaerter, MD, MBA, President IDSA
Melanie Thompson, MD, Chair HIVMA
Paul Spearman, MD, FPIDS, President PIDS
Keith Kaye, MD, MPH, FSHEA

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.

House Passes Bills that Address Infections Related to the Opioid Epidemic

6/13/2018

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

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.

The SECURE -- Securing Experts to Control, Understand, and Respond to Emergencies -- Act (HR 5998), a bill that would establish Epidemic Intelligence Service student loan repayment at the Centers for Disease Control and Prevention, was introduced today by Rep. Jan Schakowsky (D-IL). This bill would represent a critical step in strengthening the infectious diseases public health workforce by allowing medical school loan repayment for physicians participating in the CDC’s two-year public health emergency preparedness and response fellowship program.
 
While similar programs at NIH and HRSA’s National Health Service Corps offer loan repayment to encourage careers in biomedical research and patient care in underserved communities, that opportunity does not now exist for careers in public health preparedness and response. HR 5998 would fill this gap.
 
IDSA was instrumental in developing this proposal, and is urging its passage. PIDS is assisting IDSA in spreading the word to our members.  Please take two minutes now to ask your representative to co-sponsor HR 5998.
 

Dinny was Professor of Community Paediatrics from late 1995, as well as a highly experienced specialist in Pediatric Infectious Diseases with many years of service to Starship (and previously Princess Mary Hospital), Kidz First/Middlemore Hospital and the University of Auckland since 1977. She was hugely respected as an academic researcher in the field both in New Zealand and internationally with over an impressive portfolio of publications. Dinny was an international expert in Rheumatic Fever and instrumental in researching and developing successful school based prevention programs which are a testament to her passion and persistence in developing timely access to quality health services on behalf of our children.

From 2002, when meningococcal disease was at epidemic levels, Dinny worked tirelessly at the national and international level in developing a vaccine and then setting up and leading clinical trials culminating in mass MeNZB vaccination program in 2004 -2008. Dinny was a champion in involving local communities and schools from the start. Her passion to reduce the inequitable burden of infectious diseases in our child community is an example to us all and will be her lasting legacy. Her career achievements will have touched many generations of New Zealand children as well as pediatricians who benefited from her wisdom and teaching.

This news will be a shock to many, as it has been to us. Her passion, leadership, and tenacity to improve the health of disadvantaged children will be sorely missed and remembered with great fondness - moe mai ra e te rangatira.

We send our love and condolences to her husband John, children William and Harry, and their families

Kua hinga te tōtara i Te Waonui a Tāne.
A mighty tōtara has fallen in the forest of Tāne.

Pediatric infectious diseases is an exciting, rewarding, and intellectually stimulating specialty, as well as one that is critical to maintaining good health in children and adolescents. Despite these characteristics, however, there are concerns that too few young physicians are entering the field to meet growing needs.

A new commentary published in JPIDS examines the looming shortage of physicians pursuing pediatric ID, factors behind the problem, and possible solutions to address it. Drawing on physician surveys, recent ID fellowship program match results, and perceptions of both compensation trends and available employment opportunities, the commentary describes the current state of the specialty and implications for the future. Led by Janet R. Gilsdorf, MD, of the University of Michigan Medical School and a past president of PIDS, the commentary authors also suggest ways forward. These include a list of practical steps pediatric ID physicians should take at their own institutions today to attract medical students and residents to the field.

Additional authors of the new commentary, “Pediatric Infectious Diseases Meets the Future,” are Paul Spearman, MD, of Cincinnati Children’s Hospital Medical Center; Janet A. Englund, MD, of the University of Washington in Seattle; Tina Q. Tan, MD, of Northwestern University Feinberg School of Medicine in Chicago; and Kristina A. Bryant, MD, of the University of Louisville School of Medicine.

Prevalence of Pertussis Antibodies in Maternal Blood, Cord Serum, and Infants from Mothers With and Those Without Tdap Booster Vaccination During Pregnancy in Argentina

Fallo AA et al. Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 1, 19 February 2018, Pages 11–17, https://doi.org/10.1093/jpids/piw069

Pertussis-related morbidity and mortality are highest among infants. In 2012, the Advisory Committee on Immunization Practices recommended Tdap vaccination for all US pregnant women during their third trimester, irrespective of their immunization status. Few studies have evaluated the optimal time for immunizing pregnant women. A study by Fallo and colleagues examined the kinetics of pertussis toxin immunoglobulin G levels (IgG-PT) among infants born to mothers immunized with the Tdap vaccine during pregnancy in Buenos Aires, Argentina.

Healthy pregnant women (aged 18-44) who delivered a singleton child at a public hospital and had not received a Tdap vaccine since 6 years of age were enrolled from 2011 to 2012 (n=99); women who delivered their child at the same center and received a Tdap vaccination were recruited from 2013 to 2014 (n=105). The control group was healthy non-pregnant women aged 18-44 (n=69). Women with current or chronic medical conditions and women with antibody levels suggestive of recent pertussis infection were excluded, along with newborns with a birth weight <2000 g. There were no significant differences in demographics or exposure to household children/adolescents among the three groups of subjects. The mothers received their Tdap vaccine at, on average, 13.2–36.6 weeks.

Paired maternal and umbilical cord blood samples were collected at the time of delivery, processed and frozen at −20°C until blind testing at the Argentina National Reference Center. IgG-PT level was measured using a Centers for Disease Control and Prevention–validated specific pertussis IgG enzyme-linked immunosorbent assay (ELISA). Purified pertussis toxin (Protein Express, Inc, Cincinnati, OH) was used as the positive control. The assay was calibrated to the World Health Organization international reference standard, 06/140. The lower limit of quantification was 1 ELISA unit (EU)/mL. In each assay, values lower than 1 EU/mL were assigned a value of 0.5 EU/mL.

IgG-PT concentration of >20 EU/mL at birth is considered “seropositive” with ≥5 EU/mL defined as the protective level.   In this study nonpregnant women had significantly higher concentrations of IgG-PT than the pregnant women who were not vaccinated (IgG-PT GMCs were 14.4 EU/mL (95% CI, 10.2–20.1 EU/mL; range, 2.7–85.5 EU/mL) and 9.8 EU/mL (95% CI, 8–12.1 EU/mL; range, 0.5–68.1 EU/mL respectively; p=0.03); 16 (16.1%) of the pregnant women had an IgG-PT level of <5 EU/mL.  Lower antibody level among non-vaccinated pregnant women was thought to be due to the immune modulation observed during pregnancy. At birth, the mothers with and without a Tdap vaccine had serum IgG-PT geometric mean concentrations (GMCs) of 35.1 and 9.8 ELISA units (EU)/mL, respectively (P < .0001); cord blood GMCs were 51.3 and 11.6 EU/mL, respectively (P < .0003); cord blood IgG-PT levels were <5 EU/mL in 2.9% and 16.1% respectively (P < .001). There was a linear correlation in IgG-PT levels between paired mother and cord serum samples. The IgG-PT level was <5 EU/mL in 3 (2.9%) of 105 immunized mothers and 33 of 105 (31.4%) had a level of <20 EU/mL. 2 of 105 (1.9%) cord samples had an IgG-PT level of <5 EU/mL.  Vaccination timing had no impact on maternal or cord serum levels; however, there were lower antibody levels at delivery in mothers vaccinated before 20 weeks of gestation. No correlation was found between cord IgG-PT concentrations and maternal age or infant birth weight.

Cord blood IgG-PT levels were higher than those of maternal serum. Placental antibody transference efficiencies (the ratio of cord blood GMC to maternal GMC) were 1.46 and 1.18 for mothers with and those without a Tdap vaccination, respectively. 

After birth, the investigators analyzed the IgG-PT kinetics in newborns born to immunized mothers.  The IgG-PT GMCs were 17.7 EU/mL in 36 infants in their first month of life and 11.6 EU/mL in 32 infants in their second month of life, representing decreases of 76% and 63.5%, respectively, from cord sample levels. This decay was earlier than that suggested by Van Savage et al.  (1) and predicted by Eberhardt et al (2). Therefore, the investigators proposed that an antibody level higher than 20 EU/mL at birth was desirable.  All infants with a IgG-PT GMC higher than 20 EU/mL at birth had a level of >5 EU/mL at 2 months of age; however, 20 of 105 (19%) had a cord level of <20 EU/mL.  No infants in this study developed pertussis. Figure 3 shows the decay of IgG-PT in infants during their first 1 and 2 months of life. 

The authors concluded that infants born to immunized mothers had significantly higher antibody levels during the first 2 months of life, and suggested that more prospective studies to determine the optimal timing of Tdap vaccination during pregnancy.

References

5/21/2018

The Ebola outbreak in the Democratic Republic of Congo announced May 8 has highlighted meaningful advances as well as critical needs that continue in the wake of the epidemic across Sierra Leone, Guinea and Liberia that ended two years ago. Because of an immediate response by the World Health Organization and partners to the confirmation of one case in the remote rural Bikoro health zone, mobile laboratories are in operation, 14 cases have been confirmed, and contact tracing as well as community engagement are underway. People who have been potentially exposed to the virus will receive a promising, investigational Ebola vaccine. All of this represents remarkable progress, due to investments in science, in practice, and in the recognition that solidarity is essential to effective infectious disease interventions globally. WHO officials Friday cited the swiftness, collaboration, and coordination of the response so far among the reasons that the outbreak does not now meet their criteria for declaring a Public Health Emergency of International Concern.

But the challenges remain formidable, with the remoteness of the region where the first cases were discovered, and the vulnerability of neighboring communities, cities and nations, posing a daunting combination of obstacles to the response, and risk of international spread. The identification of four cases in Mbandaka, a city of 1.2 million people, confirms the urgency of closing gaps in resources and capacities that fuel the spread Ebola. For those reasons, the WHO committee will revisit the threats posed by this advancing outbreak.

It is essential now to take stock of what needs to be done, not just to reach, diagnose, and care for those who have been affected by this outbreak, and to contain its spread, but to improve future responses, and prevent future threats from Ebola and other diseases. Funding allocated by Congress in 2014 to support responses to the outbreak in West Africa have gone a long way toward supporting the enhanced global health security needed to accomplish those goals. Continued investments in global health security and biomedical research are essential to maintaining the momentum now underway. On the same day the Ebola outbreak in the Democratic Republic of Congo was announced, however, the White House made its own announcement, of a proposal to rescind $252 million of funding supporting USAID’s global health security efforts.

As organizations of more than 12,000 infectious diseases, pediatric infectious diseases and HIV physicians, as well as infection prevention specialists, the Infectious Diseases Society of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society and the Society for Healthcare Epidemiology of America offer our solidarity, support, and expertise to the outbreak response in the Democratic Republic of Congo. We urge Congress to support those efforts as well, by rejecting White House rescission proposals and by basing robust funding for global health security and biomedical research on the realities reflected in the current Ebola outbreak.

Paul Auwaerter, MD, MBA, President IDSA
Melanie Thompson, MD, Chair HIVMA
Paul Spearman, MD, FPIDS, President PIDS
Keith Kaye, MD, MPH, FSHEA

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. 


05/10/2018 

The Infectious Diseases Society of America, the HIV Medicine Association the Pediatric Infectious Diseases Society and the Society for Healthcare Epidemiology of America call on Congress to reject legislative attempts, including House Resolution 3 introduced Wednesday evening, that advance the Trump administration’s rescissions package. The resolution and the administration proposal both undercut future budget deals, thus endangering critical investments in public health, treatment and biomedical research programs, including activities to combat infectious diseases.

HR 3 mirrors the administration’s proposal by rescinding $7 billion in budget authority for the State Children’s Health Program. Such a cut would dramatically reduce resources available to House and Senate appropriators as they determine funding for vital health programs, including infectious disease and HIV domestic and global programs at the National Institutes of Health, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the State Department, and USAID.

HR 3 also follows the administration’s proposal to rescind $252 million of USAID funding for combating Ebola and other emerging infectious disease threats through the Global Health Security Agenda. This is deeply concerning to the members of IDSA, HIVMA, PIDS and SHEA. The most recent outbreak of Ebola in the Democratic Republic of Congo, announced by the World Health Organization on the same day, highlights the shortsightedness of the proposal, as well as the urgency of efforts to build capacities to detect, prevent, and respond to infectious disease outbreaks where they originate.

Congress recognized this priority by directing part of the remaining emergency funding allocated in response to the 2013-to-2016 Ebola outbreak in West Africa to global health security programs in the omnibus funding bill for fiscal year 2018. The funding supports surveillance, laboratory capacity, and public health workforce strengthening in countries with limited public health resources. It is essential to averting future devastating outbreak impacts like those caused by the Ebola crisis across three West African countries, and to protecting the health of Americans at home and abroad. Funding for global health security strengthening activities is available through September 2019 – the administration’s attempt to rescind remaining funding would impact the ability of USAID to stop outbreaks at their source.

HR 3 also would undermine efforts to combat the critical and growing global health threat of antimicrobial resistance, with cuts to funding that supports health provider training to prevent health care associated infections and expanded surveillance of drug-resistant bacteria. In addition, a proposed $148 million rescission of funds allocated to the Animal and Plant Health Inspection Service at the Department of Agriculture threatens efforts to address disease outbreaks from re-emerging diseases, including the avian influenza.
Ultimately the outcomes of the rescission package announced by the administration Tuesday and echoed in HR 3 will not be savings, but added costs, when the effects of infectious diseases abroad, and failures to stop them at their source, come home.

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
Paul Spearman, MD, FPIDS, President PIDS
Keith Kaye, MD, MPH, FSHEA